Upper extremity kinetics of children with myelomeningocele during Lofstrand crutch-assisted gait.

The use of quantitative methods for evaluating upper extremity (UE) dynamics in children with myelomeningocele (MM) is currently limited. We present a novel biomechanical model for assessment of UE dynamics during Lofstrand (forearm) crutch-assisted gait with application in 9 children with MM. Two prominent types of forearm, crutch-assisted gait patterns were studied: 1) reciprocal gait (RG) and 2) swing-through gait (STG). The model demonstrated the ability to successfully detect meaningful differences in wrist, elbow, shoulder and crutch dynamics in the population of 9 children tested. Significant differences in kinetics with reciprocal and swing-through gait patterns were found bilaterally at all joints. Notable differences were found in the mean superior/inferior joint forces, ranges of joint force, and maximum inferior joint forces. Accurate quantitative assessment may help to prevent injury from longer-term crutch use and has the potential for improving clinical intervention and therapeutic management of ambulation in children with MM.