Spina bifida is a birth defect where the spine and spinal cord do not form properly during early pregnancy. This neural tube defect occurs when the neural tube, which develops into the brain and spinal cord, fails to close completely. The impact of spina bifida on an individual’s walking ability varies significantly. Therefore, there isn’t a simple “yes” or “no” answer to whether someone with spina bifida can walk; rather, it depends on many specific factors.
Understanding Walking Potential
The primary determinant of walking ability in individuals with spina bifida is the type and level of the spinal lesion. The extent of nerve damage dictates the degree of muscle weakness or paralysis in the lower limbs.
Myelomeningocele represents the most severe form of spina bifida, where the spinal cord and nerves protrude through an opening in the back, often contained within a sac. This type results in significant impact on mobility, often causing weakness or paralysis in the legs, potentially requiring extensive support or wheelchair use. The higher the lesion is located on the spine, the greater the potential for severe leg weakness or paralysis, as nerves controlling lower body function originate from these segments.
In contrast, meningocele is a rarer and less severe form where a sac of fluid bulges through a spinal opening, but the spinal cord itself is not within the sac, and nerve damage is minimal or absent. Individuals with meningocele experience little to no neurological impairment and walk without significant difficulty.
Spina bifida occulta is the mildest and most common type, involving a small, skin-covered gap in the spine, usually without symptoms or effect on walking ability, and often discovered incidentally.
Factors Influencing Mobility
Beyond the primary spinal lesion, several other conditions and complications can influence a person’s mobility. These secondary issues can impact walking mechanics and overall independence.
Hydrocephalus, a common condition in individuals with myelomeningocele, involves a buildup of fluid in the brain that can exert pressure on brain tissue. This fluid accumulation can affect motor control and balance, further complicating walking ability.
Orthopedic issues, such as scoliosis (spinal curvature) and joint deformities, occur due to muscle imbalances and nerve damage. These structural changes can hinder effective walking patterns and may necessitate interventions to maintain alignment and function. Muscle weakness and imbalance, stemming directly from nerve damage, contribute to an altered gait, making movements less efficient and requiring more effort. Sensory loss in the feet, common with nerve damage, can impair balance and coordination, increasing the risk of falls and making walking more challenging.
Supportive Interventions and Aids
A combination of therapeutic and medical interventions plays a significant role in maximizing mobility for individuals with spina bifida. These strategies aim to enhance function, promote independence, and adapt to individual needs.
Physical therapy is fundamental, focusing on strengthening muscles, improving balance, and refining gait patterns. Therapists work to maintain joint range of motion, build muscle strength, and improve flexibility, often starting these interventions early in life. Occupational therapy assists individuals in developing practical skills for daily living, such as dressing and bathing, and helps them adapt their environment to foster greater independence.
Assistive devices are employed to provide support and stability. Braces, also known as orthoses, such as ankle-foot orthoses (AFOs) or hip-knee-ankle-foot orthoses (HKAFOs), support joints and limbs, helping to prevent deformities and facilitate walking. Crutches and walkers offer additional stability and support, reducing the weight placed on lower limbs.
For longer distances or when walking is not feasible, wheelchairs—both manual and power—provide an effective means of mobility and independence. Surgical interventions can also improve mobility by correcting orthopedic issues like severe scoliosis or managing hydrocephalus through shunt placement. Early intervention with therapies and assistive devices is beneficial for promoting long-term mobility and functional outcomes.