Ambulatory Ability in Pediatric Patients After Spinal Cord Injury

Objectives: To examine the level of ambulation achieved by pediatric patients with spinal cord injuries (SCI) who utilized lower extremity bracing for ambulation or standing.

Methods: 639 pediatric patients with SCI were treated at Shriners Hospitals for Children-Chicago in the last 20 years. Chart reviews were completed for patients who were followed for 4 or more years, achieved ASIA impairment level A, B, C or D and had no secondary medical diagnosis that would limit ambulation. Patient demographics, type of brace, highest level of ambulation, and the length of use were recorded.

Results: 169 subjects met the study criteria. The average age of injury was 9, 53% were male, and the average length of follow-up was 8 years. 113 (67%) patients utilized bracing for ambulation, 11 (7%) utilized bracing for standing regularly, and 45 (27%) did not use ambulatory or standing devices. Of the 113 patients who ambulated, 17 achieved community level ambulation during the course of their treatment. The mean ASIA motor score for patients who utilized standing devices was 25, therapeutic ambulators was 50, household ambulators was 57, and community level ambulators was 72. All 26 (15%) ASIA D patients achieved ambulation, with 10 (39%) community and 9 (35%) household. Of the 7 remaining community level ambulatory patients, there were no patients with cervical or high thoracic injuries, 6% (3/54) with low thoracic, 11% (1/9) with upper lumbar and 50% (3/6) with lower lumbar lesions.

Conclusions: Community level ambulation was achieved by 17 of 169 patients. A patient’s level of injury, ASIA impairment score and motor score are three variables that should be examined prior to developing achievable ambulatory goals for pediatric patients with SCI.