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The Effects of Mobility Devices for Children with Spina Bifida Based on the World Health Organization Classification System: Orthoses versus Wheelchair. Marcia Mohammed
Purpose: To evaluate the effects of using orthoses compared to wheelchairs on children with Spina Bifida with thoracic, lumbar and sacral lesions on variables of impairments, activities and participation. Method: A literature search was performed using Medline (1985-1999) and CINAHL (1982-1999) databases. Keywords that were used were: Spina Bifida, ambulation, wheelchairs, orthoses and parapodium. All relevant papers were included and the papers’ reference lists were used to locate more articles. Results: Twelve articles were identified. Within the impairments classification, there was more evidence to suggest that hip flexion contractures, knee flexion contractures, pressure sores, and the occurrence of fractures were less when a child used orthoses. Under the classification of activities, evidence suggested that children can perform activities of daily living equally, independent of mode of mobility. Children were more energy efficient when using wheelchairs. With respect to participation, children were found to be equally involved in extra-curricular activities, independent of mobility device. Children were also reported to perform better in certain academic activities (e.g. writing and printing) when they used a wheelchair over orthoses. Conclusions: From these observational studies, there was more evidence to suggest that orthoses can help in the reduction and prevention of impairments while the benefits of wheelchairs are more evident in the activity and participation classifications. Clinical Relevance: Young children with Spina Bifida should be given the opportunity to benefit from the use of orthoses. These individuals should be closely monitored, especially when they enter school, to determine when their performance will be optimal in a wheelchair.