Myelomeningocele

[Heidi Lee]

Hi- my question is related to this question on practice exam 2:

A 2-year-old child with myelomeningocele with a motor level of L4 is evaluated in your outpatient physical therapy clinic. She demonstrates 1/5 hip extensor and hip abductor muscle strength and 3/5 knee extensor muscle strength. The child’s mother is questioning whether the child will be able to walk. The best answer to give this mother is:

The correct answer (d) makes sense. My question was your explanation of L1-3 levels “Manual w/c use without ambulation describes thoracic L1-3” I thought that L1 was exercise ambulators & L2-3 were household ambulators, not community. THanks for your assistance!

[Helen Carey]

Hi Heidi,
Jessica’s explanation in a previous response about variability in motor function in children with myelo also applies here. A parent in this situation will not understand the difference between walking for exercise or walking for function, therefore, we should interpret the question as the parent asking if their child will walk similar to their peers. Children with motor levels of L1-3 might ambulate for exercise or short distances in the home, but not without extensive support (orthoses and assistive device). This level of ambulation is often not functional or sustainable and children in these levels often abandon ambulation for more efficient w/c use. We wrote this question to help participants think about broader functional outcomes, not just specific motor levels. Remember, during tests like the PCS, you should always choose the best or most correct answer. Other answers may be partially correct, but not the best response.

Hope that helps!
Helen

[Heidi Lee]

Yes, thank you. Much appreciated!

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