Ambulation in children and youth with spinal cord injuries

Objective: To delineate the natural history of ambulation of children and youth with spinal cord injuries (SCIs). Design: Retrospective single-center. Participants/Methods: One hundred sixty-nine subjects who sustained SCI at 18 years of age or younger and who were followed up for at least 4 years. Results: Ambulation was significantly associated with age at injury and neurological impairment but not gender. Younger age at injury was associated with greater likelihood of ambulation, higher level of ambulation, and greater duration of ambulation. Lesser severity of neurological impairment was associated with greater likelihood of ambulation. Excluding ASIA D lesions, household ambulation was noted in 5% of subjects with tetraplegic, 26% with high thoracic, 30% with low thoracic, 44% with upper lumbar, and 33% with lower lumbar lesions. Of the 7 community-level ambulators with non-ASIA D lesions, none had cervical or high thoracic injuries, 3 had low thoracic, I had upper lumbar, and 3 had lower lumbar lesions. Using multiple regression analysis, predictive factors for ambulation were younger age at injury, total ASIA motor score, and ASIA impairment scale score. Less cumbersome orthotics were associated with higher levels of ambulation. Conclusion: Ambulation status is a function of neurological impairment, age at injury, and type of orthotic.