Introduction 

Spinal bifida is a birth defect affecting the neural tube during the first month of pregnancy, causing severe spinal nerve problems, due to incomplete spinal closure. Mobility has become one of the most significant concerns, and individuals usually necessitate mobility aids for assistance. So, let’s keep reading to know more about the role of mobility aids in enhancing independence and quality of life among the spina bifida population. 

Types and severity of spina bifida 

Occulta

Occulta is the mildest and most common spinal bifida, involving a minimal spine portion. While it usually shows no symptoms and requires no treatment, it rarely causes leg weakness, numbness, bladder infections, and incontinence during an adolescent growth spurt when the spinal cord becomes stretched.¹ 

Meningocele

Meningocele is the least common spina bifida, with meninges protruding as a lump or sac through the spinal opening. It can be surgically repaired during infancy, with little or no leftover nerve damage. Thus, leading to undamaged, normal spinal cord development, without causing any neurological problems.¹ 

Myelomeningocele

Myelomeningocele is when the undeveloped spine protrudes out as an uncovered sac containing cerebrospinal fluid(CSF) and blood vessels. Lower limb weakness or paralysis, neurogenic bladder and bowel problems will often occur, with trunk and upper limbs involved in extreme. With 70–90% of cases comorbid with hydrocephalus, causing brain damage.¹ 

Mobility challenges in spina bifida 

Lower limb weakness and paralysis

The motor neuronal signal transmission could impact the undeveloped spinal cord, causing lower limb weakness or paralysis.  It primarily affects the lower limbs and the core to some degree, difficulty walking, moving, and transfers are induced.²  

Loss of sensation and proprioception

Loss of sensation and proprioception further exacerbate mobility issues. Sensory deficits in the lower body make it challenging to perceive temperature, pressure, or pain, increasing the risk of pressure injuries. The affected proprioception also impairs balance and coordination, despite core weakness.² 

Orthopaedic complications 

Orthopaedic issues, such as scoliosis and hip dislocation can cause discomfort, limited range of motion, and joint contractures, adversely affecting one’s mobility.² 

Hydrocephalus

Many individuals with spina bifida also experience hydrocephalus, with excessive spinal fluid buildup in the brain causing brain damage, accompanied seizures, and motor and visual impairments, which could potentially exacerbate mobility limitations.^1,3   

Role of mobility aids in spina bifida 

Mobility aids can be beneficial to the spina bifida population as follows: 

Enhancing independence and accessibility 

Mobility aids can provide support and stability for spina bifida individuals to move around different environments, and get access to various locations without help from others.  

Reducing the risk of falls and injuries

By providing extra support during ambulation, mobility aids can help prevent falls and injuries, especially for individuals with balance and coordination difficulties. 

Energy conservation

Mobility aids can reduce the energy expenditure required for mobility By minimising exertion upon those weakened or paralyzed muscles, individuals can conserve energy and engage in activities for longer periods. 

Postural alignment

Specialized designed orthotic devices (e.g., leg braces, AFOs) and wheelchairs can improve gait patterns, and support proper postural alignment, reducing the risk of orthopaedic complications. 

Promoting social participation and inclusion

By enabling active participation in social, recreational, and educational activities, mobility aids help promote social inclusion among the spina bifida population, to increase their engagement and overall quality of life.⁴

Types of mobility aids 

Wheelchairs and power chairs

Wheelchairs are one of the most common mobility aids used by individuals experiencing significant mobility limitations with spina bifida, to provide essential support and independence. Wheelchairs come in different types, including manual wheelchairs and electric wheelchairs. Some individuals may require customised wheelchairs to accommodate their specific postural needs.⁵ 

Walkers, crutches, and canes 

Walkers, crutches, or canes can provide stability and support to individuals with mild to moderate spina bifida, who can bear some weight on the legs. Walkers typically provide the most stability, crutches will require sufficient upper body strength, and there are also choices of standard single or four-tip (s) canes, depending on the weight-bearing support needed.⁵ 

Orthotic devices 

Orthotic devices can stabilise and align joints and muscles. Among spina bifida, they are often used to support their lower limbs, correct foot deformities, and improve ambulation. While ankle foot orthoses (AFOs) are used to prevent contractures and provide support for standing and walking, KAFOs can provide additional knee support.⁶  

Wheelchair evaluation and assessment 

Assessment of individual needs and abilities

Usually starts with a comprehensive assessment of an individual's motor and sensory function, muscle strength, range of motion, and coordination. Both the individuals’ activities of daily living (ADLs), instrumental activities of daily living (IADLs), and environmental factors will also be considered to identify the specific requirements and goals.⁷ 

Determining the appropriate wheelchair type 

Based on the evaluated result, the appropriate option wheelchair type is determined. While options may range from manual wheelchairs to power wheelchairs, taking into account factors such as upper limb functions, endurance, and the need for specialised positioning features. The wheelchair should facilitate independent mobility while addressing specialised functional limitations.⁷ 

Proper fitting and adjustments for optimal support and posture

Proper fitting and adjustment are essential to ensure optimal support and posture. The wheelchair should be adjusted to accommodate the individual’s body dimension, providing individuals with adequate seat depth, width, and height. Adjustable seating positions, pressure-relieving cushions, and customisable support options can also be utilised to promote postural stability, pressure redistribution and comfort. Proper wheelchair alignment components, such as footrests, and armrests are also crucial for proper balance and function.^5,6 

Gait aids and orthotic devices 

Gait trainers

Gait trainers are wheeled base-supporting walking frames with handles that offer dynamic gait pattern assistance by improving balance and stability for mobility and independence promotion among spina bifida individuals. 

Ankle-foot orthoses (AFOs)

Ankle-foot orthoses (AFOs) are one of the most important orthotic devices for individuals with spina bifida. These custom-made braces provide stability and support to the foot and ankle, improving ambulation, preventing foot drop, and reducing the energy cost during walking. Thereby, enhancing mobility and promoting overall functionality among the spina bifida population.⁸ 

Knee braces and hip abduction orthosis

Knee braces and hip orthosis are valuable devices for spina bifida. Knee braces provide stability, alignment correction, and support for the knees, while hip abduction orthosis addresses hip instability and strengthens relative muscles and ligaments, to improve functional mobility, and promote better overall body mechanics among the spina bifida population.^9,10 

Rehabilitation training and education 

Physical therapy

Physical therapy plays a crucial role in improving muscle strength, flexibility, balance, and coordination among those with spina bifida. Personalised exercise programs ranging from strength training, stretching, balance training, gait training, and aquatic therapy are designed to address specific needs and challenges, enhance mobility, promote independence, and prevent secondary complications.¹¹ 

Occupational therapy

Occupational therapy is essential for the spina bifida population to achieve optimal independence and participation in daily activities. While working on fine motor skills, self-care, and functional tasks, providing customised interventions to improve hand dexterity, coordination, sensory integration, and adaptive techniques. Occupational therapy also helps with environmental modifications, assistive technology, patient and family education on wheelchair transfer, and strategies to enhance productivity and engagement in school, work, and leisure activities. 

Orthotic assessment and management

Orthotic specialists assess the individual’s musculoskeletal needs, functional limitations, and goals to determine the appropriate device needed. Custom-design braces and supports are designed to address specific challenges, such as foot drop, joint instability, alignment issues or deformity prevention. With regular follow-up adjustments, modification appointments, and ongoing monitoring for orthotic devices’ effectiveness, independent mobility among the spina bifida population can be facilitated.⁹ 

Adaptations for accessibility 

Wheelchair ramps and accessible environments

Wheelchair ramps, widened doorways, and accessible environments are crucial for mobility-challenged spina bifida individuals to navigate barriers, and access buildings and spaces, enabling smooth transitions, and enhancing mobility and freedom. 

Wheelchair accessories and adaptations 

Wheelchair accessories and adaptations enhance functionality and convenience for wheelchair users. These include tray tables and cup holders for easy access to foods and drinks, bags and pouches for storage, plus specialised seating and headrests for comfort and support, to cater to individual needs and improve wheelchair users’ optimal experience.    

Environmental control systems (home automation)

Environmental control systems, or robotic smart home design, play a significant role in the lives of wheelchair users’ lives. These systems allow individuals to navigate various aspects of their home environments, such as transfer, home automation control, and information assistance. By providing safe and independent mobility and control over their surroundings, robotic home systems enhance the comfort and convenience of wheelchair users.¹²  

Public accessibility initiatives

Public accessibility initiatives, such as accessible parking, infrastructure, and inclusive recreation, are crucial to ensure inclusive public spaces, buildings, and transportation systems access to promote independence, participation, and equal opportunities for the mobility-challenged spina bifida population.

Transition to adulthood 

The transition to adulthood can be significantly challenging for teens with spina bifida, involving various aspects, as follows.

By raising awareness and speaking up, we can make it easier and more meaningful for teenagers with spina bifida to move into adulthood.¹³ 

Summary 

Spina bifida is the congenital incomplete spinal development, leading to mobility impairments. While mobility aids are crucial for mobility and independence among the spina bifida, gait aids and various specialised orthotic devices are also available to address the specific challenges, offering support to ambulation, correcting deformities, and improving stability. With appropriate rehabilitation training, monitoring, accessible adaptations, and social awareness, mobility limitations can be overcome, improving the quality of life among the spina bifida.