Abstract
Background Even today, myelomeningocele (MMC) is still encountered in clinical medicine and
its incidence has not decreased over the last 20 years despite a known reduction in
risk due to the use of folic acid supplements. The spectrum of clinical symptoms is
extremely broad and, depending on the level of the defect, varies from mild to severe.
Subject to the degree of paralysis, patients are reliant on the use of orthopaedic
aids and orthoses for the treatment of primary contractures and deformities and the
prevention of secondary ones. This forms the basis for attaining or maintaining mobility
in many patients. The objective of the study was to determine the practical application
of the proposed Ferrari concept for the provision of orthoses for children and adults.
Patients and Material The retrospective study comprised medical records of 180 patients (97 m) with an
average age of 19.44 years (3 – 52 years, SD 9.3) at the time of investigation. The
average duration of treatment was 15.34 years (1 – 38 years, SD 8.96). Data relating
to deformities of the vertebral column and lower limbs, provision of hydrocephalus
shunts and orthoses, and patient mobility was evaluated.
Results Most patients were given systematic treatment with orthoses at an early stage. In
58,9% of cases, it was possible to implement the proposed concept for providing patients
with dynamic orthoses, whereby the treatment concept was more difficult to implement
with high lumbar lesions than with lower lesions. Moreover, a decrease in the patientsʼ
mobility with increasing age was noticeable. Some 42.3% of adult patients were able
to walk with marked variations in mobility in relation to the different levels of
lesions.
Conclusion Taking into consideration the complexity of both the clinical picture and therefore
the provision of orthopaedic devices, the result of the implementation of the proposed
orthotic concept can be considered positive. Similarly, early commencement of provision
of orthoses and hence the possibility of achieving a positive influence on later mobility
can be considered a success. The need for individual concepts and further development
in order to increase mobility particularly in the case of patients with thoracic or
high lumbar lesions is evident. A more comprehensive provision of information to patients
regarding orthotic treatment options and their consequences for prophylaxis and quality
of life should be an important component of interdisciplinary long-term patient care.
Key words
MMC - orthotics - mobility - orthopaedic treatment concept
