Spina bifida -- specifically myelomeningocele, the most severe open form -- causes a neural tube defect that results in paraplegia, sensory loss, bladder/bowel dysfunction, and often hydrocephalus at the level of the defect. Adults who walked as children with orthotics and crutches may experience a phenomenon known as adult-onset walking deterioration, where the ambulatory function achieved in childhood is partially or completely lost in adulthood due to accumulated musculoskeletal complications, increasing body weight, and neurological changes.
Why Adults with Spina Bifida May Require Walking Aid Change
The natural history of ambulation in myelomeningocele is well-documented:
- Children with sacral or low lumbar lesions who were community ambulators may remain so into adulthood
- Children with mid-lumbar lesions who were household ambulators often transition to wheelchair use in adulthood as the energy cost of ambulation becomes unsustainable
- Adults experience increased musculoskeletal pain (hip dysplasia, scoliosis, tethered cord symptoms) that were not present or were manageable in childhood
Cane Use in Adults with Spina Bifida
For adults with low lesion levels (sacral, S1-S2) who have good lower limb function but reduced balance or mild weakness, a cane may be appropriate:
- Sensory loss in the feet (a universal feature regardless of level) impairs proprioception -- a cane provides supplementary ground contact input
- Hip abductor weakness at S1-S2 level produces a mild Trendelenburg gait -- contralateral cane reduces lateral trunk shift
- Balance impairment from hydrocephalus (if present) is addressed by the cane providing additional stability reference
Upper Limb Considerations in Spina Bifida
Adults with spina bifida who have used forearm crutches or manual wheelchairs for years may have shoulder pain and rotator cuff pathology from upper limb overuse. Transitioning from crutches to a cane (as gait improves) or supplementing wheelchair use with a cane for short walks requires consideration of shoulder integrity.
Spina Bifida Lesion Level and Walking Aid
| Lesion Level | Typical Adult Ambulation | Cane Role |
|---|---|---|
| Sacral (S1-S3) | Community ambulation; possible mild weakness | Cane for balance (sensory loss), outdoor terrain |
| Low lumbar (L4-L5) | Community or household ambulation with KAFO/AFO | Cane for balance; supplement to AFO rather than substitute |
| Mid lumbar (L2-L3) | Household ambulation; often transitions to wheelchair in adulthood | Cane insufficient alone; two canes or crutches for household |
| High lumbar/thoracic | Typically wheelchair user; therapeutic ambulation only | Cane not appropriate for functional ambulation |
Related: Walking Cane for Spinal Cord Injury. Explore DaiWalk walking canes.
