Outcomes of a 5-Week Aquatic Physical Therapy Program for a Child With Myelomeningocele: A Case Report

Abstract

Background and Purpose: Myelomeningocele (MM) is a congenital disorder resulting from insufficient closure of the spinal column, with neural tissue compromise. MM can result in multisystem deficits that may result in functional limitations. Physical therapists may use an aquatic environment as a tool in rehabilitation. The principles of water enable ease of movement and mobility. Aquatic physical therapy (APT) has led to functional improvements in children with neuromuscular disorders. However, evidence of the effect of APT on children with MM is limited. The purpose of this case report was to present the outcomes of a 5-week APT intervention for a child with MM. Case Description: This case was an 8-year-old girl with T8 MM with hypotonia throughout the trunk and limbs and absent motor function and sensation throughout the right lower extremity, impacting her functional mobility. She demonstrated atypical preservation of motor function and sensation throughout the left lower extremity (LLE) with fair strength. APT was implemented twice a week for half-hour sessions over 5 weeks. Outcomes: After 10 APT sessions, improved average gait speed measured using computerized gait analysis was documented. A change of 18.6 seconds was obtained on the Timed Up and Go Test, which far exceeds its minimal detectable change (MDC) of 1.40 seconds. LLE strength gains were obtained as measured by hand-held dynamometry. Strength gains were obtained in the LLE hip and knee extension of more than 6 lb, exceeding the MDC of 1.7 lb. Discussion: A 5-week APT program appeared to contribute to functional and clinical improvements in a child with atypical thoracic-level MM. APT may be considered an appropriate intervention for children with MM. Further research with larger samples of children with MM using similar APT protocols is recommended to explore generalizability of results and optimize frequency and duration of APT implementation.