Learning about SB: Beyond Walking

Will he walk? That is always the question that people ask when they learn about Spina bifida. And that is one of my first questions as well. We are lucky and everyone seems very confident that yes, he will walk. But how do we picture walking? Walking down the street like you and I walk? Walking with a limp? Walking with crutches and braces? Walking with a walker? All of those are walking. And if he needs to use a wheelchair – I’m ok with that (it’s easy to say that now – I’ve heard it’s very hard on the parents, but not so much on the children). Walking is NOT the be-all and end-all of life.

 I found this picture that I think helps to show how walking can be affected by nerve damage. Nerves do not progress all the way down; some nerves go to the front of the leg, some to the back. Spinal nerves are what carry the messages to and from the brain and muscles. Thoracic nerves go to the chest, back and stomach, upper lumbar nerves (L1-L3) to the hips and thighs, lower lumbar nerves (L4-L5) to the knee and front of the lower leg and sacral nerves (S1-S3) to the ankles, feet, back of legs, buttocks, bladder and bowels.

Walking involves more than just nerves, there is mobility and sensation. Here is a common table that explains level of Spina bifida and walking:

This chart came from Understanding Spina Bifida booklet from Spina bifida team at Bloorview MacMillan Centre

What is needed for walking? There are a variety of different things that need to be all lined up for someone to walk. Balance, range of motion, control and power. This is (something that I am learning about as well, so I'm sorry if it's a little dry)
1. Balance, is that center of gravity of the spine, pelvis, hip, knee and foot.
2. Range of motion of the joints, how they move and ‘step’, and the hip is the most important part of walking.
3. Control is needed. I could go into all the muscles that are important for control of the hips, but what the information I have is at least a page long, and I find it hard to follow with talking about different names of muscles – so I’m not going into it – but what I have came from Hip Function Fact Sheet from Spina Bifida Association of America http://www.sbaa.org/.
4. Finally we look at power. This is more than power to control joints, but to actually push and pull muscles. Calf muscles and hip extensors are used, and are sent messages from the sacral level. Power to move may not move forward, but side to side to move forward –the shifting that you see to move forward. Whatever works.

But this all takes a lot of energy, and some things are more important than walking. I’ll even say it again. There are some things more important than walking.

The next time you take a step, just one. Stop and think about all of the things that your body is doing. The nerve impulses, how you flex a muscle and a joint. And how you do it without any effort at all. THIS is what everyone takes for granted.

We are not here yet, and we won't be thinking about walking for a while yet, we are still getting control of Nick's trunk and rolling before thinking about crawling and being upright and standing before even thinking about walking. But the question that everyone has (including us) when we talk about spina bifida is will he walk? Well it doesn't have a simple answer.


Picture http://www.improve-education.org/id52.html
http://www.spinabifidaassociation.org/site/c.liKWL7PLLrF/b.2700279/k.91AF/Hip_Function_and_Ambulation.htm