Dual Task and Upper Extremity Performance in Children With Myelomeningocele

Myelomeningocele is a neural tube defect caused by the failure of the neural tube to close in the caudal part. The exposed spinal cord in myelomeningocele usually causes neural damage. Children with myelomeningocele have varying degrees of disability depending on the level of lesion and the presence of CNS-related anomalies. Lower limb weakness, sensory loss or deformity, and impaired bowel and bladder function are common disabilities that need to be managed. Performing multiple tasks simultaneously is a necessity in the daily lives of both adults and children. Although the majority of children with myelomeningocele lack the ability to ambulate and spend most of the day sitting, they have to perform dual tasking while performing activities of daily living as in all children. In the literature, dual task performance has been evaluated in many studies in adult individuals with diseases such as Multiple sclerosis, Stroke, Parkinson's, etc. However, there are few studies in the pediatric population in the literature. Most of the studies conducted in children include children with cerebral palsy and there are almost no studies in children with myelomeningocele. Therefore, the aim of this study was to compare dual task and upper extremity performance in children with myelomeningocele to typically developing peers.

Within the scope of the study, socio-demographic information of the individuals will be recorded first. Afterwards, the Box Block Test and 9-hole peg test will be performed for single task assessment. The children will be seated on a chair with back support and before the test starts, all the details about the application will be explained to the person and the person will be given the opportunity to make a trial and if there are mistakes, they will be warned and then the actual evaluation will be started.

After the single task evaluation, the dual task performance will be evaluated. When testing dual task performance, participants will be asked to perform both tasks without prioritizing them and to do their best. However, they will also be instructed not to pause for reflection. A rest interval of at least 3 minutes will be given between all tests. Dual task complexity of the given upper limb functions will be measured by calculating the 'dual task effect' for both tasks. The formula used to calculate the dual task effect is as follows (Kelly, Janke, \&amp; Shumway-Cook, 2010; Plummer \&amp; Eskes, 2015): Dual Task Effect=(Dual Task-Single Task/Single Task)x 100. If the result is positive, it is assumed that there is an improvement in the dual task conditions; if it is negative, it is assumed that there is a decrease in the dual task conditions. The results of children's performance will be recorded in the relevant table in the demographic data form

Eligibility Criteria:
Inclusion Criteria:

For children with meningomyelocele

* To be between the ages of 7-18
* To have been diagnosed with meningomyelocele
* To have scored 27 points or more on the modified mini mental test

For children with typical developing

* Being between the ages of 7-18 years
* Having no typically developing musculoskeletal problems and volunteering to participate in the study
* Not having a chronic neurological, cardiovascular or orthopedic disease
* Having a score of 27 or above on the modified mini mental test

Exclusion Criteria:

For children with meningomyelocele

* Not agreeing to participate in the study,
* Having undergone surgery or Botolunium toxin administration within the last six months
* Having suffered a fracture of the upper extremity within the last six months

For children with typical developing

* Having severe visual or hearing impairment
* Having attention problems to the extent that they cannot understand the assessment instructions
* Having a musculoskeletal, cardiovascular, pulmonary, metabolic or other disease severe enough to prevent participation in the study.