General functional expectations have been developed for patients in each lesion-level group to help direct physical therapy goals within an appropriate developmental context from infancy through adulthood. In managing the cases of newborns with myelomeningocele, the physical therapist establishes a baseline of muscle function. As the child develops, the physical therapist monitors joint alignment, muscle imbalances, contractures, posture, and signs of progressive neurological dysfunction. The physical therapist also provides caregivers with instruction in handling and positioning techniques and recommends orthotic positioning devices to prevent soft tissue contractures. The therapy programs should be designed to parallel the normal achievement of gross motor milestones. Provide the infant with sitting opportunities to facilitate the development of head and trunk control (Liptak, 1998).

Near the end of the first year of life, provide the child with an effective means of independent mobility in conjunction with therapeutic exercises that promote trunk control and balance. For patients who are not likely to become ambulatory, place emphasis on developing proficiency in wheelchair skills (Brown, 2001). For patients who are predicted be able to walk pregait training should begin with use of a parapodium or swivel walker. Exercise or household distance ambulation may be pursued with use of traditional long leg braces (e.g., hip-knee-ankle-foot orthosis, knee-ankle-foot orthosis) or the reciprocating gait orthosis [RGO]). Teach the school-aged child community-level wheelchair mobility skills, emphasizing efficiency and safety. The physical therapist assists with assessment of the community, home, and school environments to determine whether architectural barriers exist that may interfere with the child's daily activities (Liptak, 1998).