Table 2, continued
Age group	Guidelines		Evidence
13–17 years $+$ 11 months	1.	Assess neurologic level and strength changes using standardized assessment tools at each clinic visit. Monitor for changes in gait, sensation, bowel and bladder function, and musculoskeletal changes.	Clinical consensus [18]
	2.	Monitor ambulation or wheelchair mobility. If ambulation is declining, suggest alternate mobility options.	Clinical consensus
	3.	Continue therapy or home programs to maintain mobility goals, emphasizing flexibility, ROM, and overall strengthening.	Clinical consensus
	4.	Verify that the teenager knows how to check insensate skin, especially after activity, and how to ameliorate friction and pressure.	Clinical consensus, Skin and Integument Guideline
	5.	Optimize gait with supportive orthoses or devices for balance. Monitor for torque forces on the joints or excessive forces in the upper body.	Clinical consensus [20]
	6.	Explore the best mobility option with the teenager and have a frank discussion about the risks and benefits of all systems.	Clinical consensus
	7.	Monitor for a secondary injury and, if identified, implement a prevention program. Areas at risk of secondary injuries for children who walk are the knees and ankles and the shoulders and wrists in those who use a wheelchair.	Clinical consensus
	8.	Recommend therapy interventions to maintain mobility if there is a change in functional status.	Clinical consensus [26]
	9.	Collaborate with orthopedic specialists to monitor for age specific musculoskeletal problems.	Orthopedic Guidelines
18$+$ years	1.	Assess neurologic level and strength changes using standardized assessment tools at each clinic visit. Monitor for changes in gait, sensation, bowel and bladder function, and musculoskeletal changes.	Clinical consensus [18]
	2.	Monitor walking or wheeling ability and check for factors that may negatively impact mobility.	Clinical consensus [26, 27]
	3.	Continue to discuss the benefits of being involved in physical activities.	Clinical consensus
	4.	Continue with home programs to maintain flexibility, ROM, and strengthening as this will impact mobility.	Clinical consensus
	5.	Optimize gait with supportive orthoses or devices for balance. Monitor for torque forces at the knee or excessive forces in the upper body.	Clinical consensus
	6.	Teach adults with Spina Bifida about the systems of care related to mobility equipment and orthoses. Adults need to know how to identify who to call when they experience problems with their mobility devices, and the extent of their health insurance coverage and benefits.	Clinical consensus
	7.	Educate adults on the importance of preventing loss of mobility (both ambulation and wheelchair) through the use of appropriate technique and maintaining a healthy weight and level of strength.	Clinical consensus
	8.	Collaborate with orthopedic specialists to monitor for age specific musculoskeletal problems.	Orthopedic Guidelines