Case 19: Spina Bifida Flashcards
Children with SB are at increased risk for…
hydrocephalus
UTI
latex allergy
skin breakdown
What is spina bifida?
group of congenital disorders characterized by varying degrees of incomplete closure of the embryonic neural tube
What are the three classifications of spina bifida?
- spina bifida occulta
- spina bifida cystica with meningocele
- spina bifida cystica with myelomeningocele
Although the reason for failure of the neural tube to close is unknown, lack of what has been deemed an early risk factor?
Folic acid
Which classification of spina bifida is described?
- mild, often asymptomatic
- openings are so small, no herniation of meninges or nerves of spinal cord
- site over lesion may have dimple, birthmark, or hair
Spinal bifida occulta
Which classification of spina bifida is described?
- meninges protrude through opening in vertebra
- no spinal cord involvement
spina bifida cystica with meningocele
Children with spina bifida cystica with meningocele have an increased incidence of …. ?
tethered cord syndrome
Which classification of spina bifida is described?
- spinal cord protrudes through vertebrae and skin
- presents as a mass of nervous tissue with no overlying covering
- protruding portion is usually damaged or incorrectly developed
Spina bifida cystica with myelomeningocele
What are some deficits that can occur due to spina bifida cystica with myelomeningocele?
- partial or complete paralysis
- gait and mobility impairments
- decreased or complete loss of sensation
- loss of muscle tone
- bowel and bladder function impairments
What are two common complications that occur with spina bifida cystica with myelomeningocele?
- hydrocephalus
- Arnold-Chiari Type II malfomation
What is hydrocephalus?
Abnormal build-up of cerebrospinal fluid (CSF) in and around the brain
What is hydromyelia?
Abnormal amount of CSF in the spinal cord that increases pressure on the nerves and causes weakness
What is a ventriculoperitoneal (VP) shunt?
Tube with valves that is inserted in the brain to permit drainage of CSF to the abdominal cavity
What is vesicoureteral reflux?
urine traveling from the bladder back into the kidneys
General physical therapy POC and goals
- prevent loss or ROM in UE and LE
- maximize independent functional mobility
- optimize health-related quality of life
- maximize health and fitness including strength and aerobic capacity
PT interventions
- pt & family education of long-term implications ad risks for obesity, osteoporosis, and UTIs
- exercises to maintain ROM and improve strength
- functional mobility training (transfers, wheeled mobility, ambulation)
Precautions during PT
- decreased cardiorespiratory endurance
- inc risk of fracture 2/2 osteoporosis
- inc risk of hip dislocation and skin break down 2/2 decreased sensation
- latex allergy
- incontinence during exercise
- difficulties with thermoregulation
- inc risk of falls
- inc spasticity with exercise
What is the leading cause of mortality in individuals with spina bifida?
complications due to Arnold-Chiari malformation
What is the second most cause of decline in function in children with spina bifida?
tethered cord syndrome
What are the most common orthopedic abnormalities associated with spina bifida?
- foot deformities
- progressive scoliosis
What are some nonmedical concerns associated with concern of spina bifida?
- educational development
- social development (social language & peer interactions)
- psychological development
Which of the following is true about ambulation in children with spina bifida?
A. They are never able to ambulate and rely on wheeled mobility to access the community.
B. They can ambulate independently with an assistive device.
C. Their ability to ambulate is dependent on the level of the spinal cord lesion.
D. Their ability to ambulate is related to the presence of hydrocephalus
C. Their ability to ambulate is dependent on the level of the spinal cord lesion.
What are some signs that a VP shunt may be failing
Headache
Lethargy
Fever
Decreased balance during walking
