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
Spina Bifida Occulta
Mild / often asymptomatic or called “hidden”
Openings are small (no herniation of meninges or nerves of spinal cord)
Site over lesion may have dimple, birthmark, or hair
Spina Bifida Cystica (Meningocele)
Meninges / CSF protrude through opening in vertebra
No involvement of neural elements (spinal cord)
Children with spina bifida cystica with meningocele have an increased incidence of …. ?
tethered cord syndrome
Spina Bifida Cystica (Myelomeningocele)
Spinal Cord / nerves / meninges / CSF protrude through vertebrae and skin
Presents as a mass of nervous tissue with no overlying covering
Protruding portion is usually damaged or incorrectly developed
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
In Spina BIfida (Myelomeningocele), what condition should you monitor for?
Scoliosis
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
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 second most cause of decline in function in children with spina bifida?
Tethered Cord Syndrome
Tethered Cord Syndrome Symptoms
Cutaneous tufts of hair or dimples / skin discoloration in LB
LBP that worsens with activity and improves with rest
Leg pain / numbness
Gait disturbance
Foot or spinal deformities (sudden / significant changes in foot posture)
Difficulties with B&B control
Repeat UTIs
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
Vomiting
Lethargy
Irritability
Fever
Swelling / redness along shunt tract
Decreased balance during walking / school performance
Periods of confusion
Seizures
You may only see ONE of these
A Ventriculoperitoneal (VP) Shunt blockage can lead to ___.
Hydrocephalus
What is the leading cause of mortality in individuals with spina bifida?
complications due to Arnold-Chiari malformation
