Conditions Spina Bifida Flashcards
Statistics and Demographics
- myelomeningocele - birth rate
- incidence in ireland and wales
- males vs females
- 3 reason for nural tube defectis decreasing world wide
- % of children with Myelomeningocele surviving into adultgood in 2005
Myelomeningocele - 60 out of 100,000 births - US
Incidence is 4 times higher in Ireland & Wales
Females 3-7 times > males
Prevalence of neural tube defects are decreasing worldwide due to:
Maternal testing abortions
Foods enriched with folic acid
multivitamins /folic acid with women trying to get pregnant
85% of children with myelomeningoceles survived to adulthood in 2005 (previously 10% in the 50s)
Causes
9 possible factors thought to contribute to Spina Bifida
- 50% -nutritionally based deficiency of folate (folic acid, B vitamin)
- Maternal alcoholism
- Diabetes
- Anticonvulsant medications
- Anti-seizure medications (Depakene, Depakote, Tegretol)
- Acne medication (Accutaine)
- Maternal hypethermia (use of saunas, high fever)
- Obesity
- Race/Ethnicity
Spina Bifida Description
- Occurs during fetal development (within the first 25 days of pregnancy) – neural tube does not form properly resulting in an open spine
- A portion of the spinal cord protrudes outside of the body putting spinal cord, meninges, and nerves at risk for damage
3 types of Spina Bifida
1) Occulta:
no visible opening in the back, but vertebrae not completely closed – “hidden spina bifida”
spinal cord, meninges covered – no nerve damage
dimple or excess hair at site of opening on the back
2) Meningocele:
Outer part of some vertebrae do not close during development
Meninges damaged, protrude through opening as a sac outside of the skin
Usually no nerve damage
Least common
3) Myelomeningocele:
Outer part of some vertebrae do not close properly in utero
Spinal cord and meninges do not develop normally
Almost always nerve damage
Usually results in some form of paralysis
Most serious type
Causes most severe disabilities
Level of Lesions - Sacral Lesions
Resulting impairments
Mild weakness at ankle or toes; bladder and anal sphincters intact; able to walk with minimal support (bracing or adaptive devices)
Level of Lesion - Low Lumbar (L4, L5) Lesions
Resulting Impairments
Weak plantar flexion and hip extension (can flex hips and extend knees); able to walk with minimal support (bracing or adaptive devices)
Level of lesion - Mid Lumbar (L3) Lesions
Resulting Impairments
Paralysis at the ankles and toes (can flex hips and extend knees); may be able to walk with extensive bracing and/or adaptive equipment
level of Lesion - High Lumbar (L1, L2) and Thoracic Lesions
Variable weakness throughout the LE; bladder and anal sphincters and musculature are affected; may be able to walk with extensive bracing and/or adaptive equipment
Primary Neurological Impairments
Paralysis & loss of sensation
- Depends on the location of the defect
- Not always symmetrical
- Always some sensation loss
Primary Neurological Impairments
Chiari Malformation
- Almost all children with meningomyelocele above sacral lesion have Chiari type II Malformation
- Symptoms: difficulty swallowing, choking, hoarseness, breath-holding spell, apnea, disordered breathing during sleep, stiffness in the arms, opisthotonos (holding the head arched backward)
- Disordered breathing during sleep: “missed diagnosis” that can cause children to be tired during the day and affect school function
Primary Neurological Impairments
Hydrocephalus
- 60-95% of children with meningomyeloceles
- Symptoms of blockage include: lethargy, headache, vomiting, irritability, strabismus, double vision, paralysis of upward gaze, change in personality, decline in school performance, and weakness of arms and legs
Secondary Impairments
- Mobility impairments
- Ambulation impaired more significantly the higher the lesion
- Use of braces, crutches, wheelchairs
- Cognitive Impairments
- ¾ have average IQ scores
- Significant impairments in perceptual skills, organizational abilities, attention span, speed of motor response, memory and hand function
- Impairment in executive functions that affect education, social, and self-help skills
- Seizure Disorders
- 15% have a seizure disorder
- Usually tonic-clonic
More Secondary Impairments
- Visual Impairments
- Strabismus, double vision, paralysis of upward gaze due to increase in intracranial pressure
- Musculoskeletal Abnormalities
- Clubfoot
- Ankle and foot deformities (use of extensive serial casting or bracing)
- Hip deformities (due to muscle imbalance and lack of movement)
- Predisposed to fractures (use of wheelchairs or weight bearing to strengthen bones)
- Arthritis
- Scoliosis, kyphosis, kyphoscoliosis
Even more Secondary Impairments
- Urinary Dysfunction
- Present in virtually all children
- Incontinence
- Lead to kidney damage or infection
- Use daily intermittent catheterization (CIC) at least 4x/day
- Many meds used to prevent infections and incontinence
- Bowel Dysfunction
- Present in virtually all children
- Constipation, diarrhea, or soiling are socially devastating
- Bowel management strategies
- Use of laxatives
- Surgical procedures to connect appendix to the colon
ugh more really? secondary Impairments
- Skin Sores
- Decubitus ulcers on weight-bearing surfaces not sensitive to pain
- Feet, buttocks
- Debridement (removal of dead tissue), plastic surgery, intravenous antibiotics
- Prevention is key
- Weight and Stature Abnormalities
- Increased risk of obesity (need for aerobic and strength training)
- Fewer calories needed due to paraplegia
- Supplied with HGH to reduce short stature
- Sexual Issues
- Pregnancy risk due to urinary tract infection, ulcers, slipped discs, and difficult vaginal delivery (hip deformity)
- Depression
