Lecture 6 - Spina Bifida Flashcards
What is spina bifida
Failure of the lamina to close during fetal development that occurs between 24-28 days gestation
What are 5 types of spina bifida
- Myelodysplasia: Range of defects in the formation of the spinal cord
- Spina Bifida Occulta: Vertebral defect without involvement of the spinal cord. They may have dimple, hairy tuft over defect
- Meningocele: Vertebral defect with protrusion of the meningeal sac without involvement of the spine
- Meningomyelocele: Herniation of the meningeal sac and neural elements (spinal cord, nerves)
5.Anencephaly/Encephalocele: Cephalic end of the spinal cord that is usually incompatible with life
What does meningomyelocele impair
Loss of motor and sensory function below level of lesion (may not be complete and may be asymmetrical). Can cause neurogenic bladder and bowel
What are 6 comorbidities of meningomyelocele
- Hydrocephalus which is where accumulation of CSF in cerebral ventricles due to obstruction to flow. It is treated with a ventriculo-peritoneal (VP) shunt). Complications of the shunt can be obstruction, infection, mechanical failure and disconnections
- Signs and Symptoms of shunt malfunction:
○Enlargement of the head
○Headache
○ Nausea
○Sunsetting eyes
○ Irritability
○ Seizures
○ Bulging of fontanelle (infants)
○Bulging/redness along shunt tubing
○Drowsiness
○ Poor appetite
- Signs and Symptoms of shunt malfunction:
- Arnold Chiari II Malformation: Downward displacement of the hindbrain (4th ventricle, cerebellum and brain stem) through the foramen magnum. It can be surgically treated with decompression if symptoms are problematic.
* Signs and Symptoms:
○ Infants:
® Respiratory distress
® Stridor
® Apnea
® Arching of neck/back
® Difficulty feeding due to poor suck and swallow
® Weak cry
○ Children/Adolescent:
® Breathing difficulties
® Neck pain
® UE weakness/stiffness/sensory changes
® Poor balance/coordination
® Feeding difficulty - Tethered Cord: Spinal cord gets stuck in the scar tissue/bony abnormalities at the site of the lesion. Symptoms appear during a growth spurt. Treated surgically if symptoms affect function.
* Signs/Symptoms:
○ Changes in LE including spasticity, weakness, pain, sensory changes, new foot deformities
○ Worsening of gait pattern
○ Changes in bladder/bowel function
○ Rapidly developing spinal curve - MSK Deformities:
* Talipes equinovirus (clubbed feet): Midline defect
* Dislocated hips: Due to lack of or imbalanced muscle function
* Spine deformities: Kyphosis and scoliosis - Latex Allergies
- Secondary Impairments:
* Shunt complications
* Skin breakdown
* LE contractures
* Osteoporosis leading to fractures
* Obesity
Renal Complications
What is the incidence of spina bifida
- Highest in Hispanic women
- Incidence is declining due to folic acid fortification
- Risk factors include genetic predisposition, dietary deficiency in folic acid, valproic acid during early pregnancy, diabetes mellitus, and environmental factors
What is the treatment for spina bifida
Delivery through C-section and lesion is repaired within 24-hours after birth. There may be a VP shunt needed to control hydrocephalus.
- In-utero surgery is being done but is higher risk for mom and baby
Describe the lesion levels potentially impacted by spina bifida and what it impairs
- Motor level is lowest functional level (grade 3 or higher)
- May be asymmetrical and it may skip levels
What should a PT assessment include for spina bifida
- Muscle strength
- ROM
- Sensation
- Motor development/motor function
- Equipment needs
What should PT treatment include for Spina Bifida
What are potential secondary impairments for CB based on Campbell et al.
What are recommendations for CB based on Campbell et al.
What is the importance of goal setting with CB
What is the importance of exercise for CB
What is important with transitioning children to adulthood for CB
What should be apart of the health care transition plan for Cerebral Palsy
What are some challenges of transitioning for CB
Describe how lack of preparation can be a challenge for CB
Describe how limited information and support can be a challenge for CB
Describe how a lack of skills needed for adult roles can challenge CB
How does disjointed adult services challenge CB
What do we know about youth with CB
What is being done for youth with CB to increase positiveness of transitioning (Part 1/2)
What is being done for youth with CB to increase positiveness of transitioning (Part 2/2)
Describe the shared management model
Describe the transition planning framework
