Midterm- Spina Bifida Flashcards
_ _ means divided spine, and refers to the non-fusion of vertebral arches. Term is used to refer to malformations involving the _ end of the _ _. AKA? (3)
Spina Bifida
Term is used to refer to malformations involving the caudal end of the neural tube.
AKA: myelodysplasia, myelomeningocele (MM), meningiomyelocele
Spina Bifida is caused by the failure of the neural tube to _ and subsequent _ _ development of the _ _ in that region. Associated with _ abnormalities and _ (incl. maternal alcohol intake, anticonvulsant intake, nutritional deficiencies- folic acid).
Failure of the neural tube to fuse and subsequent abnormal development of the embryonic tissue in that region. Associated with genetic abnormalities, and teratogens . . .
5 types myelodysplasia?
MOMMA
Spina Bifida with meningocele Spina Bifida Occulta (hidden) Spina Bifida with myelomeningocele Spina Bifida with myeloschisis Spina Bifida Aperta (visible)
What type of spina bifida is described: vertebral defect due to arches not fusing
Spina Bifida Occulta (hidden)
What type of spina Bifida is being described: dural space with or without spinal cord protruding
Spina Bifida Aperta (visible)
What type of spina Bifida is described: cyst-like protrusion containing meninges and CSF
Spina Bifida with Meningocele
What type of spina Bifida is described: cyst-like protrusion also containing spinal cord and/or nerve roots.
Spina Bifida with myelomeningocele
What type of spina Bifida is described: neural plate spinal cord stayed open and a flattened mass of nervous tissue formed.
Spina Bifida with myeloschisis
Myelomeningoceles usually cause a marked _ _ at and below the level of? Is?
Usually cause a marked neurological deficit at and below the level of the protruding sac
Is most of what is seen in the clinic
Hydrocephalus, Arnold- Chiari Type II malformation, spinal cord tethering, upper limb dis coordination, cranial nerve palsies, spasticites and seizures are all?
Examples of associated complications of Spina Bifida
Hydrocephalus is _ _ of _ in the _. -% require a _. 2 types?
Excessive accumulation of CSF in ventricles
80-90% require a shunt
2 types: ventriculoatrial shunt (VA) and ventriculoperitoneal shunt (VP)
What is described: Cerebellar hypoplasia and herniation of the hindbrain thru the foramen magnum, and cerebellar signs.
Arnold-Chiari Type II malformation
_ _ _ occurs from scarring of the neural placode or spinal cord to the overlying dura or skin with resultant traction on neural structures.
Spinal cord tethering
_ _ _ is characterized by halting deliberate movements. Frequently seen in children with Myelomeningocele who also have hydrocephalus. 3 possible causes?
Upper limb dyscoordination
MMC
- motor cortex or CS tract damage caused by hydrocephalus
- motor learning deficits resulting from use of UE’s for balance and support rather than manipulation and exploration
- Cerebellar ataxia associated with Arnold-Chiari Type II malformation
What are signs and symptoms of cranial nerve palsies? (5) Associated nerves? (3)
May have ocular motor palsies (CN 6), apnea, croupy, hoarse cry, and swallowing difficulties (CN 9, 10)
Spasticity: Muscle tone can be _ (LMN absent) or _ (LMN & UMN intact) or _ (UMN compromised, LMN intact) depending on? Spasticity is monitored to see if?
Muscle tone can be:
- Flaccid (LMN absent)
- Normal (LMN & UMN intact)
- Spastic (UMN compromised with LMN intact)
Depending on the site of nervous system damage
Spasticity is monitored to see if neurological impairment is progressing.
_ - _ % of spina Bifida patients have seizures. Can be due to associated brain _, _ malfunction or _.
10-30%
Can be due to associated brain malformations, shunt malfunction, or infections
Musculoskeletal deformities can occur due to: poor _ _, coexisting _ _, imbalance of muscle pull due to _ _, reduced or absent _ _ motion, and deformities that develop after _.
Poor intrauterine positioning Coexisting congenital malformations Imbalance of muscle pull due to neurological dysfunction Reduced or absent active joint motion Deformities that develop after fractures
Scoliosis, Kyphosis, Gibbous, lower limb torsional deformities, hip dislocations, hip or knee flexion contractures, genu varus or valgus, equinovarus or valgus, and plantar flexion contractures are all examples of? Depending on?
Frequently seen musculoskeletal impairments depending upon the level of spinal cord involvement.
Motor paralysis can present in 3 ways: Lesions resembling _ _ transactions, _ lesions with mixed presentation of _ and _ control, or _ (_) lesions with isolated function of _ _ the _ _.
3 Ways:
Lesions resembling complete cord transactions
Incomplete lesions with mixed presentation of spasticity and volitional control
Skip (sparing) lesions, with isolated function of muscles noted below the level of the lesion
Neurogenic bowel/ bladder: requires careful _, including frequent _ _ to fully empty the bladder. May have _ complications later in life.
Requires careful management including frequent urinary catherization to fully empty the bladder
May have renal complications later in life
_ is commonly seen in Spina Bifida patients, because torque generated by volitional muscle control is absent, and causes decreased _ _ _. Many sustain?
Osteoporosis
Causes decreased bone mineral density
Many sultan osteoporotic fractures
Decubitus ulcers and other types of skin breakdown occur in -% of all children with Spina Bifida by the time the reach _ _. 4 most common causes?
85-95% of children by the time the reach young adulthood
4 most common causes (FUCT)
- Friction, shear, burns
- urine/ stool soiling
- casts or orthotic devices
- tissue ischemia from excessive pressure
_ is also common mostly due to decreased activity and decreased muscle mass available to burn calories, especially after puberty.
Obesity
_ _ occurs in up to 73%, compared to 1-5% in control group.
Latex allergy
Which 2 motor level involvement catagories of spina Bifida will be wheelchair bound? Which 2 will be ambulators?
Wheelchair:
- thoracic (T9-12)
- Upper lumbar/ high lumbar (L1-2)
Ambulators:
- low lumbar (L4-L5, maybe S1)
- Lumbsacral (L5, S1, S2)
Which level of motor involvement is the most variable? Wheelchair? Orthosis?
Mid-lumbar is the most variable
W/C: long distance ambulation/ community
Orthosis: short distance ambulation/ household
With Thoracic level Spina Bifida patients what muscle(s) are effected? Musculoskeletal problems? (3)
Abdominals (intercostal nerves)
Musculoskeletal problems: KiSS
-kyphosis, spinal deformities, and scoliosis
With upper lumbar level Spina Bifida patients which muscles are affected? (3) Musculoskeletal problems? (3)
Hip flexors affected
- Iliopsoas, sartorius, rectus femoris
Musculoskeletal problems: HuSH
- hip flexion contractures
- spinal deformity
- hip subluxation/ dislocation
What muscles are affected with mid lumbar involvement? (3)
Knee extensors:
Quads
Hip Adductors
Medial Hamstrings
_ _ and _ are common musculoskeletal problems associated with mid-lumbar level involvement. Why?
Hip subluxation and dislocation
Due to unopposed pull of adductors
What muscles are affected with low-lumbar level involvement? (5)
HAIL E
Hip Abductors Ankle dorsi flexors Inverters Lateral hamstrings Evertors
_ _ is a common musculoskeletal problem associated with low- lumbar involvement.
Foot deformities
What muscles are affected by lumbosacral level involvement? (2) Possible Musculoskeletal problem?
Hip extensors, and plantar flexors
Foot deformities possible
Which two levels of spina Bifida might use parapodiums or RGO (reciprocating gait orthosis)?
thoracic and upper lumbar
Which level might use: HKAFO, KAFO, AFO-ground reaction type preferred as potential ambulation devices? What is the determinant?
mid-lumbar
Determinant is the level of quad strength
Which level might use KAFO, or an AFO- ground reaction type preferred? _ or _ ambulation is possible.
Low Lumbar level
SDA (short distance ambulation) or LDA (long distance ambulation) is possible
Which level might use an AFO- ground reaction type if needed, supramalleolar AFO, UCBL, or no potential ambulation devices. _ for all mobility needs.
Lumbosacral level
Walks for all mobility needs
