Myelodysplasia Flashcards
Myelodysplasia
- defective development of spinal cord (any part, especially lower)
- spina bifida is one type
Spina Bifida Occulta
- closed SC lesion
- large/small subcutaneous lipoma
- dimples above gluteal cleft/may have tuft of hair/discolored
- with or without paralysis at birth
Spina Bifida Aperta
- open SC defect protruding dorsally
- usually categorized as myelomeningocele
- protrude dorsally
- not covered in skin
- motor nerve paralysis
Neurulation
- folding of ectoderm on each side of primitive spinal cord to form a tube from hind brain to S2
- before gestational day 28
- most of spina bifida is from problems with neurulation
Canalization
- nerve cells form to become distal end of SC
- caudal to S2
- impairments cause skin covered meningoceles and lipomas of SC distal to L3
Diagnosis of neural tube defects
- AFP blood test
- 2nd trimester US
- amniocentesis analysis
Classifications of Spina Bifida
- Asperta
- Occulta
Impairments
- MS deformity
- Osteoporosis
- Motor Paralysis
- Sensory Deficits
- Hydrocephalus
- Cognitive Dysfunction
- Language Dysfunction
- Latex Allergy
- UE dyscoordination
- Visuoperceptive deficits
- CN palsies
- spasticity
- Progressive neurologic dysfunction
- Seizures
- Neurogenic Bowel/Bladder
- Skin breakdown
- obesity
Postural Deviations/Contractures:
Thoracic->L2
- hip flexion
- abduction & ER
- knee flexion
- ankle PF
Postural Deviation/Contractures:
L3-L5
- knee flexion
- lumbar lordosis
- genu & calcaneal valgus
- pronated foot
- crouched gait
Postural Deviations/Contractures:
Sacral
- mild hip/knee contractures
- lumbar lordosis
- ankle/foot may be valgus/varus, sup/pron
Goals/Intervention:
Infancy
- manage dislocated hips/foot deformities
- family edu
- handling
- facilitate sensorimotor experiences
- prepare for mobility
Goals/Intervention:
Preschool
- address impairments
- promote play & self-care
- ID effective means of independent mobility
- orthotics
Goals/Intervention:
School-age/Adolescence
- mntn achieved level of activity
- prevent deterioration
- seating/mobility
- promote participation in age-appropriate sport & activities
Mobility by age_____
1-2 years
Mobility:
Thoracic->L3
-Wheelchair
Mobility:
L4 and lower
- walk with AD
- reverse walker/crutches
- may require w/c when older
Mobility:
Sacral
- May walk alone
- may need upper limb when older
Orthotics:
Sacral
- SMO
- supramalleolar orthosis
Orthotics:
L4-S1
AFO
Orthotics:
L3-L4
KAFO
Orthotics:
L1-L3
- HKAFO
- RGO
Orthotics:
Thoracic-L2
- THKAFO
- Parapodium
Outcomes:
Thoracic
- w/c
- sliding board tfr
- supervised living
Outcomes:
L1-L2
- KAFO/RGO and upper limb support for household ambu
- w/c community
- 50% live independently
- employment rare
Outcomes:
L3
- KAFO and forearm crutches for household ambu
- w/c for community
- 60% live independently
- 20% employed
Outcomes:
L4
- functional ambu with forearm crutches and AFO
- w/c for community
- 20% continue to ambu as adults
- 60% live independently
- 20% employed
Outcomes:
L5
- ambu w/o orthoses but may need for alignment
- upper limb support or w/c
- 80% live independently
- 30% full time employment
- 20% part time employment
Outcomes:
S1-S3
- ambu w/o orthoses or upper limb support
- foot orthoses may be good for alignment
Causes of Neural Tube Disorders
- genetics
- teratogens
- nutritional deficiencies
Exam
- tone
- dislocated hips/foot deformities
- spontaneous activity and elicited movement
- strength
- sensation
- ROM
- position sense
- fine/gross motor development
- ADL
- Joint alignment
- mobility/gait
- accessibility of environment
- bed mobility/floor/transfers
- w/c mobility
