Myelodysplasia (Spina Bifidia) Flashcards
Development of NS
- By 18 days of gestation
Cells of the neural plate differentiate to create the neural tube and neural crest
Development of NS
- Neural Crest
Neural crest becomes the peripheral nervous systems (cranial and spinal nerves, autonomic nerves and ganglia)
Development of NS
- Neural Tube
Neural tube becomes CNS: brain and spinal cord
Development of NS
- 24th day of gestination
Cranial end of neural tube closes
Development of NS
- If cranial end of neural tube does not close
Results in anencephaly a fatal condition
Development of NS
- 26th day of gestination
Caudal end closes
Development of NS
- If caudal end does not close
Failure to close at any point along the caudal border causes spina bifidia
Development of NS
- Absence of motor and sensory function
Occurs below the level of defect
Development of NS
- Level of defect
Loss of neural control of bowel and bladder
Functional deficits may be partial/complete but almost always permanent
Determines the neuromuscular dysfunction
Type of neural tube defect
Other names of neural tube defect
Spina bifida
Spina bifida aperta
Spinal dysraphism
Myelomeningocele
Meningomyelocele
Etiology
Genetic predisposiiton
Env’t influences
Lower maternal folic acid levels
Maternal use of valproic acid (anticonvulsant)
Use of antidepresasnts
Highest accuracy in Irish and Celtic heritage
Medical Diagnosis
Prenatal screening
Ultrasound
Amniocentesis
Medical Diagnosis
- Prenatal screening
Maternal serum alpha-fetoprotein (AFP) levels
Medical Diagnosis
- Prenatal screening
–> Alpha fetoprotein levels
AFP created by a developing baby
Lower levels indicate neural tube defects
Testing done between 15-20 wks of pregnancy
Depends on the trimester and the number of babies
Common complications
Hydrocephalus
Arnold-Chiari Malformation II
Tethered Cord
Hydrocephalus
Abnormal accumulation of CSF in the cranial vault
Arnold-Chiari Malformation II
Deformity of cerebellum, medulla, cervical spinal cord
Posterior cerebellum and brainstem herniate caudally through foramen magnum and obstruct CSF released in the 4th ventricle
Tethered Cord
As the child grows, the spinal cord gets tethered to the previous scar tissue, resulting in loss of motor/sensory function
Surgical Managment
Fetoscopic surgery to close the neural tube defect in utero
Surgical closure of the site within 72 hours of birth
VP shunt to manage hydrocephalus
Subsequent surgery to manage tethered cord
Orthopedic surgeries to correct deformities
Impairments
Sensory and motor paralysis
Msk deformities
Osteoporosis
Hydrocephalus
Cognitive dysfxn
Language dysfxn
Latex allergy
Cranial nerve palsies (auditory/vestibular, glossopharyngeal and vagus)
Spasticity
Seizures
Neurogenic bowel and bladder
Skin breakdown (pressure ulcers)
Obesity
PT examination
Developmental testing
Muscle tone
ROM
Muscle extensibility
Joint alignment
Deformities
Sensation
Posture and gait
PT examination Pt. 2
Scoliosis (congenital or acquired)
Muscle strength
Endurance
Mobility skills
ADLs
Equipment needs
Env’t accessibility
Principles of PT Management
Maintain available motor and sensory fxn
Identify signs of worsening condition
Prevention of complications
Use available fxn to perform ADLs and improve participation
Orthotic prescription
Adaptive equipment
Pre and post op care in case of corrective orthopedic surgeries
Principles of PT Management
- Prevention of complications
Pressure sores
Tightness/contractures/deformities
Orthotic and Equipment Management
Foot and supramalleolar orthoses
AFO
KAFO
HKAFO
THKAFO
Parapodiums
Manual wheelchair
RGOs
Walkers
Crutches
