Myelomeningocele

Question 1

List 8 primary impairments associated with a myelomeningocele.

Answer 1

1. Paralysis
2. Muscle imbalance
3. Flaccid/spastic
4. Sensory deficits
5. Deformities secondary to position in utero
6. Hydrocephalus
7. Arnold-Chiari malformation
8. Incontinence

Question 2

Hydrocephalus affects the _____ system, leading to a collection of _____ in the brain.

Answer 2

Ventricular system

CSF

Question 3

Describe Arnold Chiari malformation.

Answer 3

Brainstem pulled in to the foramen magnum affecting breathing and eating capabilities

Question 4

List 6 secondary impairments associated with a myelomeningocele.

Answer 4

1. Contractures
2. UE restrictions secondary to use for WB during ambulation and function
3. Rotational deformities of LE (anteversion/intoeing)
4. Spinal deformities (lordosis)
5. Osteoporosis
6. Obesity

Question 5

List 3 impairments a child with a thoracic to L2 myelomeningocele may experience.

Answer 5

1. Contractures
2. Hip dislocation
3. L2 ambulate with KAFOs or RGOs (reciprocating gait orthoses) with assistive devices

Question 6

List 3 contractures one might see in a thoracic-L2 myelomeningocele.

Answer 6

1. Knee and hip flexion
2. Hip abduction and external rotation
3. Ankle plantar flexion

Question 7

List 3 contractures one might see in a L3-L5 myelomeningocele.

Answer 7

1. Hip and knee flexion
2. Genu and calcaneal valgus
3. Pronated feet

Question 8

What orthoses will L3, L4, and L5 myelomeningocele use? (3)

Answer 8

L3 KAFOs with forearm crutches
L4 AFOs (ground reaction) forearm crutches
L5 foot orthoses for push off, gluteal lurch without AD

Question 9

List 3 contractures one might see in those with sacral lesions.

Answer 9

1. Mild hip and knee flexion
2. Ankle varus/valgus and forefoot sup/pronation
3. Toe clawing

Question 10

Describe 3 gait deviations one might see in patients with sacral lesions.

Answer 10

1. Gluteal lurch, crouch gait unless gastroc. Gr. 3
2. Weak push off on stairs and running
3. Orthotics to provide med/lat stability

Question 11

______% of individuals with a myelomeningocele will experience skin breakdown.

Answer 11

85-95%

Question 12

List 5 signs/symptoms of a shunt malfunction.

Answer 12

1. Fever or malaise
2. Recurring headache
3. Changes in vision, speech, appetite, weight personality
4. Decreased activity, school performance, strength
5. Onset or worsening of incontinence, seizures, spasticity, scoliosis

Question 13

Tethering can raise the level of the _____.

Answer 13

Lesion

Question 14

List 6 signs and symptoms of tethering.

Answer 14

1. Worsening gait/muscle strength
2. Progressive foot deformities
3. Rapidly changing scoliosis
4. Increasing incontinence
5. Back pain
6. Spasticity

Question 15

________ strength is the best gait predictor for patients with a myelomeningocele.

Answer 15

Iliopsoas strength

0-3 MMT partial or completely WC dependent.

Question 16

Aside from iliopsoas, strength of what 3 muscles groups also serve as a significant predictor of gait in patients with myelomeningocele?

Answer 16

1. Quadriceps
2. Anterior tibialis
3. Hamstring

4-5 MMT = ambulate without aids

Question 17

______ strength is the best predictor of aids or orthoses.

Answer 17

Gluteus medius

0-1 MMT = 96% required AD/orthoses
4-5 MMT = 11% required AD/orthoses