Myleomenigocele/Spina bifida Flashcards
Neural tube defects incidence
- 1 in 10,000 in US develop NTD
- 3-4 times more in wales/ireland
- less frequent in africa
- Females > males
- increases with maternal age and lower socioeconomic status
Types of neural tube Defects
- encephalocele: malformation of the skull allows portion of brain usually malformed to protrude in a sac
- anencephaly: malformation of the skull and brain in which no neual development occurs above the brainstem
- spina bifida: a split of the vetebal arches
What is thought to cause spina bifida
- genetic components
- family history on either side
- lack of folate vitamin: B-12 contraceptive pill, depletes folic levels
- women with diabetes
- a BMI over 30
- taking certain epilepsy medication need moe folate
- previous NTD pregnancy
Other Conditions common with spina bifida
- obesity
- digestion
- social and mental health conditions including depression
- vision
- UTI
- hydrocephalus
- difficulty breathing and feeding
- skin integrity
What is diastematomyelia
- rare abnormality of the neural tube
- usually assoicated with other spinal malformations
- spina bifida, hemivertebra, butterfly veteba or kyphoscoliosis
- clinical presentation of diastematomyelia is similar to tethered cord syndrome
- due to damage and tension on the spinal cord due to limited space in the vertebral canal
Myelomeningocele: patients present with what neurologic disturbances
- back pain
- asymmetric eflexes
- progressive weakness
- muscle atrophy
- loss of sensation
- paresthesia
- bowel and
hypertrichosis
excessive hair growth anywhere on the body in either males or females
what are some things that are often different in people with spinda bifida
- sensation
- balance
- thinking and learning
- mobility
- bladder and bowel function often learn to self cath
What are some impaiments noted with myelomeningocele MMC
- motor level of the lesion is assigned based on functional muscles
- reduced sensation
- hydrocephalus
- altered brain development
- tethered cord
- spasticity
- osteoporosis
- obesity
Level of involvment: L1-L2
mobility expectation
motor function and mobility expectation
Motor function
- weak hip musculature
- hip flexion and adduction contractures common
Mobility expectation:
- short distance mobility with KAFOs or RGOs and an AD
- WC for community distances
L 3 spinda bifida involvement Motor function and mobility expectation
Motor function:
- strong hip flexion and adduction
- weak hip rotation and knee extension
mobility expectation:
- KAFOs and gait assistive device for short distance WC for long distance
L4 spinda bifida involvement Motor function and mobility expectation
motor function:
- medial hamstrings or anterior tibialis grade 3/5
mobility expectation:
- AFOs or KAFOs and a gait assistive device for short distance
- WC for long distance
- many stop ambulating after growth
L5 spinda bifida involvement Motor function and mobility expectation
Motor function:
- lateral hamstrings 3/5 and gluteus minimus and medius 2/5
- posterior tib 3/5 or peroneus tertius 4/5
Mobility expectation:
- orthoses for alignment
- gait assistive device for long distances
- WC for very long distances or rapid growth
mobility differences with lumbar involvement vs TS vs sacrum
- LS involvment are most commonly prescribed assistive devices
- patietns with T-spine involvement may move using a parapodium for exercise but will use a WC for functional mobility
- patients with sacral level involvement can often ambulate without an assistive device
what compensation strategies and functional skills are often seen with children at different spinal levels?
- a higher level of involvement results in increased compensatory motions
- children wtih lumbar MMC often develop knee flexion contractures resulting in a crouched gait secondary to weak hip and knee extensors
- the variety in presentation of strength and weakness means people with the same spinal level involvement will not always achieve the same functional level
- ambulation for children with MMC has a high energy cost and greater O2 requirement
- they need AD to allow for momentum
How can we help with energy efficiency with Spina bifida
- children need to go to school, children need exercise
- children need to play
- choose device that helps to conserve energy and prevent overexertion
Review feasibility of a wheelchair and biped ambultation criteria and evaluation
Physical activity with spina bifidia
- engage in active play with friends
- roll or walk in neighborhood
- enjoy parks and recreation areas with playgrounds that are accessible for those with disabilities
- attend summer camps and recreational facilities that are acessible
- participate in sports and teams for people with disabilities
- recommended to engage in 60 minutes per day
Sports children with spina bifidia should avoid with a shunt
- judo
- golf
- rugby
- horse back riding
- roller costers
- twisitng at the wasit can dislogde a shunt
