Spina Bifida Flashcards
1
Q
Spina Bifida Etiology and Diagnosis
A
Etiology
- Folic acid deficiency, teratogens, family hx
- obstetric care - C section - surg repair
Diagnosis
- Fetal Ultrasound - 18 wks
- Alphafetoprotein - blood test - 16wks
- Amniocentesis - 20wks
2
Q
Types of Spina Bifida and Severity
A
- Myelomeningocele
- most severe - 2nd most common
- vertebral arches dont close
- open membranous sac contains CSF, meninges, SC and damaged below
- Meningocele
- 2nd severe, least common
- vert arches dont fuse
- SC intact
- neural elements covered
- paresis, bowel and bladder
- SB Occulta
- least severe, most common
- vert arches dont fuse
- no damage SC/nerves
- dimpling/tuft of hair
3
Q
SB Level Identification
A
- post natal surgery 24-72 hours
- motor level is assigned according to last intact nerve root found
- determined by surgeon at time of reparative surgery
prenatal surgery = 19-25 weeks followed by cesarean section at 37 weeks gestation to reduce trauma to SC
4
Q
Arnold Chiari CNS Abnormalities
A
- primary cause of hydrocephalus
- occurs 85% of time with SB
- lower brain stem, cerebellum, 4th ventricle herniate through foramen magnum and impede flow of CNS
5
Q
Symptoms Associated with Arnold Chiari
A
- Stridor
- apnea
- GERD
- vocal cord paralysis
- difficulty swallowing
- seizures
- nystagmus
- problems with feeding
- ataxia
- hypotonia
- UE weakness/spasticity
6
Q
Signs of Shunt Malfunction with Hydrocephalus (Infants and Toddlers)
A
Infants
- bulging fontanelle
- vomitting
- changes in appetite
- sunset sign of eyes
- edema and redness along tract
Toddlers
- vommiting
- irritability
- headache
- Edema
7
Q
Signs of Shunt Malfunction School Age Children
A
- headache
- lethargy
- irritiability
- edema/redness on tract
- handwriting changes
- high pitched crying
- seizures
- rapid growth of head circumference
- thinning of skin over scalp
- nystagmus (new)
- vomiting
- personality changes
- changes in school performance
- memory changes
8
Q
Skeletal abnormalities associated with SB
A
- scoliosis
- deformity from muscle imbalance
- club foot - talipes equinovarus
- hip dislocation
9
Q
Hydromyelia - Neurological Deterioration
A
- accumulation of CSF in central canal of SC
- signs: rapid progression of scoliosis, UE weakness, increased tone
10
Q
Tethered Cord
A
- adhesions form to anchor SC at original lesion site
- Signs:
- UTI or incontinence
- leg/foot weakness; loss of nerve function
- numbness
- spasticity
- leg or foot length discrepancy
- foot deformity (claw toes)
- spinal deformity scoliosis
- pain/irritability
11
Q
Frequently Related Problems with Spina Bifida
A
- Laytex allergy
- intelligence varied
- poor STM
- impaired hand/eye coordination
- decreased receptive language skills
- poor attention span
- difficulty with organizational skills
- poor problem solving skills
- frequent hospitalizations affect social development
12
Q
GOALS of PT WITH SB
A
- Establish motor level by MMT
- provide information to medical team about available LE movement
- provide instruction to family regarding positioning and handling to prevent deformity
- provide HEP for development
- Input regarding orthotic and mobility aids
- monitor patient for CNS deterioration
13
Q
Focus of Treatment with Infant
A
- age appropriate developmental skills
- head/trunk control
- postural reactions
- mobility training
- prone for UE strength
- adaptive seating or standing (parapodium)
- goal = upright standing
14
Q
Focus of Treatment Preschool
A
- functional upright mobility
- orthotic management
- orthopedic intervention
- skin care
- strengthening
- adaptive training
- skill acquisition
15
Q
Focus of Treatment School Age
A
- Energy expenditure
- orthopedic intervention
- orthotic management
- home, school, community negotiation
- skin care and pressure relief
