Spina Bifida Flashcards
Spina Bifida literally means what?
“Split spine”
MOST COMMON permanently disabling birth defect in US
Spina Bifida
Spina Bifida defined
Defective dev. of any part (esp lower segments) of SC
most common permanently disabling birth defect in US**
4 Main types of Spina Bifida
- Spina Bifida occulta
- Closed neural tube defects
- Meningocele
- Myelomeningocele
MILDEST and MOST COMMON FORM of Spina Bifida
Spina Bifida Occulta
1.Spina Bifida Occulta
- mildest/most common
- one or more vertebrae malformed
- Occulta=”hidden”
- layer of skin over defect
- rarely causes disability or sx’s
- Closed Neural Tube Defects
- Diverse group of defects→ spinal cord marked by malformations of fat, bone, or meninges
- few or no sx’s
- Malformations can cause incomp. paralysis w/ urinary and B&B dysf.***
- Meningocele
- Defect where spinal fluid/meninges protrude thru abnorm vertebral opening
- SC unaffected, may or may not be covered w/ skin
- Sx’s vary from NO motor dysf/sx’s all the way to comp paralysis w/ B&B dysf***
MOST SEVERE FORM OF SPINA BIFIDA
MYELOMENINGOCELE
- Myelomeningocele
- SC/neural elements exposed thru opening in spine
- MOST SEVERE FORM
-
Results→ partial OR complete paralysis of parts of body below spinal opening
- like SCI
Spina Bifida Types pics
see pics
Spinal dysraphism vs Meningocele vs Myelomeningocele
see pics
Etiology of Spina Bifida
- Abnorm growth/dev. of SC or spinal column
- MM cause unknown
-
Attributed to few factors:
- genetics
- teratogens→ alcohol/anticonvulsant exposure in utero
- Nutrition deficiencies→ dec folic acid
- daily supp 3mos prior to conception
Incidence/Prevalence
- .4-.9/1000 births
- Better technology and prenatal screening==> prevents early death from birth trauma to neural sac
-
Perinatal mgmt:
- option to terminate, better options thru c-section, repair in-utero of neural sac
Spina Bifida: Overview
- M + S loss varies
- Any lesion== risk for loss of function over time
- Paralysis may not be observed until later in life:
- abnorm tissue growth (dysplasia) == pressure on nerves
- progress. neuro impairment via tethering of SC
- ==> growth spurts: SC does not lengthen @ same rate
PRIMARY spina bifida clinical impairment:
Motor paralysis
Motor paralysis ===
PRIMARY spina bifida clinical impairment
Spina Bifida Clinical impairments:
- Primary=> Motor Paralysis***
- MSK deforms, OP, sensory defs, hydrocephalus, cog/lang delays, latex allergy, upper limb dyscoord, CN palsies, spasticity, progress. neuro involvement, SZs, neurogenic B&B, skin breakdown, obesity
Motor Paralysis→ Primary clinical impairment***
- Paraplegia from SC malform or abnorm
- main deficit in SB
- Motor lvl= lowest intact functional segment
- Lesions mimic 1 of 3 patterns:
- Comp SC transection
- Incomp. lesion
- Skip lesions→ zones of preservation
- Grading→ International Myelodysplasia Study Group Criteria for Assigning Motor Lvls OR ASIA scale
Motor Paralysis: Common Lvl Characteristics→
know your myotomes!!!
Thoracic Lvl
- Full innervation→ neck, upper limb, shoulder girdle, and trunk
- NO VOLITIONAL LE MVMTS
-
Higher T/S lesion→ diff sitting upright, transfers, decd respiratory status
- req aides to assist in all ADLs
- Lower T/S lesion→ able to sit, IND w/ transfers, attempt amb w/ aides, likely use w/c for primary loco.
- T/S lesions→ lower cog, req supervision later in life, do not maint. job
Motor Paralysis: Common Lvl Characteristics→
HIGH Lumbar (L1-L2)
- Weak hips, hip flex and ADD contractures
- SHORT dist amb w/ KAFOs or RGOs and UE support feasible
- W/C for most mob.
- 50% achieve IND living, rarely main. job
Motor Paralysis: Common Lvl Characteristics→
L3
- STRONG hip flex/ADD, WEAK hip rot and some antigravity knee EXT
- 3/5 MMT for quads→ KAFOs and UE support for amb.
- Amb short comm. dist’s w/ WC for long dist.
- 60% achieve IND living, few maint. job
Motor Paralysis: Common Lvl Characteristics→
L4
*remember everything BELOW→ so L4 still intact
- Antigravity knee flex, grade 4 ankle DF w/ INV
- medial HS or tib ant. has at least 3/5
- knee EXT usually strong
- Functional amb. w/ AFO or crutches→ may do amb train w/ KAFOs and walkers
- Living/employment similar to L3
Motor Paralysis: Common Lvl Characteristics→
L5
- Lateral HS 3/5, grade 2 glute min/med, grade 3 post tib, grade 4 peroneus tertius
- Antigravity knee flex+ weak hip EXT, weak ABDs, PFs, and toes, → gluteal lurch during gait
- Ambs w/out orthotics→ but they help maint alignment defs and sub for lack of push-off
- AD recommended for comm dist amb
- goals→ dec gait devs, improve eff, safety and align.
- 80% IND living, 30% employed full time
Motor Paralysis: Common Lvl Characteristics→
S1
-
Mm function present thru S1:
- Gastroc/soleus= 2/5
- glute med/max= 2/5
- improved hip stability, amb w/out aides or AD, mild-mod gluteal lurch w/ mild push off weakness w/ stairs/running
- MAYBE AFOs→ foot deforms control/align.
Motor Paralysis: Common Lvl Characteristics→
S2, S2-S3, and No-Loss
- PF @ least 3/5, glutes 4/5
- Decd push off and stride length w/ fast amb or running
- FOs→ recommended to maint. foot in neutral align.
MSK Deformities in SB
- Spinal+LE deforms, Jt contractures related to:
- MM imbalances, progress neuro dysf, intrauterine pos., coexist congen malforms,
- Arthrogryposis (congen. contractures), post natal pos’ing,
- reduced mvmt in utero 2* paralysis
- Alignment issues==functional limits (i.e. crouch gait)
MSK Deformities
Common postural findings:
- FHP, rounded shoulders, kyphosis/scoliosis, excess lumbar lordosis w/ APT
- Rot. deforms of hip or tibia, flexed hips/knees, pronated feet
Crouch Gait (similar to CP)
Occurs 2*:
- insuff. soleus strength to maint. vertical tibia
- Ortho deformity
- Hip+knee contractures
MSK Deformities:
Scoliosis, Kyphosis, Lumbar Lordosis
- >> in higher lvl lesions, gen. worsen over time
- Severe→ hinders lung/chest wall expansion
- TLSO→ help maint. trunk pos. for function, does not prevent progression of deform*
- Spinal fusions recommended, ~puberty