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Medpsych: Final > Spina Bifida > Flashcards

Spina Bifida Flashcards

1
Q

what is spina bifida?

A

neural tube defect which occurs in utero and is present at the time of birth

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2
Q

how does anormal neural tube develop?

A

nervous system develops from a portion of the embryonic ectoderm called the neural plate. During gestation, the neural plate develops folds that begin to close, forming the neural tube

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3
Q

what is Spina Bifida Occulta?

A

Cosmetic impairment no physical disability
Lack of closure between vertebral arches
Spinal cord and meninges are unimpaired

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4
Q

what does Spina Bifida Occulta occur?

A

3rd month of development

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5
Q

in what portion of the spinal cord does spina bifida occulta usually occur?

A

lumbo-sacral area

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6
Q

what does spina bifida occulta look like?

A

Covered with skin and marked with a dimple or hair

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7
Q

what is spina bifida cystica (meningocele)?

A

Protrusion of the meninges and CSF only into a cystic sac
Spinal cord remains in the vertebral canal
(uncommon)

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8
Q

what is the prognosis of spina bifida cystica (meningocele)?

A

If spinal cord isn’t injured there aren’t abnormalities

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9
Q

what is spina bifida cystica (myelocele)

A

Dilation of the central canal of spinal cord producing a large covered cyst
Neural tube appears closed but is distended due to swelling
(rare)

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10
Q

what is spina bifida cystica (Myelomeningocele)?

A

Both spinal cord and meninges are herniated through the defective vertebral arches into a sac
Extensive abnormalities of spinal cord and neural tissue
(common)

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11
Q

what are the impairments seen for Myelomeningocele?

A

sensory and motor impairment at the level of the lesion and below

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12
Q

what can cause spina bifida?

A

Nutritional deficiencies (folic acid, vit A)
Environmental factors
Amniocentesis: high levels of alpha-phetoprotein

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13
Q

what are the clinical manifestations of Myelomeningocele?

A

Flaccid paralysis
loss of sensation
absent reflexes
bowel and bladder incontinence

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14
Q

what are the orthopedic problems of myelomeningocele?

A

Contractures of hip, knee, ankle and foot

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15
Q

what is muscle imbalance in meningomyocele caused by?

A

L4-L5 lesion will have inactive extensors and active flexors

no balance

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16
Q

what is the common position for myelomeningocele?

A

bilateral hip flexion and abduction that becomes contracted

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17
Q

what causes contractures in myelomeningocele?

A

muscle imbalance
Stress, posture and gravity
Associated congenital malformations
Abnormal positioning in utero

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18
Q

what Malformations of the vertebral bodies might require surgical reconstruction for myelomeningocele?

A

Hemivertebrae and various deformities
Lumbar deformities
Stress and gravity cause need for surgery

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19
Q

what can cause scoliosis for kids with myelomeningocele?

A

Congenital or acquired
Neurogenic due to weakness or asymmetrical spasticity
Lordoscoliosis is common in teens and associated hip flexion contractur

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20
Q

what deformities of the foot can occur to kids with myelomeningocele?

A

Equinovarus deformity (club foot)
Calcaneovalgus: calcaneus tipped
Vertical talus: talus tipped

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21
Q

what hip deformities occur for kids with myelomeningocele?

A

Hip dislocation and subluxation

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22
Q

what is the most common neurogentic bladder dysfx for kids with myelomeningocele?

A

Hypotonic bladder resulting in retention, incontinence and frequent urination with incomplete emptying

Bacterial growth causing UTI
OT teaches self-catheterization

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23
Q

what % of children with spina bifida develop hydrocephalus?

A

80-90%

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24
Q

what does hydrocephalus cause?

A

thinning of white matter and must be managed immediately

Uncontrolled can result in increased brain damage + death

25
Q

what is Arnold Chiari Malformation Type II?

A

Brain structures herniated into neck (usually between C1-C4)
not all symptomatic
99% chance Chiari malformation with myelomeningocele

26
Q

what is Arnold Chiari Malformation Type II associated with?

A

paralysis of the vocal cords, respiratory difficulties and apnea

27
Q

what is Hydromyelia?

A

Central portion of spinal cord swells

28
Q

what can cause hydromyelia?

A

May be a consequence of untreated or poorly treated hydrocephalus

29
Q

what are symptoms of hydromyelia?

A

rapidly progressive scoliosis, weakness and spasticity

30
Q

how is hydromyelia txed?

A

with shunt revision or posterior cervical decompression

31
Q

what causes tethered spinal cord?

A

scar tissue or lipoma (fatty tissue tumor) at the repair site

32
Q

how do you tx tethered spinal cord?

A

Surgical intervention is performed to untethered the cord

33
Q

what are the Cognitive and Perceptual Deficits of myelomeningocele?

A

Intellectual fxing vary: profound mental retardation to normal intelligence. (caused by hydrocephalus)
Perceptual and visual-motor deficits area common
Speech and language deficits
Cocktail party speech

34
Q

what is the medical management of myelomeningocele?

A

Closure of the sac takes place within24 to 48 hours after delivery.
Neural tissue is placed back into vertebral canal
Spinal defect covered for a water-tight sac closure

35
Q

what is Hydrocephalus?

A

ventricles in brain increase in size due to reduction of flow of CSF

36
Q

how do you tx hydrocephalus?

A

Placement of a ventricular shunt (ventricles to abdomen) for life

37
Q

what are the types of ventricular shunts?

A

ventriculoperitoneal shunt (VP shunt): most common. composed of proximal catheter, distal catheter and 1 way valve.

ventriculoatrial shunt (VA shunt) drains into heart b/c of abnormalities

38
Q

how do you tx arnold chiari malformation?

A

Surgery – posterior cervical decompression to relieve pressure
Respiration is affected neurologically

Requires aggressive medical management since it can be life-threatening

39
Q

how is bladder management controlled?

A

Clean intermittent catheterization (every 3-4 hrs)
Urinary diversion through the abdominal wall
Cutaneous vesicostomy
Monitoring of bowel evacuation

40
Q

what is the OT assessment for spina bifida?

A

Complete eval of functional motor skills (Orthopedics, ROM, MMT)
Sensory testing with attention below level of lesion
Perceptual testing (from hydrocephaly)
Visual-motor testing
ADL-functioning
Evaluation of seating and positioning needs

41
Q

what is muscular dystrophy?

A

group of hereditary myopathies characterized by progressive muscular weakness

42
Q

what is duchenne muscular dystrophy?

A

Characterized by the replacement of muscle tissue with fibrous and fatty tissue (psedohypertrophy)

43
Q

what does duchenne MD lead to?

A

total paralysis and early death in the late teens or young adulthood
No cure

44
Q

what is the incidence of duchenne MD?

A

X-linked and recessive pattern (only males affected)

45
Q

what are the clinical features of duchenne MD?

A

Between ages 2 and 5 years symmetrical weakness proximal to distal
first: weakness of shoulder girdle and pelvis
next: Weakness of extremities and trunk
Symptoms rarely before 2

46
Q

what is the most common cause of death in duchenne MD?

A

respiratory failure

47
Q

what occurs in lower extremities for duchenne MD?

A
  1. Pseudohypertrophy
  2. Development of hip, knee and ankle contractures
  3. muscle imbalance + lordotic posture (pregos) + plantarflexion
  4. loss of independt ambulation
48
Q

what is duchenne MD Common compensation boys use to get off floor?

A

gowers maneuver: Maintaining hip flexion entire time and using arms to push up b/c of weak lower extremities

49
Q

what occurs in upper extremities for duchenne MD?

A

Functional UE loss lags behind LE weakness (manual wheelchair)
Early weakness at scapula and shoulder girdle (Meryon’s sign)
Gradual loss at biceps, brachioradialis, triceps and distal musculature

50
Q

how can you test for Meryon’s sign?

A

Slip through hold at shoulders

due to weak shoulder muscles

51
Q

what are the medical txs of duchenne MD?

A

Genetic counseling
Corticosteroids and growth hormone
no cure

52
Q

what are the orthopedic problems with duchenne MD?

A

Scoliosis occurs in at least half of all cases

53
Q

what are the onsets for duchenne scoliosis?

A

Early onset – develops prior to wheelchair age and tends to be most severe
Late onset – develops typically 4 years after wheelchair dependence and is milder

54
Q

what are surgical management options for duchenne scoliosis?

A

Spinal fusion with instrumentation (Harrington rods)
Segmental fixation systems
Surgical management can improve comfort in positioning

55
Q

what are LE orthopedic problems with duchenne?

A

Hip and knee flexion contractures.

Equinus deformity

56
Q

what are nutritional concerns for duchenne MD?

A

Excessive weight gain due to decreasing calorie requirement

Nutritional assessment to prevent obesity that compromises fx, makes care more difficult

Swallowing difficulties may require alternative feeding through nasogastric tube or gastrostomy (later)

57
Q

what is OT assessment for duchenne MD?

A

Manual muscle testing
ROM evaluation
ADL assessment
Mobility and seating needs

58
Q

what are tx goals for duchenne MD?

A

Maintain ROM and prevent contractures
Maintain strength / prevent atrophy from disuse
Maximize ADL independence
Maintain participation in school related-related tasks

59
Q

what are the psychosocial considerations for duchenne MD?

A

Psychological support for the family and child
Support groups
Individual counseling for the child
Peer support groups and community organizations

Medpsych: Final (5 decks)

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