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Peds > Spina Bifida > Flashcards

Spina Bifida Flashcards

1
Q

What is it? How common? What causes it?

A
  • Neural tube defect causing neurologic dysfunction
  • Second most common birth defect
  • No definitive cause has been established
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2
Q

Linked to? Also associated with?

A
  • Linked to maternal lack of folic acid in first trimester

- Also associated with valproic acid (Seizure medication)

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3
Q

Spinal defect diagnosed by? Contains? Can be? Most commonly located where?

A
  • the presence of an external sac on the infant’s back
  • Contains meninges and spinal cord tissue protruding through a dorsal defect in the vertebrae
  • Can be covered by membrane or exposed
  • Most commonly located in the lumbar region
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4
Q

Spinal bifida occulta involves? Without?

A
  • Involves nonfusion of the halves of the vertebral arches

- Without disturbance of the underlying neural tissue

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5
Q

What is Myelocele? (2) Deficits?

A
  • Protruding sac containing meninges and cerebrospinal fluid (CSF)
  • Nerve roots and spinal cord remain intact and in their normal positions
  • No motor or sensory deficits, associated hydrocephalus, or other central nervous system (CNS) problems
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6
Q

What is Lipomeningocele? (2)

A
  • Superficial fatty mass in the low lumbar or sacral level of the spinal cord
  • Significant neurologic deficits and hydrocephalus are not expected
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7
Q

Prenatal Testing and Diagnosis? (7)

A
  • α-Fetoprotein levels (AFP)
    » Remain abnormally high after 14 weeks gestation
  • Fetal ultrasound
  • Fetal surgery
  • Repair the exposed spine in utero
    » Associated with decreased hydrocephalus
    » No significant changes in motor function
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8
Q

Prognosis? What is tx? (3)

A
  • Greater than 90% survival with early treatment
  • Closure of spine
  • Shunt for hydrocephalus
  • Clean, intermittent catheterization
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9
Q

Impairments: are based on the level of the lesion and can include? (4)

A
  • Disruption of nerve conduction below level of the lesion
  • Joint contracture due to muscle imbalances
  • Loss of sensation (need to brace)
  • Loss of Bowel and Bladder control
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10
Q

Associated disorders - neurological? (6)

A
  • Hydrocephalus
  • Arnold Chiari Malformation
  • Hydromyelia (herniation through ventricles)
  • Tethered Cord
  • Decreased speech and cognitive function
  • “Cocktail party” speech
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11
Q

Associated disorders - musculoskeletal? (2)

A

Club Feet

Congenital Hip Dislocation

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12
Q

What is Hydrocephalus? Causes? (3)

A
  • An abnormal accumulation of cerebral spinal fluid (CSF) in the cranial vault

Causes:

  • Overproduction of CSF
  • A failure in absorption of CSF fluid
  • Obstruction in the normal flow of CSF through the brain structures and spinal cord
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13
Q

Management of Hydrocephalus? What is it?

A
  • Shunt placed within first several days to 6 months

- Thin, flexible tube that diverts CSF away from the lateral ventricles

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14
Q

Ventriculoatrial (VA) shunt moves? Ventriculoperitoneal (VP) shunt is?

A
  • Ventriculoatrial (VA) shunt
    Moves excess CSF from one lateral ventricle to the right atrium of the heart
  • Ventriculoperitoneal (VP) shunt
    Preferred treatment for hydrocephalus
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15
Q

Chiari II Malformation is? (3)

A
  • Deformity of the cerebellum, medulla, and cervical spinal cord
  • The posterior cerebellum is herniated downward through the foramen magnum
  • Brainstem structures also displaced in a caudal direction
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16
Q

Signs of Shunt Malfunction? (9)

A
  • Headache
  • Irritability
  • Fever Unrelated to Illness
  • Nausea
  • Increased spasticity in innervated muscles
  • Increased difficulty with postural control
  • Decreased school performance
  • Decreased level of consciousness
  • “Sunset” sign of the eyes bc of increased ICP and decreased rotation
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17
Q

Hydromyelia is? Causes? (2) Requires?

A
  • Excess CSF collects in pockets down the spinal cord that created areas of pressure and necrosis of the surrounding peripheral nerves
  • Causes scoliosis
  • Progressive upper extremity weakness and hypertonus
  • Requires shunting
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18
Q

Tethered Spinal Cord is? (2) Causes? Assosciated?

A
  • Adhesions anchor the spinal cord at the site of the original lesion
  • Cord is not free to slide upward and reposition
  • Excessive stretch causes metabolic changes and ischemia of the neural tissue
  • Associated degeneration in muscle function
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19
Q

Tethered Spinal Cord signs? (7) Requires?

A
  • Rapidly progressive scoliosis,
  • hypertonus at one or several sites in the lower extremities,
  • changes in gait pattern and changes in urologic function,
  • increased tone on passive
  • ROM,
  • asymmetric changes in manual muscle testing results,
  • areas of decreasing strength, or discomfort in the back
  • Requires surgical repair
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20
Q

Families and specialists must monitor ? Early intervention can?

A
  • Families and specialists must monitor deterioration of skills/function
  • Early intervention can minimize the effects of secondary complications
21
Q

Objectives of Management - facilitate? Achieve? Reduce? Maintain?

A
  • Facilitate mastery of appropriate developmental skills
  • Achieve highest level of functional mobility via ambulation or w/c
  • Reduce contractures and prevent further contractures
  • Maintenance of weight
22
Q

Objectives of Management - conduct? (2) Assist with? Investigate? Facilitate?

A
  • Conduct ongoing assessment of neurological, musculoskeletal and functional assessment
  • Conduct ongoing patient and parent education
  • Assist with equipment acquisition and adjustment
  • Investigate home / school situation and coordinate program planning with other disciplines
  • Facilitate age appropriate participation in activities
23
Q

Management of the Neonate? (3)

A
  • Studies support early and aggressive intervention
  • Prevent infection
  • Closure of the back within 72 hours of birth
24
Q

Care for the Young Child? (2)

A
  • Followed by team of professionals over the lifetime

- Facilitation of communication for all involved

25
Q

Developmental Issues? (3)

A
  • Mild/moderate developmental delay
  • Develops compensatory strategies for low tone/proprioceptive input
  • Movement and exploration is limited
26
Q

Handling Strategies for Parents? (4)

A
  • Education should focus on gross, fine, and perceptual motor abilities
  • Upper/lower extremities, head, and trunk
  • Learning pace depends on child and family capacity to learn
  • Emphasize upright positions
27
Q

Physical Therapy for the Growing Child - kind of care? Based on? Repeated? Identify? intervention is?

A
  • Long-range plan of care
  • Based largely on the objective findings from the physical therapist’s evaluations
  • Repeated manual muscle tests and careful observation of the child’s development
  • Identify the child’s strengths and weaknesses
  • Intervention is directed at the specific needs of the lower extremities and gross motor development
28
Q

Developmental Concerns? (4)

A

Equilibrium and righting reactions
Prone positioning
Early weight bearing
Assessment of quality of movement

29
Q

Infant Devices - which ones are negative? (5) Therapist should? Encourage?

A
  • Infant walkers, jumper seats, swings, bouncer chairs, and the excessive use of infant car seats can have a negative impact on motor development and sensorimotor learning
  • Therapist should discourage use of these
  • Encourage active participation of these upright experiences by parents
30
Q

General Principles of Bracing(2 schools of thought) - Predictable level of? Advocates? Many factors?

A
  • mobility exists for children at each motor level
  • Advocates establishing reasonable expectations for each child
  • Many factors affect continuation and discontinuation of ambulation
31
Q

General Principles of Bracing(2 schools of thought) - do what for as long as reasonable? Children?

A
  • Early standing and gait training for as long as seems reasonable
  • Children attain their optimal level of performance, regardless of their motor level, and assist them to maintain this level for as long as is feasible
32
Q

Children with Thoracic Level Paralysis - posture? Total? Include?

A
  • Posture of flaccid lower extremities and at risk for developing a frog-legged deformity
  • Total contact body brace
  • Include a lower leg section to hold the ankle in a neutral or plantigrade position
33
Q

Thoracic Level Lesions - T-6 – T-12 - present how? (2) Tendency to have? (3) Orthosis needed? (5) Why?

A
  • Upper trunk working, No LE Muscles working
    -Tendency to have
    Kyphoscoliosis
    Hip abduction / external rotation (frog) contractures
    Club feet
  • Orthosis Needed:
    TLSO, AFO’s, Night Splints or leg wraps
    Parapodium
    May show some potential for upright mobility when young and may out grow this potential
34
Q

Children with High Lumbar Paralysis require? Are at?

A
  • Require a high level of bracing for standing and ambulation
  • Are at high risk for hip subluxation/dislocation
35
Q

Lumbar Lesions L1- L3 - muscles working? (3) Tendency to have? (4) Orthosis needed? (5)

A
  • Muscles working:
    Hip flexors, adductors, minimal knee extensors
  • Tendency to have
    Hip flexion contractures, hip dislocation, wind blown posture, Scoliosis
  • Orthosis needed
    Abduction splint, or A-Frame
    Parapodium early, HKAFO’s later, RGO
36
Q

Orthotics for Children with Thoracic & High Lumbar Paralysis? (8)

A
  • Early standing can use an A frame
  • Swivel standers
  • HKAFOs (hip knee ankle foot orthoses)
  • RGOs (reciprocal gait orthoses)
  • Rolling walkers
  • Lofstrand crutches
  • Swing through gait
  • Wheelchair sports, recreational activities toward adolescence
37
Q

L4 – L5 Muscles working? (5) Tendency to have? (5) Orthosis needed? (5)

A
  • Muscles working
    L4 knee extensors, ankle invertors and dorsiflexors
    L5 Hip abductors, minimal knee flexors
  • Tendency to have
    Hip flexion contractures, hip dislocation, lumbar lordosis, calcaneovarus, calcaneous
  • Orthosis needed
    Night Splint (abduction), RGO, HKAFO, KAFO, AFO later
38
Q

Orthotics for Children with Low Lumbar Paralysis(L4/L5)? (6)

A
  • Strong hip flexors and adductors
  • Calcaneal valgus/varus deformities
  • Clubfoot deformity
  • RGOs
  • AFOs if trunk control
  • KAFO if crouch present
39
Q

S1- S2 muscles working? (5) Tendency to have? (4) Orthosis needed? (5)

A
  • Muscles working:
    Knee flexors, hip extensors, ankle evertors and plantar flexors, toe flexors
  • Tendency to have:
    Calcaneous, calcaneovarus, toe clawing, foot ulcers
  • Orthosis needed
    AFO, SMO, shoe inserts, nothing, need caution with choice of foot wear
40
Q

Orthotics for Children with Sacral Level Paralysis? (3)

A

Most control of hip/knee
AFOs
Work on active trunk and lower extremity alignment

41
Q

Casting following Orthopedic Surgery? (4)

A
  • Usually required for 2-8 weeks after surgery
  • Consider positioning while in the cast
  • Prevention of pressure sores
  • Decreased mobility experiences
42
Q

Scoliosis - bracing may? Functions becomes? Other option?

A

Bracing may help decrease but not eliminate progression
Function becomes difficult
Surgical option for fusion

43
Q

Common allergy? Depended on? Allergic rx can develop with?

A
  • Latex Allergy
  • Depended on for its impermeable qualities and strength while still providing sensitivity to touch
  • Allergic reaction can develop with increased exposure
44
Q

Perceptual Motor and Cognitive Performance? Some studies show? (2)

A
  • Wide variety of cognitive levels depending on treatment of hydrocephalus, episodes of cerebral infection, and the presence of other CNS abnormalities
  • Some studies show increased attention deficit
  • Decreased ocular function
45
Q

Wheelchair Mobility options? (3)

A
  • Adapted strollers for young children
  • Standard wheelchair by school age
  • Power wheelchair and scooters as child ages
46
Q

Recreation and Leisure Activities? (2)

A

Encourage full participation in recreational activities with adaptations as needed
Aquatics

47
Q

Transition to adolescence and adulthood - prevention of? What other changes? Spinal stabilization procedures often occur in? Larger school communities require? Moving to a wheelchair should?

A
  • Prevention of weight gain and promotion of life-long health related fitness
  • Hormonal changes, growth, weight gain can cause fatigue and loss of interest in walking
  • Spinal stabilization procedures often occur in adolescence and can lead to loss of ambulation
  • Larger school communities require faster mobility of the wheelchair
  • Moving to a wheelchair should not be seen as failure
48
Q

The Adult with Spina Bifida - Common complaints include? (10)

A
  • Obesity, incontinence, recurrent urinary tract infections, chronic decubiti, joint pain, hypertension, neurologic deterioration, and depression
  • Self-image is important
  • Urinary tract issues are most common cause of morbidity

Peds (7 decks)

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