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Pediatrics > Spina Bifida > Flashcards

Spina Bifida Flashcards

1
Q

Clinical Signs of Spina Bifida

A

-Absence of motor and sensory function (usually B) below the level of the spinal defect
Loss of neural control of bowel/bladder function
Unilateral and asymmetric motor and sensory loss
-Higher motor or sensory level on one side than on other
-functional deficits may be partial or complete

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2
Q

What is hydrocephalus

A

abnormal accumulaation of CSF in cranial vault

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3
Q

What are causes of hydrocepalus

A

Overproduction of CSF
Failure in absorption of CSF fluid
Obstruction in normal flow of CSF through brain structures and spinal cord

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4
Q

What is Chiari II Malformation

A
  • common to children with SB
  • deformity of cerebellum, medulla, and C-spinal cord
  • posterior cerebellum is herniated downward through foramen magnum
  • brainstem structures also displaced in caudal direction
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5
Q

What are Prenatal Testing and Diagnosis?

A
  • γ-Fetoprotein levels (AFP)
  • ->Remain abnormally high after 14 weeks’ gestation
  • Fetal ultrasound
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6
Q

What is fetal surgery and what is it associated with

A

repair the exposed spine in utero

associated with decreased hydrocephalus

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7
Q

What are the risks of fetal surgery

A

premature labor, placental abruption, and thinning of uterus

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8
Q

What are management ideas for the Neonate

A
  • Studies support early and aggressive intervention
  • Prevent infection
  • Closure of the back within 72 hours of birth
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9
Q

What is the general philosophy of treatment

A
  • DEPENDS on extent of neurologic impairment
  • DEPENDS on extent of hydrocephalus
  • Extend of kyphoscoliosis/scoliosis
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10
Q

Scoliosis in patients with Spina Bifida

A
  • bracing may help decrease but not eliminate the problem
  • function becomes difficult
  • surgical option for fusion
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11
Q

Latex allergy in patients with spina bifida

A
  • increased in children with spina bifida
  • will need to make sure you are using latex free things (including Thera-Band)
  • allergic reaction can develop with increased exposure
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12
Q

What is the perceptual motor and cognitive performance?

A
  • wide variety of cognitive levels depending on treatment of hydrocephalus, episodes of cerebral infection, and the presence of other CNS abnormalities
  • increased attention deficit
  • decreased ocular function
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13
Q

What is the wheelchair mobility in patients with spina bifida?

A
  • adapted strollers for young children
  • standard wheelchair by school age
  • power wheelchair and scooters as child ages
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14
Q

What should we say to pts about recreation and leisure activities?

A
  • encourage full participation in recreation activities with adaptations as needed
  • aquatics are also good
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15
Q

What are some common complaints of young adults with spina bifida?

A
  • Obesity, incontinence, recurrent urinary tract infections, chronic decubiti, joint pain, hypertension, neurologic deterioration, and depression
  • Social integration, vocational issues, and sexual counseling
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16
Q

What is the most common cause of morbidity in spina bifida?

A

urinary tract issues

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17
Q

___% of those who undergo neonatal surgery for back closure will develop hydrocephalus. These pts will require a shunt placement.

A

90

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18
Q

Ventriculoatrial (VA) shunt

A

Moves excess CSF from one lateral ventricle to the right atrium of the heart

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19
Q

Ventriculoperitoneal (VP) shunt

A

Preferred treatment for hydrocephalus. Shunt runs down to peritoneum where CSF is absorbed and the excess is excreted.

20
Q

MMT should be performed preoperatively and postoperatively on day __, at __ months, and yearly thereafter.

A

10, 6

21
Q

Name two types of contractures common with spina bifida.

A

Hip flexion due to unopposed hip flexors and ankle dorsiflexion due to unopposed dorsiflexors

22
Q

Spina bifida is the ___ most common birth defect.

A

2nd

- 3.4 per 10,000 live births

23
Q

What are possible causes of spina bifida?

A
  • Has been linked to maternal lack of folic acid in first trimester
  • Also associated with valproic acid (Seizure medication)
24
Q

What are some early treatment options for a patient with spina bifida? How is the prognosis?

A
  1. Closure of spine (surgical), Shunt for hydrocephalus, Clean, intermittent catheterization for urination
  2. Greater than 90% survival with early treatment
25
Q

Spina bifida can also be known as…..

A 
Myelomeningocele
Meningomyelocele
Spina bifida aperta
Spina bifida cystica
Spinal dysraphism
Myelodysplasia
26
Q

What is spina bifida?

A

Spinal defect diagnosed by the presence of an external sac on the infant’s back

27
Q

Where is the most common place for the external sac to be located?

A

In the lumbar region

28
Q

What is contained in the external sac?

A
  • Meninges and spinal cord tissue
  • Protruding through a dorsal defect in the vertebrae
  • Can be covered by membrane or exposed
29
Q

What is spinal bifida occulta?

A
  • Involves nonfusion of the halves of the vertebral arches

- Without disturbance of the underlying neural tissue

30
Q

What is a myelocele?

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 CNS problems
31
Q

What is a lipomeningocele?

A
  • Superficial fatty mass in the low lumbar or sacral level of the spinal cord
  • Significant neurologic deficits and hydrocephalus are not expected.
32
Q

Explain the embryology behind spina bifida.

A
  • Caudal end of the neural tube closes on approximately day 25-26 of gestation
  • Failure of the neural tube to close at any point along the caudal border initiates the defect of spina bifida cystica or myelomeningocele
33
Q

Developmental Issues (3)

A

1) Mild/moderate developmental delay
2) Develops compensatory strategies for low tone/proprioceptive input
3) Movement and exploration is limited.

34
Q

2 handling strategies for parents

A

1) Education should focus on gross, fine, and perceptual motor abilities.
2) Emphasize upright positions.

35
Q

4 developmental concerns

A

1) Equilibrium and righting reactions
2) Prone positioning
3) Early weight bearing
4) Assessment of quality of movement

36
Q

We should discourage the use of what 5 infant devices?

A

Infant walkers, jumper seats, swings, bouncer chairs, and the excessive use of infant car seats

37
Q

We should encourage what type of active participation?

A

upright experiences by parents

38
Q

Explain the principle of bracing that says: predictable level of mobility exists for children at each motor level

A
  • Advocates establishing reasonable expectations for each child
  • Many factors affect continuation and discontinuation of ambulation
39
Q

Explain the principle of bracing that says: Early standing and gait training for as long as seems reasonable

A

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

40
Q

A well-defined orthotic approach should begin as early as…

A

the child’s first day of life.

41
Q

What is the posture of the LEs in a child with thoracic level paralysis and what does this posture put them at risk for?

A

Posture of flaccid lower extremities and at risk for developing a frog-legged deformity

42
Q

What type of bracing is required for a child with thoracic level paralysis?

A

total contact body brace

43
Q

What should the total contact body brace include?

A

lower leg section to hold the ankle in a neutral or plantigrade position.

44
Q

What type of bracing is required for a child with high lumbar paralysis?

A

high level of bracing for standing and ambulation

45
Q

What are children with high lumbar paralysis at risk for?

A

hip subluxation/dislocation

Pediatrics (13 decks)

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