Spina Bifida

Question 1

Spina bifida

Answer 1

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

Question 2

Most common location

Answer 2

lumbar region

Question 3

Spina bifida occulta

Answer 3

involves nonfusion of the halves of the vertabral arches

without disturbance of underlying neural tissue

Question 4

Myelocele

Answer 4

protruding sac containing meninges and cerebrospinal fluid
nerve roots and spinal cord remain intact and in normal positions
No motor deficits, associated hydrocephalus, or other CNS problems

Question 5

Lipomeningocele

Answer 5

superficial fatty mass in low lumbar or sacral level of the spinal cord
significant neurologic deficits and hydrocephalus are not expected

Question 6

Caudal end of neural tube closes on approximately day __ of gestation

Answer 6

26

Question 7

Clinical signs

Answer 7

Absence of motor and sensory function below level of spinal defect
Higher motor or sensory level on one side than on the other
Functional deficits may be partial or complete

Question 8

Hydrocephalus

Answer 8

Abnormal accumulation of CSF in cranial vault

Question 9

Causes of hydrocephalus

Answer 9

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

Question 10

Chiari Malformation

Answer 10

deformity of cerebellum, medulla, and cervical spinal cord

posterior cerebellum is herniated downward through foramen magnum, displacing brainstem in caudal direction

Question 11

__% of infants develop hydrocephalus after back closure surgery

Answer 11

90%

Shunt will be placed withing first several days to 6 months

Question 12

Ventriculoatrial (VA) shunt

Answer 12

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

Question 13

Ventriculoperitoneal (VP) shunt

Answer 13

preferred treatment for hydrocephalus, less severe complications

Question 14

MMT should be performed…

Answer 14

preoperative, 10 days postop, 6 months post op, and yearly

Question 15

Purpose of MMT

Answer 15

can provide level of function, motor level is defined as lowest level which has antigravity movement

Question 16

Typical contractures in spina bifida

Answer 16

hip flexion due to unopposed hip flexors

ankle due to unopposed dorsiflexors

Question 17

Considerations for thoracic level paralysis

Answer 17

Flaccid LE
At risk for developing frog-legged deformity
Will have total contact body brace including lower leg section to hold ankle in neutral or plantigrade

Question 18

Considerations with high lumbar paralysis

Answer 18

Require high level bracing for standing and ambulation

High risk for hip subluxation/dislocation

Question 19

Orthotics for kids with Thoracic and High Lumbar paralysis

Answer 19

Early standing can use A frame
Swibel standers
HKAFOs
Reciprocating gait orthoses (RGOs)
Rolling walkers
Rorearm crutches
Swing through gait

Question 20

Orthotics for kids with Low Lumbar paralysis (L4/L5)

Answer 20

Strong hip flexors and adductors
Calcaneal valgus/varus deformities
Clubfoot deformity
RGOs
AFOs if trunk is controlled 
KARO if crouch is pressent

Question 21

Orthotics for kids with Sacral level paralysis

Answer 21

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

Question 22

Hydromyelia

Answer 22

excess CSF collects in pockets down the spinal cord that created areas of pressure and necrosis of surrounding peripheral nerves
Causes Scoliosis

Question 23

Tethered Spinal Cord

Answer 23

Adhesions anchor spinal cord at site of lesion, cord is not free to slide upward and reposition
Excessive stretch causes metabolic changes and ischemia of the neural tissue

Question 24

Signs of Tethered spinal cord

Answer 24

rapidly progressive scoliosis
hypertonus at one or several sites in LE
changes in gait pattern
changes in urologic function
increased tone on PROM
asymmetric changes in MMT results
discomfort in back