Spina Bifida Flashcards
Spina bifida
spinal defect diagnosed by presence of an external sac on infant’s back
Most common location
lumbar region
Spina bifida occulta
involves nonfusion of the halves of the vertabral arches
without disturbance of underlying neural tissue
Myelocele
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
Lipomeningocele
superficial fatty mass in low lumbar or sacral level of the spinal cord
significant neurologic deficits and hydrocephalus are not expected
Caudal end of neural tube closes on approximately day __ of gestation
26
Clinical signs
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
Hydrocephalus
Abnormal accumulation of CSF in cranial vault
Causes of hydrocephalus
Overproduction of CSF
Failure in absorption of CSF fluid
Obstruction in normal flow of CSF through the brain structures and spinal cord
Chiari Malformation
deformity of cerebellum, medulla, and cervical spinal cord
posterior cerebellum is herniated downward through foramen magnum, displacing brainstem in caudal direction
__% of infants develop hydrocephalus after back closure surgery
90%
Shunt will be placed withing first several days to 6 months
Ventriculoatrial (VA) shunt
mores excess CSF from one lateral ventricle to the right atrium of the heart
Ventriculoperitoneal (VP) shunt
preferred treatment for hydrocephalus, less severe complications
MMT should be performed…
preoperative, 10 days postop, 6 months post op, and yearly
Purpose of MMT
can provide level of function, motor level is defined as lowest level which has antigravity movement
Typical contractures in spina bifida
hip flexion due to unopposed hip flexors
ankle due to unopposed dorsiflexors
Considerations for thoracic level paralysis
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
Considerations with high lumbar paralysis
Require high level bracing for standing and ambulation
High risk for hip subluxation/dislocation
Orthotics for kids with Thoracic and High Lumbar paralysis
Early standing can use A frame Swibel standers HKAFOs Reciprocating gait orthoses (RGOs) Rolling walkers Rorearm crutches Swing through gait
Orthotics for kids with Low Lumbar paralysis (L4/L5)
Strong hip flexors and adductors Calcaneal valgus/varus deformities Clubfoot deformity RGOs AFOs if trunk is controlled KARO if crouch is pressent
Orthotics for kids with Sacral level paralysis
Most control of hip/knee
AFOs
Work on active trunk and LE alignment
Hydromyelia
excess CSF collects in pockets down the spinal cord that created areas of pressure and necrosis of surrounding peripheral nerves
Causes Scoliosis
Tethered Spinal Cord
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
Signs of Tethered spinal cord
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
