Spina Bifida

Question 1

What is Arnold-Chiari Malformation?

Answer 1

Brainstem is displaced inferiorly beyond the foramen magnum

Question 2

What is a Syrinx?

Answer 2

Cyst in the spinal column

Question 3

What are some associated complications with patients with spina bifida?

Answer 3

Shunt Malformation: a lot of signs and symptoms
Latex Allergies
Tethered Cord

Question 4

When are valgus and varus deformities common?

Answer 4

Occur most frequently in L3 and above group

Question 5

When are foot and ankle problems more common?

Answer 5

Lesion is at L5 and above

Question 6

What are common joint limitations if lesion is L2-3 or L3-4?

Answer 6

Tight hip flexors

Adductor tightness

Question 7

What level would you expect a lesion if the patient exhibits strong dorsiflexion?

Answer 7

L5

strong DFs, with no PF or toe flexors

Question 8

What levels are required for bowel and bladder control?

Answer 8

S2-S4

Question 9

There is no LE voluntary movement and patient cannot maintain upright positioning. Recommended orthotic is a THKAFO. Where is the lesion?

Answer 9

Somewhere in the thoracic

Question 10

What type of orthotic would be needed in a patient with a lesion at L1-3?

Answer 10

HKAFO, or RGO

Question 11

Patient can ambulate, but only over short household distances, they have hip flexion and ADD, but unable to maintain upright with hips extended. Where is the lesion?

Answer 11

L1-3

Question 12

Where is the lesion if a patient needs a KAFO for ambulation?

Answer 12

L3-4

Question 13

The patient has knee extension as well as upper level innervation. They have weak quads and M/L knee instability. They can ambulate in the house but are limited in the community. Where is the lesion?

Answer 13

L3-4

Question 14

What movements will a patient still have if there is a lesion in L4-5?

Answer 14

They will have hip ABD, knee flexion, ankle DF/IN, toe extension and upper level innervation.

Question 15

What type of orthotic will a patient with an L4-L5 lesion have?

Answer 15

AFO

Question 16

What type of orthotic will a person with a lesion in sacral segments 1-3 have?

Answer 16

SMO or orthotic or insert

Question 17

What are the levels of ambulation for each lesion?

Answer 17

Thoracic: Only for exercise with extensive adaptations
L1-L3: Only short household distances
L3-4: Household with limited community
L4-5: Household with limited community (a little more)
S1-3: Community

Question 18

What tests can be done with a patient with spina bifida?

Answer 18

PEDI
PDMS-2
School Function Assessment
6 minute walk

Question 19

Describe with orthotics should be used for each level.

Answer 19

L1-3: HKAFO, RGO
L3-4: KAFO
L4-5: AFO
S1-3: SMO, shoe orthotic