Spina Bifida Flashcards
What is Spina Bifida?
Failure of the neural tube to close primarily in the thoracolumbar region.
What causes Spina Bifida?
Genetic Predisposition Maternal folic acid deficit Hot tub soaks? Alchol/valproic acid use during gestation.
Alternative names for Spina Bifida are…?
Myelomeningocele Meningomyelocele Spina bifida aperta Spina bifida cystica Myelodysplasia All of the above involve an open sac with meninges and spinal cord contents through defect in vertebral column
Describe Spina Bifida Occulta…
It’s often asymptomatic…found on X-ray. Bony abnormality with intact overlying skin. Tuft of hair on the lumbar region usually. May have a tethered cord resulting in a bladder/bowel problem.
Define Meningocele…
Protruding sac. ONLY contains meninges (dura and arachnoid) and CSF.
Do kids with a meningocele usually have motor or sensory problems?
AHHHH HELL NAAWWWWWW
Granny’s carrying a myeolomeningocele…whats in it?
Spinal cord, meninges, and CSF
What motor impairments may be seen with Spina Bifida?
BELOW THE LEVEL OF THE LESION: Creates muscle imbalance between flexors and extensors, ABs/ADs, IRs/ERs due to flaccid in one muscle group and active in antagonist muscle (abnormal tone) Spasticity due to associated CNS abnormalities Musculoskeletal issues due to above
If a child with SB has a sensory impairment, is it below or above the level of the lesion?
I hope to God that you said above.
If a Spina Bifida child has a bowel or bladder impairment, what is usually the root cause?
A tethered cord.
What type of cognitive processing disorders may present with Spina Bifida?
Intellectual Disability Learning disability/ADHD Language Disorders (they are usually chatty).
What type of visual and perceptual issues can occur with SB?
Nystagmus (double vision) Strabismus
What is Talipes Equinovarus?
They’re born golfers. CLUBFOOT Stuck in plantarflexion, Inversion, and Adduction.
What is Hydrocephalus?
Previously open spinal cord now closed so the CSF pressure rises! Due to the overproduction of CSF. OH MYYYY! NOT GOOD!!!
How often does the Hydrocephalus occur in SB?
85-90% 80% requires immediate surgical repair within days after birth.
What is an Arnold Chiari Malformation?
Cerebellum and brainstem displaced distally through foramen magnum. Causes obstruction of CSF. Diagnosed with an MRI
What are the signs and symptoms of Hydrocephalus?
Sunsetting eyes Bluging anterior fontanelles
Signs and Symptoms of Shunt Malfunction?
Vomiting Redness along shunt site/tract Seizures Sunsetting eyes Headaches Lethargy Irritability Bulging fontanelles Nystagmus
How is an Arnold Chiari Malformation treated? If causing symptoms!
Cervical laminectomy and posterior fossa decompression.
What does a tethered cord result in?
Stretching results in changes in: Scoliosis Gait Bladder function DTRs Increased tone Decreased strength Back pain
How is a tethered cord diagnosed?
Myelogram Treated with surgical release and is most common in lesions below T12.
What are some prenatal tests for Spina Bifida?
Alpha Fetoprotein (AFP) in amniotic fluid. Fetal ultrasound Fetal surgical repair (20-25 weeks gestation) Usually a C-section for delivery.
Describe the post-surgical management of SB…
Neurosurgery to close the sac. (prevent meningitis). Urology consult Orthopedic consult (clubfoot). bony alignment.
What allergy is common with Spina Bifida?
LATEX Due to frequent young exposure. Avoid latex products. Blood test available.
Goals of a physical therapy intervention…
MOTOR MILESTONES! Facilitate normal motor milestones Prone on elbows Rolling Sitting Standing Commando crawling on belly Transitioning into/out of sitting and quadruped Creeping on hands and knees Pulling to standing Lowering self to sitting Cruising Standing independently Ambulating using push cart Ambulating with 1-2 hands held Taking steps independently Ambulating independently
What equipment needs do you usually satisfy?
Anything that needs done.
What are some PT findings?
No volitional lower limb movements Posture found in LE : Hip Flex, Abd, ER contractures KF, Ankle PF contracture Lumbar Lordosis (weak lower trunk) Club feet common Hip dislocation, subluxation Kyphoscoliosis Decreased respiratory function
PT interventions for Thoracic Level…
Maintain straight spine level pelvis symmetric lower limbs Teach sliding board transfers Attempt ambulation with parapodium Wheelchair mobility
See powerpoint slides for PT Examination Findings and PT Interventions…
Slides 27-38
See powerpoint slides for PT Examination Findings and PT Interventions…
Slides 27-38
Things to remember for kids with Spina Bifida…
Kids with Spina Bifida use UEs for weight bearing/transfers (balance and support) so may have UE dyscoordination
Skeletal growth exceeds muscle extensibility and mass…decrease flexibility of trunk and two-joint limb muscles…progression of spinal deformity and decline in mobility for kids with spina bifida
Comprehensive Evaluation schedule for Spina Bifida is what?
*Newborn pre-op
*Newborn post-op
*6 months
*12 months
*18 months
*24 months
*Annually after 24 months and after any period of immobilization, bed rest, or period of rapid growth spurt
Things to remember for kids with SB continued…
*Avoid habitual postural positions that can lead to deforming forces
*Look for proper joint alignment
*Do not allow crouched gait
*No “W” sitting
*Keep feet flat on floor in sitting or flat on foot rests (achieve plantigrade foot position even if non-ambulatory)
*Maintain 90-90-90 position in sitting (hip, knee, ankle)
*Use tilted/angled work surface to avoid excessive head/neck/trunk flexion
*Energy expenditure for independent mobility can be huge
*always look at endurance, efficiency, effectiveness, safety, degree of independence and accessibility to:
*Bed mobility, floor mobility, transfers, wheelchair mobility, and ambulation
Most important muscle groups for gait…in order of importance.
*Key Muscle Groups identified for community ambulation (in order of importance)
(1) Iliopsoas
(2) Gluteus medius and maximus
(3) Quadriceps
(4) Anterior tibialis
(5) Hamstrings
(1) Standardized Assessments for Functional Abilities are…
(2) Standardized Assessments for Ambulators are…
(1) PEDI, WEEFIM, if greater than 3 years…assess developmental abilities.
(2) 10m walk for gait velocity, 6m walk for endurance
What is the most glaring problem with the new Jurassic Park Trailer starring Chris Pratt?
Why in the hell would a company seeking to pursue a multibillion dollar venture not check if the island they want to build it on was an active volcano. Come on Hollywood.
