Spina Bifida

Question 1

What is Spina Bifida?

Answer 1

Failure of the neural tube to close primarily in the thoracolumbar region.

Question 2

What causes Spina Bifida?

Answer 2

Genetic Predisposition Maternal folic acid deficit Hot tub soaks? Alchol/valproic acid use during gestation.

Question 3

Alternative names for Spina Bifida are…?

Answer 3

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

Question 4

Describe Spina Bifida Occulta…

Answer 4

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.

Question 5

Define Meningocele…

Answer 5

Protruding sac. ONLY contains meninges (dura and arachnoid) and CSF.

Question 6

Do kids with a meningocele usually have motor or sensory problems?

Answer 6

AHHHH HELL NAAWWWWWW

Question 7

Granny’s carrying a myeolomeningocele…whats in it?

Answer 7

Spinal cord, meninges, and CSF

Question 8

What motor impairments may be seen with Spina Bifida?

Answer 8

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

Question 9

If a child with SB has a sensory impairment, is it below or above the level of the lesion?

Answer 9

I hope to God that you said above.

Question 10

If a Spina Bifida child has a bowel or bladder impairment, what is usually the root cause?

Answer 10

A tethered cord.

Question 11

What type of cognitive processing disorders may present with Spina Bifida?

Answer 11

Intellectual Disability Learning disability/ADHD Language Disorders (they are usually chatty).

Question 12

What type of visual and perceptual issues can occur with SB?

Answer 12

Nystagmus (double vision) Strabismus

Question 13

What is Talipes Equinovarus?

Answer 13

They’re born golfers. CLUBFOOT Stuck in plantarflexion, Inversion, and Adduction.

Question 14

What is Hydrocephalus?

Answer 14

Previously open spinal cord now closed so the CSF pressure rises! Due to the overproduction of CSF. OH MYYYY! NOT GOOD!!!

Question 15

How often does the Hydrocephalus occur in SB?

Answer 15

85-90% 80% requires immediate surgical repair within days after birth.

Question 16

What is an Arnold Chiari Malformation?

Answer 16

Cerebellum and brainstem displaced distally through foramen magnum. Causes obstruction of CSF. Diagnosed with an MRI

Question 17

What are the signs and symptoms of Hydrocephalus?

Answer 17

Sunsetting eyes Bluging anterior fontanelles

Question 18

Signs and Symptoms of Shunt Malfunction?

Answer 18

Vomiting Redness along shunt site/tract Seizures Sunsetting eyes Headaches Lethargy Irritability Bulging fontanelles Nystagmus

Question 19

How is an Arnold Chiari Malformation treated? If causing symptoms!

Answer 19

Cervical laminectomy and posterior fossa decompression.

Question 20

What does a tethered cord result in?

Answer 20

Stretching results in changes in: Scoliosis Gait Bladder function DTRs Increased tone Decreased strength Back pain

Question 21

How is a tethered cord diagnosed?

Answer 21

Myelogram Treated with surgical release and is most common in lesions below T12.

Question 22

What are some prenatal tests for Spina Bifida?

Answer 22

Alpha Fetoprotein (AFP) in amniotic fluid. Fetal ultrasound Fetal surgical repair (20-25 weeks gestation) Usually a C-section for delivery.

Question 23

Describe the post-surgical management of SB…

Answer 23

Neurosurgery to close the sac. (prevent meningitis). Urology consult Orthopedic consult (clubfoot). bony alignment.

Question 24

What allergy is common with Spina Bifida?

Answer 24

LATEX Due to frequent young exposure. Avoid latex products. Blood test available.

Question 25

Goals of a physical therapy intervention…

Answer 25

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

Question 26

What equipment needs do you usually satisfy?

Answer 26

Anything that needs done.

Question 27

What are some PT findings?

Answer 27

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

Question 28

PT interventions for Thoracic Level…

Answer 28

Maintain straight spine level pelvis symmetric lower limbs Teach sliding board transfers Attempt ambulation with parapodium Wheelchair mobility

Question 29

See powerpoint slides for PT Examination Findings and PT Interventions…

Slides 27-38

Answer 29

See powerpoint slides for PT Examination Findings and PT Interventions…

Slides 27-38

Question 30

Things to remember for kids with Spina Bifida…

Answer 30

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

Question 31

Comprehensive Evaluation schedule for Spina Bifida is what?

Answer 31

*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

Question 32

Things to remember for kids with SB continued…

Answer 32

*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

Question 33

Most important muscle groups for gait…in order of importance.

Answer 33

*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

Question 34

(1) Standardized Assessments for Functional Abilities are…

(2) Standardized Assessments for Ambulators are…

Answer 34

(1) PEDI, WEEFIM, if greater than 3 years…assess developmental abilities.

(2) 10m walk for gait velocity, 6m walk for endurance

Question 35

What is the most glaring problem with the new Jurassic Park Trailer starring Chris Pratt?

Answer 35

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.