Spina Bifida

Question 1

Difference between spina bifida aperta and occulta

Answer 1

Aperta - visible or open

Occulta - not visible/hidden

Question 2

Do PTs work more with spina bifida aperta or occulta more?

Answer 2

Aperta

Occulta may not be necessary until adulthood when balance issues may present

Question 3

Difference between myelomeningocele and meningocele.

Answer 3

Myelo - no skin cover and associated with nerve paralysis

Mening - skin covering with no nerve paralysis and sac filled with membrances and non-functioning nerves

Question 4

Difference between myelomeningocele and myelodisplaysia

Answer 4

MMC - fluid filled sac

Displaysia - Neural parts of spinal move posterior/out of place

Question 5

higher/lower the level of involvement means more likely to have a shunt

Answer 5

higher

Question 6

spina bifida forms when end of neural tube fails to close at how many days?

Answer 6

26-28

Question 7

Results of MOMS study.

1) Did prenatal surgery increase/decrease 12 month death need for shunt
2) Increase or decrease number of kids who needed crutches to ambulate
3) Increase/decrease presence of Arnold Chiari malformation

Answer 7

1) Decrease
2) Decrease
3) Decrease

Question 8

Shunts:

1) Higher OR Lower level increases need for shunt
2) At what spine level is shunt 100% necessary

Answer 8

1) HIGHER

2) T/s

Question 9

What is leading cause of death in infancy period and what are signs

Answer 9

Chiari II Malformation
Paralysis of vocal cords, difficulty feeding, difficulty crying, difficulty breathing (central apnea), gagging, and quick downward movements are s/s of compression

Question 10

Common s/s of tethered cord

Answer 10

PROGRESSIVE SCOLIOSIS (most common) 
Pain, weakness, numbness is legs
Changes in B/B
Changes in structure of foot
Associated with growth spurts

Question 11

Untreated hydrocephalus and shunt malformation leads to what?

Answer 11

Hydromelia

s/s: progressive scoliosis, urologic problems, pain, and motor/sensory defects (such as decrease grip strength and thenar atrophy)

Question 12

You are collaborating with a local orthotic company to obtain a helmet for a child with plagiocephaly. The child had general developmental delays that are undiagnosed at this time. You are having a conversation with the orthotist about documentation needed to obtain coverage from the insurance company. The orthotist makes a passing comment about the latest head shape readings she obtained and says that the she has been noticing a faster than normal increase in overall head size. What should you do/say?

1) Mention that the mom did say the kid has been eating more so it’s probably related to his increased nutrition intake.
2) Retake measurements again at followup in 3 weeks since it could be a fluke.
3) Refer child to leading physician with noted head size concerns

Answer 12

3) could be sign of hydrocephalus

Question 13

You are working with a 15 year old male with L3 spina bifida who has a shunt, bilateral hinged AFOs, and posterior wheeled walker for long distance ambulation. You are having a conversations with his mother about how his recent IEP meeting went mom mom notes that the teachers were telling her that her son appears to be more withdrawn recently and he is now struggling with math, which he previously excelled in. Mom believes that he is just being a moody teenager What would be the best thing to say to mom?

1) Changes in mood could be a sign of shunt issues so she should followup with leading physician
2) Keep an eye on emotions and if they get worse refer to therapist

Answer 13

1) Changes in mood could be a sign of shunt issues so she should followup with leading physician

Question 14

S/S shunt malfunction in infant

Answer 14

Chiari malformation signs
increased head size
vomiting 
irritable
bulging fontanel 
crossing eyes
new onset seizures 
observable changes in shunt/tubing

Question 15

S/S shunt malformation in toddler

Answer 15

Chiari signs
vomiting
increased head size 
leg pain
continence changes 
changes in strength/motor symmetry 
vomiting 
new onset seizures
irritability 
headaches 
declining school performance

Question 16

S/S shunt malformation in teens

Answer 16

vomiting
declining school performance 
headaches
new onset seizures
depression
personality changes
vision changes
chiari signs
leg pain
continence changes 
changes in strength/motor symmetry

Question 17

In this population, when should a fracture be suspected.

Answer 17

warm, swollen limb

Question 18

what type of allergy is common in this population?

Answer 18

latex

Question 19

what type of curve is normally present in scoliosis for these kids

Answer 19

c curve

Question 20

if scoliosis is present under 6 years of age, what 2 differential diagnosis should be expected?

Answer 20

Tethered cord

hydromelia

Question 21

if a child with AFOs has an externally rotated tibia, which malleoli may have skin breakdown?

Answer 21

medial

Question 22

Calcaneus deformity present most commonly at what level

Answer 22

L4-5

Question 23

equinus deformity most present at what level of spine involvement

Answer 23

Thoracic and high lumbar

Question 24

At what following level of involvement are the following orthotics most appropriate:

1) Foot/SMO
2) AFO and ground reaction
3) KAFO
4) HKAFO

Answer 24

1) S1
2) L4-S1
3) L3-4
4) L1-3

Question 25

Expected activated muscles for involved level of innervation:

1) T10
2) T11-L1
3) L2-3
4) L4-5
5) Sacral

Answer 25

1) Respiratory and trunk control
2) Above + hip flex
3) Above + knee extension and hip ADD
4) Above + Hip ABD, knee flexion, DF, IN, EV
5) PF and toe flex/ext

Question 26

Expected level of functional mobility for involved level of innervation:

1) T10
2) T11-L1
3) L2-3
4) L4-5
5) Sacral

Answer 26

1) Nonambulatory and wheeled mobility
2) exercise ambulation and wheeled mobility
3) Household ambulation and AFO-HKAFO
4) Household ambulation and community ambulation and AFO-KAFO
5) Community ambulation and FO-AFO

Question 27

When child is an infant, should goals be functional or developmental age related?

Answer 27

Functional to reduce secondary impairments. As most kids won’t catch up

Question 28

what age is best to start discussing AD or wheelchair recommendations

Answer 28

12-18 months

Question 29

You are working with a 2 year old boy with level L3 involvement at an outpatient facility. He participates in once a week EI services, once a week PT services, and has KAFOs and night splints and recently submitted claims for a stander. His mother reports to you that she is concerned about her child’s lack of ability to stand on his own and wants to increase his EI and outpatient services both to 2x per week. What would be the best thing to say to mom:

1) EI services probably won’t be increased but we can increase outpatient to 3x per week to make up for it
2) That sounds like a good plan and we can start right away since he should be standing by now
3) educate mom that standing most likely won’t happen until 3 years age but we can work on adapting goals to be more focused about standing

Answer 29

3)
**Average age milestone achievement in kids with spina bifida
Sitting: 1-2yr
Crawling: 1-2yr
Standing: 3yr
Walking: 3-7yr

Question 30

At what age does self-cathing become a big goal

Answer 30

preschool/school age

Question 31

When lifting or transferring people, NIOSH recommends a __-pound limit per person

Answer 31

35 lb per person (aka, 65 lb kid requires 2 person lift assist)