Spina Bifida Flashcards
Difference between spina bifida aperta and occulta
Aperta - visible or open
Occulta - not visible/hidden
Do PTs work more with spina bifida aperta or occulta more?
Aperta
Occulta may not be necessary until adulthood when balance issues may present
Difference between myelomeningocele and meningocele.
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
Difference between myelomeningocele and myelodisplaysia
MMC - fluid filled sac
Displaysia - Neural parts of spinal move posterior/out of place
higher/lower the level of involvement means more likely to have a shunt
higher
spina bifida forms when end of neural tube fails to close at how many days?
26-28
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
1) Decrease
2) Decrease
3) Decrease
Shunts:
1) Higher OR Lower level increases need for shunt
2) At what spine level is shunt 100% necessary
1) HIGHER
2) T/s
What is leading cause of death in infancy period and what are signs
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
Common s/s of tethered cord
PROGRESSIVE SCOLIOSIS (most common) Pain, weakness, numbness is legs Changes in B/B Changes in structure of foot Associated with growth spurts
Untreated hydrocephalus and shunt malformation leads to what?
Hydromelia
s/s: progressive scoliosis, urologic problems, pain, and motor/sensory defects (such as decrease grip strength and thenar atrophy)
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
3) could be sign of hydrocephalus
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
1) Changes in mood could be a sign of shunt issues so she should followup with leading physician
S/S shunt malfunction in infant
Chiari malformation signs increased head size vomiting irritable bulging fontanel crossing eyes new onset seizures observable changes in shunt/tubing
S/S shunt malformation in toddler
Chiari signs vomiting increased head size leg pain continence changes changes in strength/motor symmetry vomiting new onset seizures irritability headaches declining school performance
S/S shunt malformation in teens
vomiting declining school performance headaches new onset seizures depression personality changes vision changes chiari signs leg pain continence changes changes in strength/motor symmetry
In this population, when should a fracture be suspected.
warm, swollen limb
what type of allergy is common in this population?
latex
what type of curve is normally present in scoliosis for these kids
c curve
if scoliosis is present under 6 years of age, what 2 differential diagnosis should be expected?
Tethered cord
hydromelia
if a child with AFOs has an externally rotated tibia, which malleoli may have skin breakdown?
medial
Calcaneus deformity present most commonly at what level
L4-5
equinus deformity most present at what level of spine involvement
Thoracic and high lumbar
At what following level of involvement are the following orthotics most appropriate:
1) Foot/SMO
2) AFO and ground reaction
3) KAFO
4) HKAFO
1) S1
2) L4-S1
3) L3-4
4) L1-3
Expected activated muscles for involved level of innervation:
1) T10
2) T11-L1
3) L2-3
4) L4-5
5) Sacral
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
Expected level of functional mobility for involved level of innervation:
1) T10
2) T11-L1
3) L2-3
4) L4-5
5) Sacral
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
When child is an infant, should goals be functional or developmental age related?
Functional to reduce secondary impairments. As most kids won’t catch up
what age is best to start discussing AD or wheelchair recommendations
12-18 months
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
3)
**Average age milestone achievement in kids with spina bifida
Sitting: 1-2yr
Crawling: 1-2yr
Standing: 3yr
Walking: 3-7yr
At what age does self-cathing become a big goal
preschool/school age
When lifting or transferring people, NIOSH recommends a __-pound limit per person
35 lb per person (aka, 65 lb kid requires 2 person lift assist)
