10-14 Hydrocephalus, Arnold Chiari Malformation, Spina Bifida

Question 1

Hydrocephalus

Answer 1

• “Water on the Brain”

- Abnormal accumulation of CSF in the ventricular system of the brain

Question 2

Causes of Hydrocephalus

Answer 2

• Overproduction of CSF
• Failure of absorption of CSF
• Obstruction in the flow of CSF

Question 3

Ventriculo-peritoneal (VP) shunt

Answer 3

• Manages hydrocephalus

- Diverts CSF from the lateral ventricles down the neck, under the clavicle, empties in the peritoneum

Question 4

Precautions of VP Shunt

Answer 4

• Do not allow head to be lowered below the abdomen (Do not want fluid to go back up into head)
• Occlusion of shunt (Buildup of CSF)

Question 5

Arnold Chiari Malformation

Answer 5

• Posterior cerebellum herniates down through the foramen magnum
• Brainstem displaced caudally
• Obstructs CSF in 4th ventricle
• Traction on lower CNs

Question 6

Spina Bifida

Answer 6

• Neural tube birth defect; causes neuromuscular dysfunction
• 2nd most common birth defect (1st is Down’s Syndrome)
• One or more vertebrae do not form bony spinal column over the spinal cord; LE paralysis can result

Question 7

Spina Bifida Occulta

Answer 7

• Asymptomatic
• Dimpling of skin or tuft of hair over affected area
• Most common in lumbar or sacral spine

Question 8

Meningocele

Answer 8

• Meninges of SC protrude through opening in vertebrae and form fluid-filled sac
• Usually no neurological deficits

Question 9

Myelomeningocele

Answer 9

• Meninges and part of SC protrude through opening in vertebrae
• Causes neurological deficits

Question 10

SB Intervention (Surgical)

Answer 10

• Sterile care of lesion

- Surgical close of sac within 72 hours

Question 11

Functional prognosis of SB

Answer 11

• Strengths of LE muscles
• CNS Status
• Motivation
• INtellectual capacity
• Family commitment, support, long-term compliance
• Other factors

Question 12

SB Interventions: MMT of infant

Answer 12

• Poor correlation between MMT and ultimate gross motor function
• Schedule of MMT: Prior to surgery, 10 days after surgery, 6 months, 1 year, Annually

Question 13

SB Interventions: Reflex movements

Answer 13

• Involuntary spasms
• Represents sparing of reflex arc
• Observe and document

Question 14

SB Inteventions: ROM in infants

Answer 14

• Assess prior to and after surgery
• Limitations should not be addresed with aggressive stretching (stretch over weeks or months)
• Begin after closure surgery
• Fit ROM exercise into daily activities (move extremities into ROM)

Question 15

SB Interventions: Positioning/handling infants

Answer 15

• May be limited to prone and side-lying (Supine restricted by closure surgery)
• Prone: Prone over lap, rock and sway side-to-side in prone, carry in prone across arm
• Against Gravity: Parent walking, infant positioned on shoulder (facilitate head control), short periods of supine and supported upright if medically cleared

Question 16

SB Interventions: Sensory in infants

Answer 16

• Assess sensitivity or insensitivity
• Use gentle touch, caress, tickle - no sharp objects
• Protective environmental strategies: educate parents in testing water temp, assess play area

Question 17

SB Developmental Issues

Answer 17

• Deficits in:
• Gross motor
• Fine Motor
• Hypotonia
• Perceptual
• Cog
• Developmental Delay (Abnormal head/neck control, abnormal righting and equilibrium reactions

Question 18

Tethered Spinal Cord

Answer 18

• Produces excessive stretch on the SC
• Ischemia of neural tissue
• Degeneration in muscle function