Spina Bifida Flashcards
(20 cards)
Spina Bifida Etiology and Diagnosis
Etiology
- Folic acid deficiency, teratogens, family hx
- obstetric care - C section - surg repair
Diagnosis
- Fetal Ultrasound - 18 wks
- Alphafetoprotein - blood test - 16wks
- Amniocentesis - 20wks
Types of Spina Bifida and Severity
- Myelomeningocele
- most severe - 2nd most common
- vertebral arches dont close
- open membranous sac contains CSF, meninges, SC and damaged below
- Meningocele
- 2nd severe, least common
- vert arches dont fuse
- SC intact
- neural elements covered
- paresis, bowel and bladder
- SB Occulta
- least severe, most common
- vert arches dont fuse
- no damage SC/nerves
- dimpling/tuft of hair
SB Level Identification
- post natal surgery 24-72 hours
- motor level is assigned according to last intact nerve root found
- determined by surgeon at time of reparative surgery
prenatal surgery = 19-25 weeks followed by cesarean section at 37 weeks gestation to reduce trauma to SC
Arnold Chiari CNS Abnormalities
- primary cause of hydrocephalus
- occurs 85% of time with SB
- lower brain stem, cerebellum, 4th ventricle herniate through foramen magnum and impede flow of CNS
Symptoms Associated with Arnold Chiari
- Stridor
- apnea
- GERD
- vocal cord paralysis
- difficulty swallowing
- seizures
- nystagmus
- problems with feeding
- ataxia
- hypotonia
- UE weakness/spasticity
Signs of Shunt Malfunction with Hydrocephalus (Infants and Toddlers)
Infants
- bulging fontanelle
- vomitting
- changes in appetite
- sunset sign of eyes
- edema and redness along tract
Toddlers
- vommiting
- irritability
- headache
- Edema
Signs of Shunt Malfunction School Age Children
- headache
- lethargy
- irritiability
- edema/redness on tract
- handwriting changes
- high pitched crying
- seizures
- rapid growth of head circumference
- thinning of skin over scalp
- nystagmus (new)
- vomiting
- personality changes
- changes in school performance
- memory changes
Skeletal abnormalities associated with SB
- scoliosis
- deformity from muscle imbalance
- club foot - talipes equinovarus
- hip dislocation
Hydromyelia - Neurological Deterioration
- accumulation of CSF in central canal of SC
- signs: rapid progression of scoliosis, UE weakness, increased tone
Tethered Cord
- adhesions form to anchor SC at original lesion site
- Signs:
- UTI or incontinence
- leg/foot weakness; loss of nerve function
- numbness
- spasticity
- leg or foot length discrepancy
- foot deformity (claw toes)
- spinal deformity scoliosis
- pain/irritability
Frequently Related Problems with Spina Bifida
- Laytex allergy
- intelligence varied
- poor STM
- impaired hand/eye coordination
- decreased receptive language skills
- poor attention span
- difficulty with organizational skills
- poor problem solving skills
- frequent hospitalizations affect social development
GOALS of PT WITH SB
- Establish motor level by MMT
- provide information to medical team about available LE movement
- provide instruction to family regarding positioning and handling to prevent deformity
- provide HEP for development
- Input regarding orthotic and mobility aids
- monitor patient for CNS deterioration
Focus of Treatment with Infant
- age appropriate developmental skills
- head/trunk control
- postural reactions
- mobility training
- prone for UE strength
- adaptive seating or standing (parapodium)
- goal = upright standing
Focus of Treatment Preschool
- functional upright mobility
- orthotic management
- orthopedic intervention
- skin care
- strengthening
- adaptive training
- skill acquisition
Focus of Treatment School Age
- Energy expenditure
- orthopedic intervention
- orthotic management
- home, school, community negotiation
- skin care and pressure relief
Clinical Presentation
Level T6-T12
Muscle Function
- upper trunk
- abdominals
- back
- intercostals
2ndary impairments
- kyphoscoliosis
- contractures
- hip abd/ER
- club feet
Prognosis walking
- SHORT DISTANCE AMB
- TLSO
- WC/standing frame
- parapodium
- RGO/Walker
Clinical Presentation
Level L1-L3
Muscle function
- hip flexors/adductors
- possible quads
2ndary impairments
- HFC
- hip dislocation
- Wind Swept Scoliosis?
Prognosis Walking
- HOUSEHOLD AMBULATION
- stander parapodium
- RGO/Walker
- HKAFO, KAFO, AFO
- FA crutches/WC
Clinical Presentation
Level L4-L5
Muscle Function
- quads
- glut med/min
- hamstrings
- AT, PT, peroneals
2ndary impairments
- HFC
- hip dislocation
- lumbar lordosis
- calcaneovarus
Prognosis walking
- HOUSEHOLD or COMMUNITY
- HKAFO, KAFO, AFO
- crutches, cane, wheelchair
Clinical Presentation
Level S1-S2
Muscle Function
- quads
- glut max
- peroneals
- gastroc
- toe flexors
2ndary Impairments
- Calcaneovarus
- toe clawing
- heel ulcers
Prognosis walking
- COMMUNITY AMBULATION
- AFO, SMO, FO
