Spina Bifida Flashcards
(45 cards)
Clinical Signs of Spina Bifida
-Absence of motor and sensory function (usually B) below the level of the spinal defect
Loss of neural control of bowel/bladder function
Unilateral and asymmetric motor and sensory loss
-Higher motor or sensory level on one side than on other
-functional deficits may be partial or complete
What is hydrocephalus
abnormal accumulaation of CSF in cranial vault
What are causes of hydrocepalus
Overproduction of CSF
Failure in absorption of CSF fluid
Obstruction in normal flow of CSF through brain structures and spinal cord
What is Chiari II Malformation
- common to children with SB
- deformity of cerebellum, medulla, and C-spinal cord
- posterior cerebellum is herniated downward through foramen magnum
- brainstem structures also displaced in caudal direction
What are Prenatal Testing and Diagnosis?
- γ-Fetoprotein levels (AFP)
- ->Remain abnormally high after 14 weeks’ gestation
- Fetal ultrasound
What is fetal surgery and what is it associated with
repair the exposed spine in utero
associated with decreased hydrocephalus
What are the risks of fetal surgery
premature labor, placental abruption, and thinning of uterus
What are management ideas for the Neonate
- Studies support early and aggressive intervention
- Prevent infection
- Closure of the back within 72 hours of birth
What is the general philosophy of treatment
- DEPENDS on extent of neurologic impairment
- DEPENDS on extent of hydrocephalus
- Extend of kyphoscoliosis/scoliosis
Scoliosis in patients with Spina Bifida
- bracing may help decrease but not eliminate the problem
- function becomes difficult
- surgical option for fusion
Latex allergy in patients with spina bifida
- increased in children with spina bifida
- will need to make sure you are using latex free things (including Thera-Band)
- allergic reaction can develop with increased exposure
What is the perceptual motor and cognitive performance?
- wide variety of cognitive levels depending on treatment of hydrocephalus, episodes of cerebral infection, and the presence of other CNS abnormalities
- increased attention deficit
- decreased ocular function
What is the wheelchair mobility in patients with spina bifida?
- adapted strollers for young children
- standard wheelchair by school age
- power wheelchair and scooters as child ages
What should we say to pts about recreation and leisure activities?
- encourage full participation in recreation activities with adaptations as needed
- aquatics are also good
What are some common complaints of young adults with spina bifida?
- Obesity, incontinence, recurrent urinary tract infections, chronic decubiti, joint pain, hypertension, neurologic deterioration, and depression
- Social integration, vocational issues, and sexual counseling
What is the most common cause of morbidity in spina bifida?
urinary tract issues
___% of those who undergo neonatal surgery for back closure will develop hydrocephalus. These pts will require a shunt placement.
90
Ventriculoatrial (VA) shunt
Moves excess CSF from one lateral ventricle to the right atrium of the heart
Ventriculoperitoneal (VP) shunt
Preferred treatment for hydrocephalus. Shunt runs down to peritoneum where CSF is absorbed and the excess is excreted.
MMT should be performed preoperatively and postoperatively on day __, at __ months, and yearly thereafter.
10, 6
Name two types of contractures common with spina bifida.
Hip flexion due to unopposed hip flexors and ankle dorsiflexion due to unopposed dorsiflexors
Spina bifida is the ___ most common birth defect.
2nd
- 3.4 per 10,000 live births
What are possible causes of spina bifida?
- Has been linked to maternal lack of folic acid in first trimester
- Also associated with valproic acid (Seizure medication)
What are some early treatment options for a patient with spina bifida? How is the prognosis?
- Closure of spine (surgical), Shunt for hydrocephalus, Clean, intermittent catheterization for urination
- Greater than 90% survival with early treatment
