Spina Bifida Flashcards

1
Q

What is Spina Bifida?

A

Failure of the neural tube to close primarily in the thoracolumbar region.

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2
Q

What causes Spina Bifida?

A

Genetic Predisposition Maternal folic acid deficit Hot tub soaks? Alchol/valproic acid use during gestation.

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3
Q

Alternative names for Spina Bifida are…?

A

Myelomeningocele Meningomyelocele Spina bifida aperta Spina bifida cystica Myelodysplasia All of the above involve an open sac with meninges and spinal cord contents through defect in vertebral column

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4
Q

Describe Spina Bifida Occulta…

A

It’s often asymptomatic…found on X-ray. Bony abnormality with intact overlying skin. Tuft of hair on the lumbar region usually. May have a tethered cord resulting in a bladder/bowel problem.

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5
Q

Define Meningocele…

A

Protruding sac. ONLY contains meninges (dura and arachnoid) and CSF.

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6
Q

Do kids with a meningocele usually have motor or sensory problems?

A

AHHHH HELL NAAWWWWWW

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7
Q

Granny’s carrying a myeolomeningocele…whats in it?

A

Spinal cord, meninges, and CSF

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8
Q

What motor impairments may be seen with Spina Bifida?

A

BELOW THE LEVEL OF THE LESION: Creates muscle imbalance between flexors and extensors, ABs/ADs, IRs/ERs due to flaccid in one muscle group and active in antagonist muscle (abnormal tone) Spasticity due to associated CNS abnormalities Musculoskeletal issues due to above

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9
Q

If a child with SB has a sensory impairment, is it below or above the level of the lesion?

A

I hope to God that you said above.

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10
Q

If a Spina Bifida child has a bowel or bladder impairment, what is usually the root cause?

A

A tethered cord.

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11
Q

What type of cognitive processing disorders may present with Spina Bifida?

A

Intellectual Disability Learning disability/ADHD Language Disorders (they are usually chatty).

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12
Q

What type of visual and perceptual issues can occur with SB?

A

Nystagmus (double vision) Strabismus

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13
Q

What is Talipes Equinovarus?

A

They’re born golfers. CLUBFOOT Stuck in plantarflexion, Inversion, and Adduction.

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14
Q

What is Hydrocephalus?

A

Previously open spinal cord now closed so the CSF pressure rises! Due to the overproduction of CSF. OH MYYYY! NOT GOOD!!!

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15
Q

How often does the Hydrocephalus occur in SB?

A

85-90% 80% requires immediate surgical repair within days after birth.

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16
Q

What is an Arnold Chiari Malformation?

A

Cerebellum and brainstem displaced distally through foramen magnum. Causes obstruction of CSF. Diagnosed with an MRI

17
Q

What are the signs and symptoms of Hydrocephalus?

A

Sunsetting eyes Bluging anterior fontanelles

18
Q

Signs and Symptoms of Shunt Malfunction?

A

Vomiting Redness along shunt site/tract Seizures Sunsetting eyes Headaches Lethargy Irritability Bulging fontanelles Nystagmus

19
Q

How is an Arnold Chiari Malformation treated? If causing symptoms!

A

Cervical laminectomy and posterior fossa decompression.

20
Q

What does a tethered cord result in?

A

Stretching results in changes in: Scoliosis Gait Bladder function DTRs Increased tone Decreased strength Back pain

21
Q

How is a tethered cord diagnosed?

A

Myelogram Treated with surgical release and is most common in lesions below T12.

22
Q

What are some prenatal tests for Spina Bifida?

A

Alpha Fetoprotein (AFP) in amniotic fluid. Fetal ultrasound Fetal surgical repair (20-25 weeks gestation) Usually a C-section for delivery.

23
Q

Describe the post-surgical management of SB…

A

Neurosurgery to close the sac. (prevent meningitis). Urology consult Orthopedic consult (clubfoot). bony alignment.

24
Q

What allergy is common with Spina Bifida?

A

LATEX Due to frequent young exposure. Avoid latex products. Blood test available.

25
Q

Goals of a physical therapy intervention…

A

MOTOR MILESTONES! Facilitate normal motor milestones Prone on elbows Rolling Sitting Standing Commando crawling on belly Transitioning into/out of sitting and quadruped Creeping on hands and knees Pulling to standing Lowering self to sitting Cruising Standing independently Ambulating using push cart Ambulating with 1-2 hands held Taking steps independently Ambulating independently

26
Q

What equipment needs do you usually satisfy?

A

Anything that needs done.

27
Q

What are some PT findings?

A

No volitional lower limb movements Posture found in LE : Hip Flex, Abd, ER contractures KF, Ankle PF contracture Lumbar Lordosis (weak lower trunk) Club feet common Hip dislocation, subluxation Kyphoscoliosis Decreased respiratory function

28
Q

PT interventions for Thoracic Level…

A

Maintain straight spine level pelvis symmetric lower limbs Teach sliding board transfers Attempt ambulation with parapodium Wheelchair mobility

29
Q

See powerpoint slides for PT Examination Findings and PT Interventions…

Slides 27-38

A

See powerpoint slides for PT Examination Findings and PT Interventions…

Slides 27-38

30
Q

Things to remember for kids with Spina Bifida…

A

Kids with Spina Bifida use UEs for weight bearing/transfers (balance and support) so may have UE dyscoordination

Skeletal growth exceeds muscle extensibility and mass…decrease flexibility of trunk and two-joint limb muscles…progression of spinal deformity and decline in mobility for kids with spina bifida

31
Q

Comprehensive Evaluation schedule for Spina Bifida is what?

A

*Newborn pre-op

*Newborn post-op

*6 months

*12 months

*18 months

*24 months

*Annually after 24 months and after any period of immobilization, bed rest, or period of rapid growth spurt

32
Q

Things to remember for kids with SB continued…

A

*Avoid habitual postural positions that can lead to deforming forces

*Look for proper joint alignment

*Do not allow crouched gait

*No “W” sitting

*Keep feet flat on floor in sitting or flat on foot rests (achieve plantigrade foot position even if non-ambulatory)

*Maintain 90-90-90 position in sitting (hip, knee, ankle)

*Use tilted/angled work surface to avoid excessive head/neck/trunk flexion

*Energy expenditure for independent mobility can be huge

*always look at endurance, efficiency, effectiveness, safety, degree of independence and accessibility to:

*Bed mobility, floor mobility, transfers, wheelchair mobility, and ambulation

33
Q

Most important muscle groups for gait…in order of importance.

A

*Key Muscle Groups identified for community ambulation (in order of importance)

(1) Iliopsoas
(2) Gluteus medius and maximus
(3) Quadriceps
(4) Anterior tibialis
(5) Hamstrings

34
Q

(1) Standardized Assessments for Functional Abilities are…

(2) Standardized Assessments for Ambulators are…

A

(1) PEDI, WEEFIM, if greater than 3 years…assess developmental abilities.

(2) 10m walk for gait velocity, 6m walk for endurance

35
Q

What is the most glaring problem with the new Jurassic Park Trailer starring Chris Pratt?

A

Why in the hell would a company seeking to pursue a multibillion dollar venture not check if the island they want to build it on was an active volcano. Come on Hollywood.