Spina Bifida Group Project - Copy 2
Spina Bifida Group Project - Copy 2
Spina Bifida Group Project - Copy 2
Meningocele: a sac of fluid comes through an opening in the baby’s back. But, the spinal cord is not in this sac.
There is usually little or no nerve damage. This type of spina bifida can cause minor disabilities
Spina Bifida Occulta: “hidden” spina bifida, mildest type of spina bifida. there is a small gap in the spine, but no
opening or sac on the back. The spinal cord and the nerves usually are normal. Many times, spina bifida occulta is
not discovered until late childhood or adulthood. This type of spina bifida usually does not cause any disabilities.
Diagnosis-Spina Bifida- means “split spine”
● Spina Bifida is the result of a defective closing of the neural tube
of a developing embryo in the uterus. It mainly affects the lower
parts of the spinal cord usually before the 28th day of gestation
inside the uterus.
● Etiology- unknown cause; 60%-70% have a genetic component
● diagnosed-high resolution u/s
● Special tests-blood test for alpha- fetoprotein
● Age/time of onset- 28 days prenatally to life.
lesions
T7-T9 upper abdominals
T9-T12 lower abdominals
T12 has weak quadratus lumborum
knees, and ankles. Secondary to
frog-leg posture
High Unopposed hip flexors, and some adductors Hip flexion, adduction
lumbar Hip dislocation, lumbar lordosis,
(L1-L2) knee flexion, and plantar flexion
Mid lumbar Strong hip flexors, adductors. Weak hip rotators, anti Hip dislocation, subluxation, genu
(L3) gravity knee extension recurvatum
Low Weak hip extension, abduction. Good knee flexion Equinovarus, calcaneovalgus, or
Lumbar against gravity, weak PF with eversion calcaneocavus foot
(L5)
● Musculoskeletal: Muscle paralysis results in an impairment of voluntary movement of the trunk and
LE
Children with the classic lower motor neuron presentation of flaccid paralysis have no LE motion, and
the legs are drawn into frog-like position by gravity.
● Gastrointestinal: some loss of bowel control (neurogenic bowel) constipation, and incontinence.
● Pulmonary: Chiari malformation- The brainstem, or lowest part of the brain above the spinal cord, is
elongated and positioned lower than usual. This can cause problems with breathing and swallowing.
Activity Limitations
Functional limitations: main problems difficulty or an inability to stand, walk, and involuntarily bladder control and
bowel functions (incontinence).
Treatment strategies: Core strengthening→ bridges, superman, LE strengthening→sit<>stand, pull<>stand
Gait training → with AD, Pelvic floor strengthening →kegels (ball squeeze)
SHUNT PRECAUTIONS : -avoid any activity which involves twisting at the waist, as this can dislodge the shunt. -Keep all
products with magnets at least 2 inches away from the valve implant site (your head) pressure
setting of some VP shunts may accidentally change. -Don’t use magnetic therapy pads and pillows
Parental Education
● You can show the child’s parents how to place the infant prone
on their laps and gently rock to soothe and stimulate head
lifting
● Holding the infant high on the shoulder, with support under the
arms, fosters head control and is easiest position for an infant
with MMC to maintain a stable head.
● The infant’s head should be supported when the infant is
picked up and put down.
● As a PTA do not hesitate to correct errors in hand placement
● When the shunt is inserted you should always follow any
positioning precautions according to the physician’s orders
Medical Treatments
Child’s primary care physician and orthopedic should also be in contact with the PT.
Neurologist/Neurosurgeon- More for cases such as hydrocephalus. Only the neurosurgeon operates.
Treating bladder problems: Many people with spina bifida have problems controlling their bladder
➔ Antibiotics
➔ Urinary Catheterization: needed to drain pee from the bladder several times a day to help prevent infection
➔ By the age of 3 or 4 most children begin to work on gaining urinary continence by using intermittent catheterization
➔ By age 6 the child should be independent in self-intermittent catheterization
Pelvic floor PT
➔ Laxatives
➔ Medications- Valproate, and carbamazepine- also treat epilepsy
Prognosis
● In general the long-term prognosis for children with Spina Bifida will likely require ongoing care and management,
the majority can expect to lead long and fulfilling lives.
➔ Advances in medical treatments, such as fetal surgery have ensured almost all children born with spina bifida
survive.
SLP Outcome: Some children with spina bifida may have difficulty forming words and speaking clearly.
➔ Speech Pathologists increase a child’s oral motor skills and communication acumen by using exercises that train
the brain to pronounce, understand, and interpret individual words, sounds, numbers, and gestures.
OT Outcome:
➔ OT’s goal is to teach children important practical skills, such as bathing, dressing, and using the bathroom. They also
help children learn to put on and take off braces or orthotics and care for these devices
The purpose of a shunt in the population
● Extra tubing is left in the extracranial site to uncoil as the child grows.
● Unidirectional valve designed to open at a predetermined
intraventricular pressure and to close when the pressure falls below
that level prevents backflow of fluid.
● You are able to palpate the shunt tubing
● Movement is usually not restricted unless MD specifies.
*Call your child’s doctor if you notice one or more of these signs in your
child*
Latex Sensitivity in Spina Bifida Population
● 50% of children with MMC (myelomeningocele spina bifida)
are allergic to latex.
● Cause: Infant is exposed repeatedly to latex products through
multiple surgeries, diagnostic tests and examinations.
➔ Exposure to latex can potentially produce a life-threatening
allergic reaction as the child gets older.
● All contact with latex products should be avoided
from the beginning, including catheters, surgical gloves,
and Theraband.
➔ Any surgery should be performed in a latex free environment
● Toys to avoid: rubber balls, balloons (any toy containing
latex)
Positions to avoid
● Upside down
● Frog leg position (prone or supine)
● W sitting
● Ring sitting
● Heel sitting
● Cross-legged sitting
Precautions with Spina Bifida
● Cover the infant’s feet, temperature regulation is impaired.
● Motor paralysis and sensory loss are BELOW the level of lesion;
test dermatomes
● Protect skin from heat (Hot bath water, hot car seats, and metal seat belt
clasps, since they may cause burns.)
●Open fetal repair of the spinal lesion has been shown to improve hindbrain herniation, ventriculoperitoneal shunting, independent mobility and
bladder outcomes for the child and, despite an increased risk of prematurity, does not seem to increase the risk of neurodevelopmental impairment.
http://sbaneny.org/secondary-conditions/latex-allergy/
Martin, S. "T., & Kessler, M. (2021). chapter 7. In Neurologic Interventions for Physical Therapy (4th ed., pp. 189–215).,
Elsevier Saunders.
Palisano, R. J., Orlin, M. N., & Schreiber, J. (2017). Chapter 23 In Campbell's physical therapy for children (5th ed., pp. 543–578).
book, Saunders.
https://nyulangone.org/conditions/spina-bifida-in-children/treatments/rehabilitation-for-spina-bifida-in-children
Sacco A, Ushakov F, Thompson D, et al. Fetal surgery for open spina bifida. Obstet Gynaecol. 2019;21(4):271-282. doi:10.1111/tog.12603