Spina Bifida assessment and management .ppt

Assessment and management

1. Spina Bifida

25. Surgical management
•During surgery, the surgeon will put the spinal cord
and any exposed tissues or nerves back into the
correct place.
•The gap in the spine is then closed and the hole sealed
with muscle and skin.
•Although this will repair the defect, unfortunately it
cannot reverse any nerve damage.

27. Systemic Involvement
•Occulta and Meningocele: no neurological dysfunction
typically present [9]
•Myelomeningocele:
•permanent neurological and musculoskeletal deficits present
•Neurological: muscle weakness, bowel and bladder
problems, seizures, paralysis, absent reflexes, sensory
impairments
•Musculoskeletal: hip dislocation, syringomyelia, scoliosis,
foot and ankle deformities

28. PT management
•By optimising and maintaining mobility, this can
eventually help children to become more independent
as they get older.
•The physiotherapist will perform an initial assessment
of the infants muscle strength and range of movement
available at certain joints.

29. A. Joint Range of Motion
•In the early stages following surgery, the physiotherapist will begin
passive range of motionexercises on the infant’s legs . This will
normally be performed 2-3 times a day. They will also demonstrate
this technique to parents or carers so that they may continue to do
these exercises as a home exercise programme when the infant is
discharged.
•They may progress these exercises to mimic more functional
movementswhich are related to normal everyday movement
patterns. For example, whilst bending the left knee and hip, the right
side will be kept straight as would happen in a normal walking
pattern.

30. •In those who have more pronounced restriction, the physiotherapist
may advise that the number of exerciserepetitions is increased and
the movement is held for longer.
•Passive range of motion exercises will therefore help to maintain
flexibility and avoid the development of muscle tightenings known as
contractures

31. B.Muscle strength
•Altered muscle tone is a common symptom of spina bifida, therefore,
physiotherapists use resistance trainingin order to strengthen these
muscles that have been weakened.
•This is normally introduced when the infant is old enough to self
mobilise.
•The physiotherapist can develop a programme of strength and
endurance training which has been seen to improve functional
abilities in children with spina bifida.
•These training programmes may involve a variety of exercises for the
upper and lower limbs, as well as muscles of the trunk and can help
improve upper limb strength and cardiovascular fitness

32. C.Positioning and Handling
•Following the first few days after surgery, the infant will normally be
placed inside or stomach lying.
•It may be advised that parents or carers hold the child underneath
the stomach and across their forearm due to the surgical wound that
will be present on the infant’s back.
•This handling technique may be used when sitting or walking around.
When advised, parents or carers may take the infant for a walk
around the hospitalresting over the shoulder. This can encourage the
child to begin to lift his or her head and begin to develop head and
neck control.

33. D.Mobility and Ambulation
•Mobility problems in children with spina bifida can vary
according to the level of the spine that has been affected
during development.
•A child with a lesion in the lower back (Lumbar or Sacral
levels), is more likely to be able to independently mobilise
than one with a lesion in the upper thoracic spine. This can
determine whether the child will require a wheelchair,
orthotics or assistive devices.

34. •Parents and carers are often discouraged from using assistive
devices such as infant walkers, jumpers and bouncer chairs
as these can delay motor development.
•Active movement allows them to participate in the learning
process. For example, rather than using a walker, parents are
advised to physically hold their child in the standing position
with as little support as possible to promote the necessary
control of the legs and torso. This also allows the child to
receive feedback from the floor and the surrounding
environment

35. •As the child begins to mobilise and ambulate more
independently, he or she may be fitted for braces or
splints to address any deformities caused by muscle
imbalance or joint limitations.
•Children with Spina Bifida lesions in the upper
thoracic regionsof the spine may require bracing or
splinting of the whole leg up to the level of the hip
and chest. This is known as a Hip-Knee-Ankle-Foot
Orthoses (HKAFO).

36. •Others may require orthotics aimed at stabilising the knee, ankle and
foot. These are known as Knee-Ankle-Foot orthoses (KAFO) and
Ankle-Foot Orthoses (AFO).

37. Reciprocal Gait Orthoses (RGO)may be also
provided in order to promote a normal rhythmic
walking pattern in the child.

38. •Children may require the additional use of crutches along with
orthoses in order to take some stress off the legs. and standing
framesare also used to help children with more severe limitations
bear weight through their legs and maintain a full range of motion at
all lower limb joints

39. •Furthermore, some children may
require castingas a way of
treating and preventing
contractures.
•Casting aims to develop a
gradual increase in the range of
motion available at a certain
joint and is a very effective
method of improving range of
motion at tight joints without
the use of surgery.