SPINABIFIDA

 INTRODUCTION:

Spina bifida is one of the neural tube defect. In which the failure of the fusion of two vertebral arches in the embryological stages of developmental spine.
Spina bifida occulta : failure of fusion could be limited only to the spinous process.
Spina bifida aperta  : these include the neural elements(involve the vertebral arch,skin meninges and cord) may fail to fuse.
Meningocoele      : In which there is protrusion of meninges.
Myelomeningocele  : In which there is protrusion of meninges and cord.
Syringomyelocoele : IN which the central canal of the cord is dilated   and  the cord is protruded.
Myelocoele        : In which the central cord remains not fused and exposed.

INCIDENCE:-
Spina bifida is one of the most common birth defect , with world wild average incidence of 1-2 cases per 1000 birth ,but English and Europens a higher incidence than the Asians.
The risk of reoccurrence after one affected child is 1 in 20, with a risk of similar affected person passing defect .after 2 affected risk of 1 in 10, and after 3 affected 1 in 4.

CAUSES:-
Spina bifida is neural tube defect ( often before the mother know she is pregnant), normally closure of neural tube occurs around 28 days after fertilization.However if sometimes interferes and the tube fail to close property , a neural tube defect occur.

1. UNKNOWN –    majority of the case are unknown.
2. MEDICATION – during pregnancy taking medicines of anti-convalescents , diabetes.
3. GENETICS –   it could be run families and genetics basis.
4. OBESITY  –   obese pregnant ladies are more prone.
5. RAISED BODY TEMPERATURE – from fever or external sources such as hot tubes and electrical blankets.
6. FOLIC ACID DEFICIENCY – contributing factor in the pathogenesis of neural tube defects.

CLINICAL FEATURES:

→ Muscle weakness of the legs, sometimes involving paralysis(flaccid or spastic)
→ Bowel and bladder problems.
→ Seizures, especially if the child requires a shunt.
→ depression or dimple in the lower back.
→ A small patch of dark hair.
→ Soft fatty deposits.
→ Port-wine nevi (deep red-purple macular lesions).
→ Saclike cyst that protrudes outside the spine.
→ Musculoskeletal deformities (scoliosis, hip dysplasia, hip dislocation, club foot, hip/knee contracture).
→ Hydrocephalus, alone with Type I or II Arnold Chiari malformation.
→ Trunk hypotonia.
→ Delayed automatic postural reactions.

EXMAINATION:-
NEUROLOGICAL EXAMINATION
The purpose of the examination is to determine, the level at which normal cord function ceases , and to asses the presence and degree of hydrocephalus.

SKULL : for examine sutures and fontanellaes palpated for evidence of distension and increase pressure. Measurement of occipital-frontal circumference (OFC) should be carried out and measured.
CRANIAL NEREVES : asses by observation of the movements of face , tongue and palate and by watching the baby suck.
SPINE : spine should be palpated along its length as sometimes there is multiple lesion which are not always obvious.The length and width of the lesion should be measured and position of spinal cord noted.
LIMBS : check active movements of limbs by simulating the leg and eliciting neonatal reflexes.The power of muscle should be assesed by with and without gravity and with and without resistance. these is useful in check deformity such as talipes and congenital dislocation of hip.
BOWEL AND BLADDER : sphincter tone and bladder function should be assesed. A patulous anus and dribling incontinence are associated with a lesion at the level of S2, 3 and 4. Re-tension of urine is associated with a lesion at S1.

First physical assessment of child. The movement of the leg in some babies appears after back is reappeared, but movement of back is lose after back reappear in some case.
This assessment both – sensation and movement both . First record general impression – abnormal position of limb , deformities present , movement (if any) present .
Reflex assessment, muscle testing.
sensory chart completed and to do tested with safety pin as, testing the epicritic feeling or light touch as with cotton wool. The most reliable test at this stage is pin prick with pin then baby cry.

PHYSIOTHERAPY TREATMENT:
Physical therapy programs are designed to parallel the normal achievement of gross motor milestones.

1. Physical therapists in the intensive care unit address infant positioning needs and provide parent and family education.
2. Early-intervention physical therapists can provide physical therapy in the home or other community-based locations to help encourage the child’s development of strength, movement, and balance skills by teaching parents specific play-based exercises.
3. School-based physical therapists often consult with other educational team members to help students with spina bifida participate in curricular activities, and develop independence within the school setting. They may recommend special equipment for the student to use during the school day.
4. Physical therapists also recommend appropriate equipment, such as braces, walkers, and wheelchairs to help people with spina bifida increase their functional mobility.
5. Physical therapy is also important for the prevention of other possible problems, such as obesity, by identifying activities that encourage continued participation in sports or other fitness-based activities that promote lifelong health and wellness.

Neonatal physiotherapy:-
prone lying facilitate – educate the ,mother to place the baby in prone position during playtime, preferably on floor.
Passive movement must be given in full rang of motion as possible to all joint starting with toes,tarsal joints,ankle,knee,hip.Mother must taught to how to carry baby and movement. Arm movement can be stared as soon as possibles the baby respond the exercise to strengthen the shoulder girdle.

A knowledge of developmental progress the milestone of a normal child then stat to ruling over, sitting up.
Play therapy with toys -facilitate mid line activity,Bridging, knee to chest.

Ambulation
When the child ready to stand, assessment needs to be made of degree of support required from orthosis. degree of support required according to neurological level of affection.

THOSE ABOVE ARE COLLECTED FROM SOME BOOKS AND WEBSITES..

THANK YOU,

SRIKUMARAN PHYSIOTHERAPY CLINIC & FITNESS CENTER