SPINA BIFIDA
Saba Ramzan
Nadia Shoukat
Laraib Yasin
Anam Waris
What is spina bifida?
• birth defect resulting from the
incomplete closure of the embryonic
neural tube
• the vertebrae overlying the open
portion of the spinal cord remains
unfused and open
• the abnormal portion of the spinal
cord sticks out through the opening
in the bones
Three forms of spina bifida
1.Occulta
1.2.Meningocele
2.3.Myelomeningocele
OCCULTA
• mildest form
• no symptoms
• gap in one or more of the vertebre of
the spine
• dimple, hairy patch, dark spot or swelling
over affected area
• spinal cords and nerves usually normal
• no treatment needed
MENINGOCELE
• rarest form
• cyst or fluid-filled sac pokes
through open part of spine
• sac contains membranes that
protect spinal cord, but not spinal
nerves
• cyst removed by surgery, usually
allowing for normal development
MENINGOMYELOCELE
• most severe form
• cyst holds both membranes and
nerve roots of spinal cord and,
often, the cord itself
• sometimes, a fully exposed
section of spinal cord and nerves
• closed surgically after birth
• affected babies: leg paralysis and
bladder and bowel control
problems
Signs and Symptoms
Swelling
Dimple in skin
Truft of hair
Muscle weakness
Paralysis
Loss of a sensation
Fluid build up (hydrocephalus)
Brain damage
Seizures
Possibly none at all
Secondary Complications
Low fitness
Obesity
Poor functional strength
Pressure sores
Respiratory difficulties
Learning and Perceptual difficulties
Motor functioning seizures
Causes
• causes of spina bifida are
not completely understood
• scientists believe both
genetic and environmental
factors cause this
• however, 95% of affected
babies are born to parents
with no family history of
these disorders
Who is at risk?
• ANYONE
• couples who already had an affected baby has an
increased risk of having another affected baby
• women who are obese, have poorly controlled diabetes, or
who are treated with certain anti-seizure meds have a
higher risk
• Low folic acid consumption by the mother during
pregnancy.
Above L3:
Physiotherapist work on their upper body
L4 And Below:
Physiotherapist work on their upper body and educate the patient how to walk
with brace
S1 and Below:
Physiotherapist work on their upper body and educate the patient how to walk
with brace
S3 and Below:
Physiotherapist work on their whole body
When to seek medical attention?
Before Pregnancy
During Pregnancy
Right after birth
When the doctor feels it is necessary
Screening and Diagnosis
Prenatal Tests
Ultrasound
Testing of Amniotic fluid
Evaluation
Analysis of individual medial history
Physical examination
Evaluation of critical body systems
Imaging Studies
X-rays
Ultrasound
CT scan
MRI
Gait Analysis
Treatment
No cure
Regular check ups with physician
Surgery (24 hours after birth)
Medication
Physiotherapy
Surgery
Usually performed with in 24-48 hours after birth.
They remove the infected area and replace it with muscle tissue and skin.
Case Presentation
Jr is a 3 year old with a history of meningomyelocele at an L3 level.The
family came in today to discuss the orthopedic issues.They feel that his
hips are popping and has his difference In his leg lengths. They also want
to know if he is going to develop a scoliosis.Jr is an L3 level , which means
he has strong hip flexors , quadriceps , and adductors. This suggests he
has medium risk for developing scoliosis and lordosis.His level places him
in a very high risk for hip subluxation/dislocation (36) % and we know that
he may develop knee contractures.Leg length problems will be based on
dislocations .He will not have foot control and could have congenital foot
abnormalities.
Scoliosis can occur at any neurologic level , but most common in the
higher lesions. Thoracic and high lumber levels almost always develop
these spinal deformities
Exercise Guidelines
Individuals with spina bifida need to develop upper body strength, endurance and
flexibility.
Parents should incorporate exercises into a daily routine with their babies. It is
important to increase their range of motion by rotating the baby's arms and legs at the
joints, such as the knees, hips, shoulders, and elbows, to prevent injury and strengthen
the muscles around the joints.
When the child with spina bifida gets a little older, it is good to place them on their
stomachs and encourage them to reach for toys, which allows them to use their arms.
It is healthy to encourage babies with spina bifida to try normal developmental skills
such as holding their heads up, and pushing their torsos off the ground with their arms.
Stretching
People with spina bifida can do many stretches. It is important to stretch
your whole body, including your neck, wrists, arms, triceps, biceps,
elbows, trunk, hamstrings, and hips while seated on a chair or in a
wheelchair.
It is important to increase the range of motion and reduce spasticity.
Many of these exercises can be done individually or with the assistance of
a Thera-band.
Strength training
Strength training should be done at least three days a
week to prevent injury and maintain the ability to do
routine tasks.
Upper body pushing and pulling exercises will help with
weight transfers and pushing a wheelchair.
Rowing exercises help with posture and preventing
shoulder injuries.This use of muscle strength will help
reduce pressure sores from sitting in the wheelchair.
Strength activities can use free weights, weight
machines, pulleys, balls, and Thera-bands
Strength training
Lat pull downs:
Muscles worked: latissimus dorsi, rhomboids,
trapezius
Reverse Fly:
Muscles worked: posterior deltoids, rhomboids,
trapezius
Hand Cycling:
Muscles worked: rotator cuff muscles, deltoids,
rhomboids, latissimus dorsi, pectoralis major and
minor
Aquatic Exercises
Working out and exercising in the pool is a great way for people with
spina bifida to get out of their wheelchairs, braces, and walkers and
enjoy the freedom and movement of the water.
Floatation devices can be added to assist in the comfort and position of
these individuals in the pool. The water is a great place for therapists to
work on the person's development of postural muscles that are required
for efficient movement in the wheelchair.
Assistive Devices
Braces
Crutches
Wheel chairs
Goals
A comprehensive program of physical activity is needed to maintain a healthy life
Intervention should occur as early as possible.
Try to include students in all activities.
Be aware of the students abilities and limitations.
Make sure activities are age appropriate.
Allow opportunities for self directed learning and experimentation.
Focus on upper body activities because of the little or no mobility in the legs.
Home based programs are needed to teach parents how to exercise their baby’s feet
and legs so they can walk with crutches, braces, and exercise is also important for use
of a wheel chair.
References
https://www.mayoclinic.org/diseases-conditions/spina-bifida/symptoms-causes/syc-
20377860
https://www.cdc.gov/ncbddd/spinabifida/facts.html
Deming, Laura (2011). Pediatric life care planning and case management (2nd ed.). Boca Raton,
FL: CRC Press. p. 392. ISBN 9781439803585.
Gombash, L. (1998). Spina Bifida Physical Therapy. Retrieved April 7, 2007
from http://harcourtassessment.com/hai/Images/resource/techrpts/TheraNotes/TN_Ped_PT
_pdf/SpinaBifida.pdf
Healthwise. (2005, May). Home treatment for the child with spina bifida. Retrieved April 7,
2007 from http://children.webmd.com/tc/Spina-Bifida-Home-Treatment
Heuttig, C. (n.d). Aquatic Program Considerations and Recommendations for Individuals
with Disabilities: Spina Bifida. Retrieved April 7, 2007
from http://www.twu.edu/inspire/Aquatics/aqsb.htm
https://www.youtube.com/watch?v=ci3VLVjmno0
https://www.youtube.com/watch?v=Toi3f_Vc4lM
https://www.youtube.com/watch?v=F1yTSb5ZjVU
Thankyou
