Spina Bifida

Spina bifida is a neural tube defect that results in incomplete closure of the vertebrae and membranes around the spinal cord.

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EPIDEMIOLOGY

In US each year 1500 babies are born with this defect. Hispanic women (relating to Spain or to Spanish-speaking countries, especially those of Central and South America) have higher rate of having a child with spina bifida. Prevalence rate is 3.80 per 10000 live births among hispanic, among afro-american is 2.73 per 10000 live births and among non-hispanic white is 3.09 per 10000 live births.

CAUSES

Lack of folic acid supplementation

Medications like Valproate and Carbamazepine etc

Family History

Genetic Disorder’s like Patau syndrome, Edward’s syndrome

Other Risk Factors include Obesity and Diabetes

TYPES

Basically divided into three types

Spina Bifida Occulta

Meningocele

Myelomeningocele

Rare types include Spina Bifida Ventralis, Myeloschisis

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Myeloschisis

The myeloschisis (rachischisis) is the severest form in this the nerve tissue is fully bare and a dermal or meningeal covering is absent. 

Spina Bifida Ventralis

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CLINICAL FEATURES AND PATHOPHYSIOLOGY

Spina bifida occulta.
the spinal nerves usually aren’t involved, typically there are no signs or symptoms some visible indications can be seen on the newborn’s skin above the spinal defect, including an abnormal tuft of hair, or a small dimple or birthmark.

Meningocele.
Membranes around the spinal cord comes out through an opening in the vertebrae, forming a sac filled with fluid, but this sac doesn’t include the spinal cord.

Myelomeningocele.
In this severe form of spina bifida.
Spinal column remains open along several vertebrae in the lower or middle back.Both the membranes and the spinal cord or nerves protrude at birth, forming a sac.Tissues and nerves usually are exposed, though sometimes skin covers the sac.

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PHYSICAL EXAMINATION AND DIAGNOSIS

Spina Bifida is often diagnosed with elevated or high level of maternal alpha feto-protein, fetal ultrasound and physical examination

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PHYSIOTHERAPY MANAGEMENT

AIM

Maximising independence in functional activities such as standing, transferring and walking

Provision of mobility aids and equipment to increase independence

Exercises to maintain or improve muscle strength and length

Anticipating, preventing and minimising secondary effects such as development of contractures

Positioning and postural advice

Teaching wheelchair skills to maximise independence

Provision of appropriate orthotics

Exercises to improve balance and coordination to prevent risk of falls

Another important factor on an individual’s walking ability is the use of assistive devices, whether it is a brace, crutches or a walker. In order to promote walking capacity an assistive device may be necessary. The study suggests that ORLAU Parawalker for children may increase their ability to ambulate which can ultimately provide other benefits that were mentioned earlier

More Physiotherapy interventions are discussed below

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Bobath Technique

Bobath technique is a neuro developmental approach for treatment and assessment of individuals suffering primarily from cerebral palsy and also for other neurological deficits.

It is a holistic approach not a specified method for treatment of neurological conditions especially cerebral palsy

For detail video regarding bobath technique visit

http://youtu.be/02erVakUNZk

PRINCIPLES OF BOBATH TECHNIQUE

(1) Bobath therapeutic techniques make normal posture and movement more easy and likely to occur

(2) Bobath technique focuses on interaction of impairment functions and life participation

(3) Movement is a sensory motor experience or integration

(4) By moving proximal parts of the body it is possible to influence change of posture and movement in distal part

(5) It is impossible to superimpose normal movement pattern on abnormal ones its important to inhibit abnormal movements primarily

AIM OF BOBATH TECHNIQUE

Change atypical tone

Mobilise tight structures

Activate appropriate muscle groups

Strengthen weak muscles

Improve quality of posture and movement with hands-on

Take hands off to increase child’s own activity

Encourage child’s problem-solving skills to improve independence

Work within appropriate context to improve functional skills

TECHNIQUES

VISIT THE FOLLOWING LINK

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CONCLUSION

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