Spina bifida is a neural tube defect that results in incomplete closure of the vertebrae and membranes around the spinal cord.
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
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
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.
PHYSICAL EXAMINATION AND DIAGNOSIS
Spina Bifida is often diagnosed with elevated or high level of maternal alpha feto-protein, fetal ultrasound and physical examination
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
