6
- Electrical stimulation
- Treadmill training program
- Strength training
- Transfers
- Functional mobility
- ROM
- Skin protection
- Positioning program
- WC
- Equipment
- Breathing/coughing
Interventions for children with spina bifida
Systems review:
- UMN/LMN
- Neurogenic bowel and bladder - UTI
Neuromuscular
Systems review:
Frequent colds, bronchitis, and pneumonia
Cardiovascular and pulmonary
- Aerobic capacity/endurance
- Anthropometric characteristics
- Assistive technology
- balance
- Circulation
- Development
- education life
- Environmental factors
- Mobility
- motor function
- Muscle performance
- Posture
- Self care and domestic life
- Sensory integrity
Tests and measures for spina bifida
Systems review:
- Healed scar where defect closed
- Erythema and skin breakdown
- Skin folds due to obesity
- Prolonged sitting
- Sensation
- Latex allergy precautions
Integumentary
- Promote overall wellness
- Encourage self care management
- Self care advocacy
- Independence
- Mobility
- All areas of participation in their homes, schools, and communities
Habilitation goals
Systems review:
- AROM/PROM
- MMT
- Scoliosis
- Contracture
MSK
- Forward head
- rounded shoulders
- Kyphosis
- Scoliosis
- excessive lordosis
- Anterior pelvic tilt
- Rotational deformities of the hip or tibia
- Flexed hips and knees
- pronated feet
Typical posture MSK problems for spina bifida
- Symmetric weight bearing
- Neutral pelvic tilt
- Slight lumbar lordosis
- Hips/knees at 90, feet flat on surface
- Can incline seat back 15 degrees
- Tilting desk or table upward improves upper trunk, head, and shoulder position
Sitting position/prevention strategy for spina bifida
- Muscle imbalance (L vs. R); secondary to neurologic dysfunction
- Progressive neurologic dysfunction
- Intrauterine positioning
- Coexisting postures after birth
- Reduced or absent active joint motion
- Deformities after fracture
- High risk of fractures and osteoporosis
MSK
Progressive spinal deformities:
10/11 in girls
12/13 in boys
Spinal fusions
- Criteria for assigning motor levels from manual muscle strength test
- Best reflect the innervation patterns of individuals with MM
International myelodysplasia study group (IMSG)
- Mixed manifestation of spasticity and volitional control
Incomplete lesions
- Biking gloves
- Proper WC seat position
- Shoes with non skid surface
- Maintenance of symmetric neutral joint alignment in sitting and standing
- Avoid extreme ROM
- Minimize overhead reaching
- Long distance mobility options to reduce joint stress
Prevention strategies - minimize stress on the MSK system
- More caudal segments are functioning despite the presence of one or more cephalic spinal segments
- Some areas work, some done, then they work again
Skip lesions
Manifest as normal function down to a particular level: flaccid paralysis, loss of sensation, absent reflexes
Lesions resembling complete cord transection
- Not clear cut
- Skip areas that lack sensation
- Sensory levels often do not correlate with motor levels
- Proprioception and kinesthetic sense may be impaired
Sensory deficits in spina bifida
Name the location:
Open areas to allow for ease of WC mobility. Assess alternative positioning and transfers to a mat via wedge
Classroom
Name the location:
Lift bus necessary for WC transport. Assist student initially to move into school and roll WC to classroom. Work on moving on and off lift independently
Bus
- Checking temperature of bath water
- Sitting near a fireplace
- Bare feet
- Footwear
- Braces (redness or blanching that goes away in 30 mins is ok)
- School situation
- independence with sensation
Sensory deficits
- Child and family related instruction
- Assistive Technology
- Motor function training
- Therapeutic exercise
- NM re-education
- Gait
- Appropriate environmental adaptations
- Intervention services to maximize function and independence
- Promote optimal positioning to prevent skin breakdown and deformity
- Functional
- task specific
Treatment for patients with spina bifida
Name the location:
Areas for WC mobility, ability to access playground equipment, including paved track around playground, cushioned-synthetic rubber surface to play structure, ramp to one level of equipment
Playground
Name the location:
Check height of table to allow sufficient WC clearance for eating lunch and provide desk or tray as needed
Cafeteria
- Impairments of SC and brain
- Congenital brain malformation
- Brainstem displaced inferiorly beyond the foramen magnum
- Partial blockage of passage of CSF from brain to SC
- CSF builds up in ventricles
- Pressure on CNS tissue
- Compromise brain tissue and development
- Hydromyelia - increased pressure of the CSF over the SC
- Weakness in UE muscles - particularly the hands
Arnold-chiari or chiari II malformation
Name the location:
Changing table/sliding board/lifting and transfer training are of immediate concern for the student and staff. Grab bar necessary to assist with rolling activity. Evaluate for use of a sliding board and begin to instruct staff and student in technique. Rolling stool needed to promote good body mechanics for staff due to low changing tables
Bathroom