SB and CP

SB 1

100

Spina bifida is a defect in the development of the _____________?

Neural tube

200

What is the time range during development in defects may occur that lead to SB?

Day 17-26

300

Briefly describe the following conditions- Meningomyelocele/ Myelomeningocele, Meningocele, Spina Bifida Occulta, Lipomeningocele, and Diastematomyelia 

Myelomeningocele- meninges and SC herniate, results in complete or partial paralysis, usually surgery is performed

Meningocele- only meninges herniate, SC is in place and intact 

SB occulta- defect of vertebrae- no herniation, may have hairy patch or dimple over area, increased chance of tethered cord 

Lipomeningocele- closed neural tube defect, fatty tissue in sac and/or SC that may result in compression to the SC 

Diastematomyelia- closed neural tube defect usually, longitudinal splitting of the SC that leads to abnormal neurological function 

400

List the S&S associated with a ventriculoperitoneal shunt problem.

-Increased head size

-Vomiting 

-Swelling at shunt site

-Headache

-Irritability 

-Seizures 

-Lethargy

-Change in school performance 

-Rapidly progressive scoliosis

500

You work at an OP Ortho site. You have an eval today with a 15 y.o. complaining of excessively tight hamstrings, back pain, and sudden spinal imbalance. When examining his spinal ROM, you notice a hairy patch around L2 level. What is the likely the cause of the pain and what will you do?

The patient most likely has SB Occulta that was undiagnosed but now is experienced tethered cord due to recent growth during puberty. You need to refer him to his PCP or a neurologist. 

SB 2

100

What is the most common and least severe form of spina bifida?

Spina Bifida Occulta 

200

What is syringomyelia?

Pressure in the central canal of the SC leading to hydrocephalus/ pressure build up- it can lead to sensory and motor loss

300

What is Chiari Type II defect and what is its clinical significance?

It is elongation of the cerebellum and medulla which also herniate through the foramen magnum. It results in compression of the hindbrain so may have lower brain stem symptoms, the medulla and pons are small and deformed (CN problems) and Chiari Type II usually leads to blockage of CSF and hydrocephalus. 

400

Describe the S&S of tethered cord syndrome

-Increased or "new" spasticity 

-Change in bowel or bladder status after ruling out UTI, constipation 

-Back pain 

-Changes in foot position 

-Development of hamstring contracture 

-Progressive scoliosis 

500

List the possible consequences of Chiari Type II?

Hydrocephalus, brainstem dysfunction, upper cervical cord dysfunction, learning disabilities, seizures, and growth problems 

Mixed

100

What is the etiology of SB?

Genetics (usually polygenic and modified by environment), embryologic component, and environmental- folic acid deficiency!

200

You are treating a patient with a Hx of Arnold Chiari malformation. What are some primary concerns you need to be aware of as their PT?

Possible latex allergy, S&S of shunt dysfunction, possible learning difficulties (may affect your pt. education delivery), Hx of seizures and how they detect if a seizure is coming (if they are able to)

300

Your patient wants to have a child but is scared of her child having spina bifida. She asks you if there is anything she can do to prevent it from happening? She has no history of SB in her family. Her sister in law is also wondering since she had one child previously that was born with meningocele. What would you tell them?

Your patient- take 0.4 mg/day of folic acid 

The sister in law- take 4.0 mg/day of folic acid- recurrence rate is 71% though 

Tell them both to start taking it 1-3 months before pregnancy and during the first 3 months of pregnancy

400

Athetoid CP would be caused by an injury to which part of the brain?

The Basal Ganglia

500

List 2 predictive signs regarding ambulation

Sit independently by age 2 (yes), not sitting independently by 4 (no), 3+ primitive reflexes beyond 2 (no).

CP 1

100

Define CP

non-progressive disorder of movement or posture of early onset (i.e. the developing nervous system) due to damage to brain (not spinal cord)

200

True or false - CP is a progressive disorder?

FALSE!!!!!!

300

What can you say about intellectual involvement with regard to severity of the CP?

More severe CP is more likely to involve IQ

400

List 5 prenatal factors that can be associated with CP

Malnutrition, lack of growth factors intrinsically, infection (herpes, rubella, toxoplasmosis), anemia, Rh incompatible, fetal anoxia, maternal diabetes, genetic/heredity cause

500

What is periventricular leukomalacia?

Damage to the white matter of the brain in the long axons near the ventricles

CP 2

100

List 4 of the disorders/deficits commonly seen with CP

Voluntary motor (always affected), sensory, intellectual, speech, audition, seizures, visual, growth abnormality

200

True or false - CP can be caused by a anoxic brain injury at 12 mo.s of age

TRUE!

300

Describe how a patient with spastic diplegia would present.

Increased muscle tone/spasticity seen in the LE bilaterally

400

A 4 year old patient presents to your clinic with spastic hemiplegia. What are some signs and symptoms you would expect to see?

Early handedness, persistent fisting of one hand, ipsilateral toe walk, UE>LE involvement, compensation with unaffected side

500

Describe the diagnostic process of CP

No definitive test. Look at motor performance and milestones. Presentation of altered/abnormal tone, posture, reflexes. Rule out other diagnoses.