Spina bifida description along with its assessment and it's physiotherapy

1. Spina bifida
Presented by
Shiksha verma
MPT(Neuro)

2. Definition
• (Latin “Split Spine”) is a developmental
congenital disorder caused by incomplete
closing of the embryonic neural tube.
• Some vertebrae overlying the spinal cord are
not fully formed and remain unfused and
open.
• It is usually occur in lumbar or sacral region.

3. Incidence
• It is the one of the most common birth defects,
with an average worldwide incidence of one to
two cases per 1000 births, but certain
populations have a significantly greater risk.
• Myelomeningocele is the most significant and
common form and this leads to disability in most
affected individuals.
• This condition is more likely to appear in females;
the cause for this is unknown.

4. Types of spina bifida

5. Transverse section of vertebrae

6. Types
1. Spina bifida occulta –
– Occulta is a latin word which means “hidden”. This is the
mildest form of the spina bifida.
– In occulta, the outer part of some of vertebrae is not
completely closed.
– The splits in the vertebrae are so small that the spinal
cord does not protrude.
– The skin at the site of lesion may be normal or it may
have some hair growing from it.

7. Spina bifida occulta

8. 2. Meningocele
– The bony vertebrae is open, part of meninges is
protruding out of the spinal canal.
– Since the spinal cord is not protruding, there is
often normal function.

9. 3. Myelomeningocele
– The bony vertebrae is open, part of meninges
and part or all the spinal cord is protruding
out of the spinal canal.
– Since the spinal cord is protruding, it is often
not fully developed.
– Involving nerve roots are often not developed
resulting in weakness, pain and/or paralysis.

10. – Arnold Chiari malformation II is often is associated
with myelomeningocele and occurs when the
cerebellum is forced downward.
– This can result in life-threatening situations because
the build-up of cerebrospinal fluid can cause
pressure on the brain.

12. Causes of spina bifida
• The exact cause of spina bifida is unknown.
• All the research to date has indicated both
genetic and environmental influence.
• The developmental process that results in
spina bifida is well studied.

13. Pathogenesis
 Neural tube defect:
 The neural plaque that develops between the 2nd and 4th weeks in
the embryologic stage is closed by curving from two edges and
forms the neural tube.
 While the brain develops from the cranial part of the neural tube,
the spinal cord develops from the caudal part. Problem that occur
during the closure of the caudal part of the neural tube in this stage
cause spina bifida and other spinal cord disorders.
 The risk of an adult with MMC having the a child with neural tube
defect is 5%.
 Women with low level of RBCs and folate level during early
pregnancy have up to a 6 times greater risk of having a child with a
neural tube defect.

14. Neural tube defect

15. Clinical manifestation
1. Spina bifida occulta: spina bifida occulta are
asymptomatic, the only features seen are:
– Dimple in the skin or growth of hair over malformed
vertebrae.
– As the child grows, he may develop foot weakness or
disturbances of bladder and bowel sphincter.
2. Meningocele:
– External cystic defect
– Weakness of leg or lack of sphincter control

16. 3. Myelomeningocele
 Primary clinical picture:
A. Abnormal nerve conduction, resulting in:
– Somatosensory losses
– Motor paralysis, including loss of bowel and bladder
control (all are below the level of lesion)
– Changes in the muscle tone
B. An enlarged head caused by:
– Hydrocephalus
– Arnold chairi malformation II
C. Bowel and bladder symptoms

17. D. Musculoskeletal deformities
– scoliosis
– clubfoot
E. Joint and extremity problems
– joint contractures
– hip subluxation
– Diminished growth of non weight bearing limb
F. Abnormal or damaged nerve tissue which can leads to
loss of extroceptive and proprioceptive sensation
 Secondary features:
– Skin breakdown
– Obesity
– Latex allergy
– Osteoporosis.

18. Surgical treatment
 There is no cure for nerve damage caused by spina
bifida.
 Surgery for spina bifida involves a variety of
neurological, orthopaedic and urologic procedures.
 This my includes-
– Closure if the defect over the spinal cord.
– Spinal deformity reconstruction.
– Lower-extremity deformity correction.
 Medical treatment-
– Antibiotics are essential in preventing infection of CNS and
UTI.

19. Physiotherapy Assessment
Subjective -
• Name
• Age/gender
• Weight
• Height
• Date of admission
• Address
• Chief complaints/ parent concern
• Past medical history
• Present medical history
• Social and family history

20. Physiotherapy assessment conti..
Objective -
• MMT
• ROM
• Sensory testing
• Reflex testing
• Developmental/ functional evaluations
cognitive evaluations

21. Physiotherapy Management
The therapy programs should be designed to parallel the
normal achievement of gross motor milestones
• Stage 1: before surgical closure of sac:
– Rom
– Positioning
– Auditory and visual stimulation
• Stage 2: after surgery during hospitalization
– Positioning in prone lying and side lying
– ROM taught to parents
– Provide toys of various colours, textures and shapes
– Therapeutic handling to encourage good head and trunk control

22. • Stage 3: pre ambulatory stage
– Work on sitting and equilibrium reactions
– Eye-hand coordination activities
– Early weight bearing on lower limbs
– Weight shifting in standing frame
– Continue home program
• Stage 4: toddler through preschool
– Choose appropriate orthotic devices
– Gait training
– Strengthening exercises
– Development in cognitive and psychological areas
– Continue home programme

23. • Stage 5 : primary school through adolescence
– Replace orthotic device as necessary
– Wheel chair prescription as necessary
– Teach locomotion activities
– Strengthening exercise of trunk and extremities
– Teach skin care
– Teach-self care activities like dressing, feeding,
hygiene, bowel and bladder care.

24. Thank you