Spina bifida is a birth defect where the spinal column does not fully close around the spinal cord. It can range from mild to severe depending on the location and severity of the opening. The main types are spina bifida occulta, meningocele, and myelomeningocele. Treatment involves early surgery, physical/occupational therapy, bracing, and management of any neurological problems or secondary issues like hydrocephalus. Taking adequate folic acid before and during pregnancy can help prevent spina bifida in future children.
Spina Bifida: Physiotherapy in the management of meningomyeloceleAyobami Ayodele
Spina bifida is a treatable spinal cord malformation that occurs in varying degrees of severity. Meningomyelocele is associated with abnormal development of the cranial neural tube, which results in several characteristic CNS anomalies. About 90% of babies born with Spina Bifida now live to be adults, about 80% have normal intelligence and about 75% play sports and do other fun activities. Most do well in school, and many play in sports.
What is Muscular Dystrophy?
Types of Muscular Dystrophy
What is Duchenne muscular dystrophy (DMD), pathophysiology, clinical presentation, Gowers sign, DMD and Becker's muscular dystrophy and functional grades
Spina Bifida: Physiotherapy in the management of meningomyeloceleAyobami Ayodele
Spina bifida is a treatable spinal cord malformation that occurs in varying degrees of severity. Meningomyelocele is associated with abnormal development of the cranial neural tube, which results in several characteristic CNS anomalies. About 90% of babies born with Spina Bifida now live to be adults, about 80% have normal intelligence and about 75% play sports and do other fun activities. Most do well in school, and many play in sports.
What is Muscular Dystrophy?
Types of Muscular Dystrophy
What is Duchenne muscular dystrophy (DMD), pathophysiology, clinical presentation, Gowers sign, DMD and Becker's muscular dystrophy and functional grades
-Detailed Introduction, Patho-physiology, Evaluation & Physiotherapy Management of Parkinsonism.
-Clinical classification is discussed.
-Various measures of evaluation and physical therapy is discussed in this.
The Bobath concept is a problem-solving approach used in the evaluation and treatment of individuals with movement and postural control disturbances due to a lesion of the central nervous system.
It is named after Berta Bobath, a physiotherapist, and her husband Karel Bobath, a psychiatrist/neuropsychiatrist, who proposed the approach for treating patients affected with Central Nervous System anomalies.
Procedure: in a “trial & error” fashion in 1948.
Concept of compensatory training.
Neglects the potential of hemiplegic side.
It is an interactive problem-solving approach that focuses on continuing reassessment with attention to individual goals, developing working hypotheses, treatment plans, and relevant objective measures to evaluate interventions.
Therapist should have:
Good posture & movement analysis skills.
PRINCIPLES
NDT THERAPY WORKS
ALWAYS TREAT THE PATIENT AS A WHOLE
WORK SIMULTANEOUSLY ON PATIENTS STRENGTHS & WEAKNESSES
INDIVIDUALIZED FOR EVERY PATIENT BASED ON ICF MODEL
GAIN THE INFORMATION FROM PAST, PRESENT & FUTURE
TEAMWORK IS CRITICAL FOR REHAB PURPOSES
UNDERSTANDING THE CONCEPT OF TYPICAL DEVELOPMENT (MOTOR CONTROL)
TRANSFERENCE OF TRAINING IN DAILY LIFE
HANDS ON INTERVENTION TO ENHANCE MOTOR LEARNING & FUNCTIONS
Brunnstrom Approach
Brunnstrom's Approach (SIGNE BRUNNSTROM)
Objectives: ➢ Discuss the concepts and principles underlying Brunnstrom’s approach ➢ Brunnstrom recovery stages ➢ Treatment principles & techniques
★ Brunnstrom’s approach was developed by the physical therapist from Sweden in the early 1950’s
★ Brunnstrom used motor control theory and observations of the patients'
★ Procedure: In a “trial & error” fashion ★ Later modified: in light of neurophysiological knowledge
Introduction: Reflex Theory Movement is controlled by stimulus-response. Reflexes are the basis for movement: reflexes are combined into actions that create behavior. Hierarchical Theory Characterized by a top-down structure, in which higher centers are always in charge of lower centers.
● When the CNS is injured, as, in a cerebrovascular accident, an individual goes through an “evolution in reverse”. Movement becomes primitive, reflexive, and automatic.
● Changes in tone and the presence of reflexes are considered a normal process of recovery.
● Movement recovery tends to be stereotypic.
● Patients exhibit only a few stereotypic movement patterns: Basic Limb Synergies.
● Based on observations of recovery following a stroke, this approach makes use of associated reactions, tonic reflexes, and the development of basic limb synergies to facilitate movements.
● The use of such a procedure is temporary.
Basic Limb Synergies:
● Normal synergistic movements are purposeful movements with maximum precision and minimum waste of energy.
● Basic limb synergy (BLS) does not permit the different combinations of muscles.
● BLS is considered primitive, automatic, and reflexive due to loss of inhibitory control from higher centers.
● Mass movement patterns in response to a stimulus or voluntary effort both Gross flexor movement (Flexor Synergy) Gross extensor movement (Extensor Synergy) Combination of the strongest component of the synergies (Mixed Synergy)
● Appear during the early spastic period of recovery
Upper Limb Flexor Synergy: Scapula: Retraction / Elevation Shoulder: Abduction and External rotation Elbow: Flexion Forearm: Supination Wrist and Finger: Flexion Lower Limb Extensor Synergy: Pelvis: posterior tilt Hip: Extension, Adduction & Internal rotation Knee: Extension Ankle: Plantarflexion Toes: Flexion Upper Limb Extensor Synergy: Scapula: Protraction / Depression Shoulder: Adduction and Internal rotation Elbow: Extension Forearm: Pronation Wrist: Extension Finger: Flexion Lower Limb Flexor Synergy: Pelvis: anterior tilt Hip: Flexion, Abduction & External rotation Knee: Flexion Ankle: Dorsiflexion Toes: Extension
Upper Limb Mixed Synergy: Scapula retraction Shoulder add.+IR Elbow flexion Forearm pronation Wrist & fingers flexion Lower Limb Mixed Synergy: Pelvis post tilt hip add.+IR Knee extension Ankle & toes plantarflexion
Rubrospinal tract Vestibulospinal tract
Associated Reactions
Primitive Reflexes
Ataxia is a medical condition which results in the lack of muscle coordination that usually affects voluntary movements such as walking, eye movements, speech, and the patient’s ability to swallow.
-Detailed Introduction, Patho-physiology, Evaluation & Physiotherapy Management of Parkinsonism.
-Clinical classification is discussed.
-Various measures of evaluation and physical therapy is discussed in this.
The Bobath concept is a problem-solving approach used in the evaluation and treatment of individuals with movement and postural control disturbances due to a lesion of the central nervous system.
It is named after Berta Bobath, a physiotherapist, and her husband Karel Bobath, a psychiatrist/neuropsychiatrist, who proposed the approach for treating patients affected with Central Nervous System anomalies.
Procedure: in a “trial & error” fashion in 1948.
Concept of compensatory training.
Neglects the potential of hemiplegic side.
It is an interactive problem-solving approach that focuses on continuing reassessment with attention to individual goals, developing working hypotheses, treatment plans, and relevant objective measures to evaluate interventions.
Therapist should have:
Good posture & movement analysis skills.
PRINCIPLES
NDT THERAPY WORKS
ALWAYS TREAT THE PATIENT AS A WHOLE
WORK SIMULTANEOUSLY ON PATIENTS STRENGTHS & WEAKNESSES
INDIVIDUALIZED FOR EVERY PATIENT BASED ON ICF MODEL
GAIN THE INFORMATION FROM PAST, PRESENT & FUTURE
TEAMWORK IS CRITICAL FOR REHAB PURPOSES
UNDERSTANDING THE CONCEPT OF TYPICAL DEVELOPMENT (MOTOR CONTROL)
TRANSFERENCE OF TRAINING IN DAILY LIFE
HANDS ON INTERVENTION TO ENHANCE MOTOR LEARNING & FUNCTIONS
Brunnstrom Approach
Brunnstrom's Approach (SIGNE BRUNNSTROM)
Objectives: ➢ Discuss the concepts and principles underlying Brunnstrom’s approach ➢ Brunnstrom recovery stages ➢ Treatment principles & techniques
★ Brunnstrom’s approach was developed by the physical therapist from Sweden in the early 1950’s
★ Brunnstrom used motor control theory and observations of the patients'
★ Procedure: In a “trial & error” fashion ★ Later modified: in light of neurophysiological knowledge
Introduction: Reflex Theory Movement is controlled by stimulus-response. Reflexes are the basis for movement: reflexes are combined into actions that create behavior. Hierarchical Theory Characterized by a top-down structure, in which higher centers are always in charge of lower centers.
● When the CNS is injured, as, in a cerebrovascular accident, an individual goes through an “evolution in reverse”. Movement becomes primitive, reflexive, and automatic.
● Changes in tone and the presence of reflexes are considered a normal process of recovery.
● Movement recovery tends to be stereotypic.
● Patients exhibit only a few stereotypic movement patterns: Basic Limb Synergies.
● Based on observations of recovery following a stroke, this approach makes use of associated reactions, tonic reflexes, and the development of basic limb synergies to facilitate movements.
● The use of such a procedure is temporary.
Basic Limb Synergies:
● Normal synergistic movements are purposeful movements with maximum precision and minimum waste of energy.
● Basic limb synergy (BLS) does not permit the different combinations of muscles.
● BLS is considered primitive, automatic, and reflexive due to loss of inhibitory control from higher centers.
● Mass movement patterns in response to a stimulus or voluntary effort both Gross flexor movement (Flexor Synergy) Gross extensor movement (Extensor Synergy) Combination of the strongest component of the synergies (Mixed Synergy)
● Appear during the early spastic period of recovery
Upper Limb Flexor Synergy: Scapula: Retraction / Elevation Shoulder: Abduction and External rotation Elbow: Flexion Forearm: Supination Wrist and Finger: Flexion Lower Limb Extensor Synergy: Pelvis: posterior tilt Hip: Extension, Adduction & Internal rotation Knee: Extension Ankle: Plantarflexion Toes: Flexion Upper Limb Extensor Synergy: Scapula: Protraction / Depression Shoulder: Adduction and Internal rotation Elbow: Extension Forearm: Pronation Wrist: Extension Finger: Flexion Lower Limb Flexor Synergy: Pelvis: anterior tilt Hip: Flexion, Abduction & External rotation Knee: Flexion Ankle: Dorsiflexion Toes: Extension
Upper Limb Mixed Synergy: Scapula retraction Shoulder add.+IR Elbow flexion Forearm pronation Wrist & fingers flexion Lower Limb Mixed Synergy: Pelvis post tilt hip add.+IR Knee extension Ankle & toes plantarflexion
Rubrospinal tract Vestibulospinal tract
Associated Reactions
Primitive Reflexes
Ataxia is a medical condition which results in the lack of muscle coordination that usually affects voluntary movements such as walking, eye movements, speech, and the patient’s ability to swallow.
Spinal Cord Disorders
Definition:-
Spinal Cord Injury(SCI) is an injury to the Spinal Cord that results in temporary or permanent changes in the spinal cords Normal motor sensory or autonomic function.
In most Spinal Cord Injuries, the balance ligaments or disc material pinch the cord, causing it to become bruised or swollen.
1. Incidence
2. Etiology
3. Pathophysiology of SCI
4. Clinical Manifestation
5. Diagnosis
6. Management
7. Nursing Process
8. Nursing Diagnosis
9. Nursing Interventions
Spinal Bifida
Spinal Bifida is a birth defect that occurs when the spinal cord doesn’t form properly.
It is the type of neural tube defect.
The neural tube is the structure in a developing embryo that eventually becomes the body’s Brain, Spinal cord & the tissue that encloses them.
1. types
2. Causes
3. Symptoms
4. Complications
REFERENCES:-
1. Brunner & Siddarth's,
Textbook of Medical-Surgical Nursing,
Spina bifida/ dysraphism - assessment and physiotherapy management Susan Jose
refrences kessler tecklin darcy.
a all round description of assesment in physiotherapeutic methods and management techniques.
participationn increasing measures and limitation reduction stratergies
MYELOMENINGOCELE copy.pptx a slide describing the conditionAjisafeZainab
Myelomeningocele is a disorder of the nervous system particularly the spine and spinal cord, before we go further in this presentation there are some terms to know to aid understanding.
➢Neural tube; The neural tube forms the early brain and spine, As development progresses, the top of the neural tube becomes the brain, and the rest of the tube becomes the spinal cord. An NTD happens when this tube doesn't close completely somewhere along its length. Neural tube closure is completed 28 days (four weeks) from conception.
➢Alpha fetoprotein; AFP is a protein that the liver makes when its cells are growing and dividing to make new cells. AFP is normally high in unborn babies. After birth, AFP levels drop very low. Healthy children and adults who aren't pregnant have very little AFP in their blood. Maternal AFP serum level is used to screen for Down syndrome, neural tube defects, and other chromosomal abnormalities.
➢Spinal bifida; Spina bifida is a condition that affects the spine and is usually apparent at birth. It is a type of neural tube defect (NTD).
Nursing management of myelomeningocele
Types of spinal Bifida
Pathophysiology of myelomeningocele
Neural tube defects are the most common congenital abnormality in India which can be easily prevented with due information and better nursing practices. Neural Tube Defects can be prevented with intake of folic acid.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
2. “Split Spine” caused by incomplete
closure of the neural tube, usually in
the lumbar or sacral region
What is spina bifida?
3.
4. Types of spina bifida?
Several classifications that vary in
severity depending on location and
extent of opening
1-Spina bifida occulta
2-Spina bifida cystica
meningocele
myelomenigocele
3-Spina bifida ventralis
5. 1-Spina bifida occulta – “hidden”
The bony vertebra is open, but the spine is within the spinal canal
The skin may have a lipoma (small benign fatty tumor), some
discoloration (birthmark), or a small tuft of hair overlying the spinal
defect
Most patients with spina bifida occulta do not know they have it
There may be tethering of the spinal cord
6. Spina bifida occulta – tethered spinal cord
Often occurs later in life
Caused by limitations of movement of the spinal cord within the
spinal column
Patients often have low back pain, weakness in the legs, and/or
incontinence depending on the site of tethering
7. 2-Spina bifida cystica – meningocele
The bony vertebra is open, part of the meninges is protruding out of
the spinal canal
Since the spinal cord is not protruding, there is often normal
function
Some cases of tethering have been reported
8. Spina bifida cystica – myelomeningocele
The bony vertebra is open, part of the meninges and part or all of
the spinal cord is protruding out of the spinal canal
Since the spinal cord is protruding, it is often not fully developed
Involved nerve roots are often not developed resulting in weakness,
pain, and/or paralysis
9.
10. Spina bifida cystica – myelomeningocele…. (continoue
Arnold Chiari malformation II is often 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
Patients with Arnold Chiari malformations often require placement of a shunt to drain
the excess fluid
11. Spina bifida ventralis – anterior opening
Much less common than other forms of spina bifida
Meningeal sac will protrude into the retroperitoneal space and impinge on
retroperitoneal organs such as the duodenum, ascending/descending colon, kidneys,
adrenal glands, pancreas, aorta, and inferior vena cava
12. causes spina bifida
- The exact cause of spina bifida is
unknown
- All research to date has indicated both
a genetic and environmental influence
- The developmental process that results
in spina bifida is well studied
13. Causes of spina bifida(continoue
• Neural Tube Defect:
– When the neural tube fails to properly close
during the 4th week embryogenesis.
15. What would prevent the neural tubes from
closing properly?
Folate seems to play a large role in the closing of the neural tube
– but it is unknown exactly how folate works in this process.
Folate influence :The lack of leafy green vegetables caused the
mother to have low levels of folate during conception.
Genetics also play a role in the development of spina bifida.
Mothers with one child with spina bifida have an increased risk
of additional children having spina bifida
16. Valproic acid (Depakote)
Oral medication used to treat seizures/convulsions,
migraines, and bipolar disorder
Mechanism of action – thought to increase GABA
levels in the brain
Pregnant women taking Valproic acid have an
increased risk of having children with spina bifida
18. a-Primary clinical pictures
1-Abnormal nerve conduction, resulting in:
Somatosensory losses
Motor paralysis, including loss of bowel and bladder
control (all are below level of lesion)
Changes in muscle tone
19. Motor level
Lesion Level
Above L3
L4 and below
S1 and below
S3 and below
Spinal-related disability
Complete paraplegia and dermatomal para-
anesthesia, Bladder incontinence, Nonambulatory
Same as for above L3 except preservation of hip
flexors, hip adductors, knee extensors; Ambulatory
with aids, bracing orthopedic surgery
Same as for L4 and below except preservation of feet
dorsiflexors, and partial preservation of hip extensors
and knee flexors; Ambulatory with minimal aids
Normal lower extremity motor function; Saddle
anesthesia; Variable bladder-rectal incontinence
21. 2-An enlarged head caused
by:
1- hydrocephalus
(“water on the brain”)
11-Arnolds Chairi
malformation 11
22.
23. i. Hydrocephalus
VP Shunt done in 85-90% of MMC
(1/3 will require revision at some time)
Most commonly due to obstruction of
Cerebrospinal Fluid (CSF) Flow
27. Arnold-Chiari type II Malformation
Definition: Medulla, Pons, 4th ventricle +/- cerebellar
vermis herniated into the cervical spinal canal
Incidence: 80-90% of those with MMC
Symptomatic: ~20%
Should be managed and treated as an emergency by
(surgical decomperssion operation)
28. 3-Urinary and Bowel symptoms
Urinary symptoms:
• In lumbosacral spina bifida cystica, few children attain urinary
incontinence
• They require urodynamic testing, including cystometrography,
uroflowmetry, and EMG of the urinary sphincter
• Types of lesions
1. “Keepers”- UMN
2. “Leakers”- LMN
According to results and consulting urologist patient may need
intermittent catheterization, pharmacological agents,
implantation of an artificial urinary sphincter or a combination.
30. Bowel symptoms
A. Constipation
B. Incontinence
Management techniques
-enemas -suppositories
-habit training - digital stimulation
-biofeedback -appendicostomy(ACE)
31. 4-Musculoskeletal deformities (scoliosis)
5-Joint and extremity deformities (joint
contractures, club foot, hip subluxations,
diminished growth of non-weight bearing limbs)
6-Abnormal or damaged nerve tissue which can
lead to loss of extroceptive and prorioceptive
sensation .
34. Management of spina bifida
1-screening and dignosis
2-Treatement
3-followup and observation
4- prevention
35. 1-Screening and Diagnosis
Prenatal Tests
AFP(alphafeotoprotien)
Ultrasound
Testing of Amniotic fluid(Amniocentesis)
Evaluation
Analysis of individual medical history
Physical examination
Evaluation of critical body systems
Imaging Studies
X-rays
Ultrasound
CT scan
MRI
Gait Analysis
36. 2-Treatment
No cure
Regular check ups with
physician
Surgery (24 hours after
birth)
Medication
Physiotherapy
38. Surgery (continue--
Surgery for spina bifida involves a variety of
neurosurgical, orthopedic, and urologic procedures.
Surgical procedures include the following:
– Closure of the defect over the spinal cord
– Spinal deformity reconstruction
– Lower-extremity deformity correction
40. Physical Therapy
Physical therapy helps to direct goals for
patients in each lesion-level group within an
appropriate developmental context from
infancy through adulthood.
Normal achievement of gross motor
milestones.
41. To establish a baseline of muscle function in
mylomeningocele.
As the child develops, the physical therapist
monitors joint alignment, muscle imbalances,
contractures, posture, and signs of progressive
neurologic dysfunction.
Provides caregivers with instruction in handling and
positioning techniques and recommends orthotic
positioning devices to prevent soft tissue
contractures.
42. Provide the infant with sitting opportunities to
facilitate the development of head and trunk
control.
Near the end of the first year of life, provide the
child with an effective means of independent
mobility in conjunction with therapeutic
exercises that promote trunk control and
balance.
For patients who are not likely to become
ambulatory, place emphasis on developing
proficiency in wheelchair skills
43. .
For patients who are predicted to ambulate, pregait
training should begin with use of a parapodium or
swivel walker.
Exercise or household-distance ambulation may be
pursued with use of traditional long leg braces (eg,
hip-knee-ankle-foot orthosis, knee-ankle-foot
orthosis) or the reciprocating gait orthosis [RGO]).
47. Example of a Parapodium
• Commonly used for
children with high lesions
(T12-L3)
• Offers support to the
hips, knees, and ankles.
48. Occupational Therapy
• Children with spina bifida often have
impairment in fine motor skills and
conducting activities of daily living (ADL).
• Initiate training early to compensate for
these deficits and progress along the
developmental sequence as closely as
possible.
49. Upper-extremity stabilization and dexterous hand use
require adequate postural control of the head and
trunk.
In the first year of life, encourage development of these
postural mechanisms or substitute passive support, if
necessary, to promote eye-hand coordination and
manipulatory skills.
When adequate fine motor skills have been achieved,
the occupational therapist provides instructions for use
of adaptive equipment and alternative methods for self-
care and other ADL for preschool- and school-aged
children.
50. Recreational Therapy
• Children with myelomeningocele often
experience restricted play and recreational
opportunities because of limited mobility
and physical limitations.
• This inactivity decreases the potential for
normal development in all spheres and can
exert a negative impact on self-esteem.
51. For the infant and toddler with
myelomeningocele, recreational therapy
enhances opportunities for environmental
exploration and interaction with other
children.
For the school-aged child, recreational
therapy provides opportunities for
participation in adapted sports and exercise
programs, which can result in long-term
interest in personal fitness and health.
52. Recreational and physical fitness goals include
socialization, weight control, and improved
fitness (eg, flexibility, strength, aerobic capacity,
cardiovascular fitness, coordination).
Recreational therapy is helpful for promoting
independence with adult living skills and often is
used to assist the patient with shopping for and
purchasing personal items, use of public
transportation, and development of appropriate
leisure activities.
53. Follow up and careful Observation
Children with myelomeningocele often have
hydrocephalus (blockage of CSF)
Children may present with paralysis,
blindness, inability to speak, convulsions
Any changes in mental status or behavior
should be quickly brought to the attention of
the child’s physician(s)
54. Folate intake
Recommended that women of child-bearing
age take 400 micrograms of folate per day
Pregnant women should take 600 micrograms
of folate per day
Women with a previous child with spina
bifida should take 4000 micrograms of folate
per day
Folate can decrease the risk of spina bifida by
up to 75%
How can spina bifida be prevented?
55. Social impact
Children born with spina bifida today
require some special treatment :
Multiple surgeries starting as early as 48 hours after birth
Physical therapy
Bowel and/or bladder surgery – helps prevent infection
and social stigmatism
Latex allergies are often present
