INTRODUCTION:- Spina bifida (SPLIT SPINE)
Spina bifida is one of the neural tube defect.In which the failure of the fusion of two vertebral arches in the embryological stages of developmental spine.
Spina bifida occulta : failur of fusion could be limited only to the spinous process.
Spina bifida aperta : these include the neural elements(involve the vertebral arch,skin meninges and cord) may fail to fuse.
Meningocoele : In which there is protusion of meninges.
Myelomeningocele : In which there is protusion of meninges and cord.
Syringomyelocoele : IN which the central canal of the cord is dilated and the cord is proytruded.
Myelocoele : In which the central cord remains unfused and exposed.
Spina bifida is one of the most common birth defect , with world wild avareage incidence of 1-2 cases per 1000 birth ,but english and europens a higher in cidence than the asians.
The risk of reocurrence after one affected child is 1 in 20, with a risk of similar affected person passing defect .after 2 affected risk of 1 in 10, and after 3 affected 1 in 4.
Spina bifida is neural tube defect ( often befor the mother knwos she is pregnant), normally clousre of neural tube occures around 28 days after fertilization.However if somtimes interferes and the tube fail to close property , a neural tube defect occure.
1. UNKNOWN – majority of the case are unknow.
2. MEDICATION – during pregnancy anti convulents , diabetes.
3. GENETICS – it could be run families and genetics basis.
4. OBESITY – obese pregnat ladies are more prone.
5. RAISED BODY TEMPRATURE – frome fever or external sourses such as hot tubes and electrical blankets.
6. FOLIC ACID DEFICENCY – contributing factor in the pathogenesis of neural tube defects.
→ Muscle weakness of the legs, sometimes involving paralysis(flaccid or spastic)
→ Bowel and bladder problems.
→ Seizures, especially if the child requires a shunt.
→ depression or dimple in the lower back.
→ A small patch of dark hair.
→ Soft fatty deposits.
→ Port-wine nevi (deep red-purple macular lesions).
→ Saclike cyst that protrudes outside the spine.
→ Musculoskeletal deformities (scoliosis, hip dysplasia, hip dislocation, club foot, hip/knee contracture).
→ Hydrocephalus, alone with Type I or II Arnold Chiari malformation.
→ Trunk hypotonia.
→ Delayed automatic postural reactions.
The purpose of the examination is to determine, the level at which normal cord function ceases , and to assesyhe presence and degree of hydrocephalus.
SKULL : for examin sutures and fontanelles palpated for evidence of distension and incresde pressure.Measurement of occipital frontal circumference (OFC) should be carried out and chared.
CRANIAL NEREVES : asses by observation of the movments of face , tongue and palate and by watching the baby suck.
SPINE : spine should be palpated along its length as somtimes ther is multiple lesion which are not always obvious.The length and width of the lesion should be measured and position of spinal cord noted.
LIMBS : check active movements of limbs by simulating the leg and eliciting neonatal reflexes.The power of muscle should be assed by with and without gravity and with and without resistance. these is useful in check deformity such as talipes and congenital dislocation of hip.
BOWEL AND BLADDER : sphincter tone and bladder function should be assed.A patulous anus and dribling incontinence are associated with a lesion at the level of S2,3and 4. Retension of urine is associated with a lesion at S1.
First physical assesment of child. The movment of the leg in some babies appers after back is reapired, but movement of back is lose after back reapire in some case.
This assesment both – sensation and movement both . First record genral impression – abnormal position of limb , deformities present , movement (if any) present .
Reflex assesment, muscle testing.
sensory chart completed and to do tested with saftey pin as, testing the epicritic feeling or light touch as with cotton whool. The most reliable test at this stage is pin prick with pin then baby cry.
Physical therapy programs are designed to parallel the normal achievement of gross motor milestones.
1. Physical therapists in the intensive care unit address infant positioning needs and provide parent and family education.
2. Early-intervention physical therapists can provide physical therapy in the home or other community-based locations to help encourage the child’s development of strength, movement, and balance skills by teaching parents specific play-based exercises.
3. School-based physical therapists often consult with other educational team members to help students with spina bifida participate in curricular activities, and develop independence within the school setting. They may recommend special equipment for the student to use during the school day.
4. Physical therapists also recommend appropriate equipment, such as braces, walkers, and wheelchairs to help people with spina bifida increase their functional mobility.
5. Physical therapy is also important for the prevention of other possible problems, such as obesity, by identifying activities that encourage continued participation in sports or other fitness-based activities that promote lifelong health and wellness.
prone lying facilitate – educate the ,mother to place the baby in prone position during playtime, preferably on floor.
Passive movement must be given in full rang of motion as possible to all joint strating with toes,tarsal joints,ankle,knee,hip.Mother must taught to how to carry baby and movement. Arm movemnt can be stared as soon as possibleas the baby respond the exercise to strenghten the shoulder girdle.
A knowledge og develomental progress the mildstone of a normal child then stat to rooling over, sitting up.
Play therapy with toys -facilitate mid line activity,Bridging, knee to chest.
When the child ready to stand, assment meeds to be made of degree of support required from orthosis.degree of support required according to neurological level of affection.