Thursday, January 10, 2019

PT Pathologies: Spina Bifida - Myelomeningocele

Spina bifida is a congentital neural tube defect that generally occurs in the lumbar spine but can also occur at the sacral, cervical, and thoracic levels.  This pathology can be classified into three categories; spina bifida- occult, meningocele and myelomeningocele.  Occult is an incomplete fusion of the posterior vertebral arch with no neural tissue protruding.  Meningocele is an incomplete fusion of the posterior vertebral arch with neural tissue/meninges protruding outside the neural arch.  Myelomeningocele is an incomplete fusion of the posterior vertebral arch with both meninges and spinal cord protruding outside the neural arch.  Spina bifida - Myelomeningocele will affect as many as 1 out of 4,000 infants.

The cause of spina bifida is unknown but health professionals think low levels of folic acid during the pregnancy is a factor.  Folic acid or folate is important for brain and spinal cord development.  This can be detected before the infant is born.  Blood tests can be done and alpha-fetoprotein can show elevation in levels at week 16 of pregnancy.  These infants might have other disorders like syringomyelia, a fluid filled cyst within the spinal cord, and a hip dislocation.  Hydrocephalus, buildup of fluid inside the brain, affects about 90% of the mylomeningocele cases.  The caregivers will place a shunt in the child's brain that will drain the excess fluid down to the abdomen area.  Myelomeningocele patients will typically use a wheelchair for their life span and the primary reason of death is due to kidney complications.

In spina bifida myelomeningocele, immediate surgical intervention is needed to repair the protruding sac from the spinal area.  Physical therapy is an important component needed in the early years of an infants life.  This focuses on educating the family about proper handling, positioning, range of motion, and therapeutic play.  In the long term, physical therapy assists in maximizing functional capacity.  Also included are range of motion exercises, facilitation of developmental milestones, therapeutic exercise, skin care, strengthening balance and mobility training.  Upper extremity strengthening will make use of assistive devices easier such as wheel chairs and walkers.  A patient with spina bifida has a near normal life expectancy as long as the patient receives consistent and thorough healthcare.

No comments:

Post a Comment