Children w/Spina Bifida
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| what is the best defense against spina bifida? | women who are sexually active should take 40 mg (400 mcg) of folic acid/daily
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| myleodysplasia is? | interrupts the signal to the nerves
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| why can you see some stg in a muscle but limited at the level of dmg? | redundant nervous system - many nerves join others
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| musculoskeletal deformities | postural, scoliosis, joint deformities/contractures, crouched gait, vertical tali, hip dislocation
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| neurology impairments | motor paralysis, sensory dysfunction, (these 2 are like SCI), hydorcephalus, cognitive dysfunction, language dysfunction, seizures (10-30%), neurogenic bowel, neurogenic bladder (these are unique to SB)
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| How to tx hydrocephalus? | shunt to drain
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| in what way and what level is cognitive dysfunction | L5, typically low end of normal, often lack executive functioning skills (plan, execute), "cocktail party" syndrome, have good knowledge on a very limited amt of information
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| if L1 - L2 involvement affects..... | have no LE
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| S1 - S2, neurology impairment | neurogenic bowel & neurogenic bladder, sphincter doesn't close all the way, causes skin breakdown b/c they cannot feel when they are wet
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| what is a determining factor in ambulation & independence? | CNS INVOLVEMENT, primary determining factor, not just physical level.
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| what is a way to deal with cognitive dys? | use note cards with ICONS to help them through a process, like how to go transfer to a chair from a wheel chair.
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| when does the dmg occur causing SB? | in utero
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| primary focus of PT for SB? | focus on independence
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| PT care for SB | joint contractures & deformities, pressure sores, brace/wheelchair assessment, independent mobility/self-care
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| what causes a static joint contracture? | contracts at rest
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| dynamic joint contracture is caused by? | antagonistweak apposing muscle such as the anterior and posterior tibia,
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| what if they are L4 involvement but no CNS involvement? | functioning 100%
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| Habitualization is | teaching something new
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| rehabilitation | teaching something they once knew
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| if they are L4, what would you expect to see and why? | no paraneal, opposing muscle, 45 deg DF & inversion or forefoot abd
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| hip flexor contracture due to? | unapposing gluts
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| knee flexion contracture due to? | unapposing quads
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| PF contracture due to? | unapposing Tib anterior
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| Tx for contractures | low load/long duration (strap on brace to pull into position), ROM, positioning
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| with a 20 degree hip flexion contracture, w/AFO & crutches, what affect on gait? | diminish gait velocity to 44% of normal
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| 10 degree hip flexion does what to gain? | reduces gait velocity to 20% of normal
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| what type of surgery would help dynamic joint contracture/deformity? | split posterior tib & put half the tendon higher up on leg to even pull
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| what causes pressure sores | usually due to lack of sensation of buttock, joint deformities & dec activity level are inc factors
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| what can help prevent pressure sores? | catheter thru belly button, pressure mapping, hourly wt shifts
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| why do SB develop severe pes planus | don't have dynamic stabilizers, spring lig & tibialis anterior & anterior
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| what level SB would require AFO? | L4, L5
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| what kind of AFO for S1? | orthotic
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| what level requires a KAFO? | L3, don't have control of hips, quads, locking jt for knee
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| what is GRAFO? | ground reaction AFO. gives advantage of longer lever arm
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| HKAFO is what level? is it functional? | includes a hip joint, L1, L2. not function, w/c is easier
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| THKAFO | not too functional b/c so difficult to get on & off
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| RGO's | reciprocating gait orthotic, walk with a circumduct, cost $5K, not functional. easier to get along w/wheel chair
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| Parapodium, how does it work and at what age? | helps develop the acetabulum w/WBing. Also helps with head (must have head control) and rotational control. Start around 9 mo. should use 20-30 min, 4-5 x day, not a passive device, add some tilting if possible
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| standing/ambulation benefits | improved bowel/bladder, prevention of bone loss, improved heart endurance, prevention of pressure sores & joint deformities, improved upper extremity stg & coordination, endurance
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| L1, L2 what ambulation trend? | Therapeutic or household walking in childhood or adulthood
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| T2-T12 ambulation | most use wheel chair in adulthood
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| Thoracic 2 to Thoracic 12 ambulation | therapeutic walking in childhood
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| L3 - L4 ambulation | household or community ambulation in childhood/adulthood, KAFO, loftstands maybe but wheel chair more efficient
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| functional trend of L3 | most use wheelchairs as primary mode
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| how many L3 will achieve independence? how many working? | 60% Ind, 20% actively in full time employment
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| L4, percentage ambulate as adults? independence? community ambulation? | 20%, 60% Ind, 20% comm
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| L5 to S1 ambulation trend | community in childhood & adult
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| muscles affected at L5-S1 | all gluts, hamstrings, gastroc (not soleus, will at L1)
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| L5 ambulation - what AD? | crutches are suggested in adults to dec energy expenditure & maintain alignment
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| L5, what % independent? full time work? part time work? | 80% ind, 30% FT, 20% PT, (50% empl as adults)
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| S1 functional | excellent long term, some studies suggest high risk for heel ulcers, infection & amputation, use of heel cups may limit (no sensation)
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| how are independent skills assessed? | PT -new survey in SDC to evaluate function level ( 9 categories)
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| do they have to walk to be independent? | NO
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| how is independence defined for SB? | toilet transfers, bowel/bladder maintenance, dressing/self-care, indoor/outdoor mobility, level surface transfer, car transfer, bed mobility, tub/shower transfer
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| what is the primary reason for not obtaining independence? | limited cognitive skills
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