(A) SPINA BIFIDA
· A neural tube defect
· Occurs during development prior to birth.
· Due to the incomplete development of the spinal cord , brain or meninges.
· Can happen anywhere along side of Spine.
· Commonly visible on back of newborn baby at birth.
· It may also visible as an out growth, fluid filled sack on the spine out side the body.
That may or may not comprise the Spinal Cord inside.
TYPES OF SPINA BIFIDA
There are three types of spina bifida:
iii. Spina bifida occulta
i. Myelomeningocele :
· most common
· severe type of spina bifida
· also termed as open spina bifia
· This condition includes a sack that contains the parts of spinal cord and nerves, outside the opening, somewhere on the spine at the back of baby.
· This causes the damage of spinal cord and neves in the sack to get damage.
Children with myelomeningocele:
· They have physical disabilities
· The intensity of disabilities may range from moderate to sever.
· disabilities may include:
o Movement inability
o Inability to feel their legs or feet
o Feel difficulty in going to the bathroom
· also contains Fluid filled sack in the back of baby outside an opening.
· IN this condition there is not any part of the spinal cord present in the sack.
· Due to this factor there are not much nerve damages.
· This causes just minor disabilities among children.
iii. Spina bifida occulta
· A mild kind of spina bifida.
· Sometime termed as Hidden spina Bifida
· May not produce any disability and go unnoticed till later in life.
· There is only a gap in spine and commonly no oprning in the back of baby.
· No damage to the spine or spinal cord in this type
CHILDREN WITH SPINA BIFIDA
· Treatment focus in children with Spina Bifida is to determine the extent of the symptoms and the development of disabilities.
· This also focuses on how to prevent those disabilities which can be prevented.
· This requires the suitable and exact rehabilitation program and medical treatment which carry along the development of the child.
· Positive attitude is mandatory for parents and clinical professionals to mange the situation for longer time. This will develop the positive outlook of the child.
FACTORS AFFECTING THE EVENTUAL AMBULATORY STATUS OF CHILDREN WITH SPINA BIFIDA
Factors which may affect the children with spina bifida and their treatment outcomes are:
(1) neurological involvement level
(2) musculoskeletal deformity degree
(3) sensory impairment
(4) acquired obesity
(5) existing muscle strength
(6) visual and motor perception impairment
(7) patient motivation
(8) family support
· Level of the motor function and the functional mobility are the basic measures to achieve the certain degree of functional and ambulation capability.
· It is very important to consider that the factors like
o Limited sitting balance
may strongly effect the walking ability of child either with or without orthosis.
· These factors along with the mother function level of child can toughly influence the effectiveness of the orthotic management
· As this is a complex major birth defect so the orthotic management is challenging for orthosist.
· A complete understanding of the Spina bifida can only develop the achievable and considerable goals.
· This must be very clear to the family to understand the treatment process as well as role of the orthosis.
· Following are the specific factors
i. hip disorders (e.g., dislocation, subluxation, contractures),
ii. knee flexion/extension contractures,
iii. foot/ankle deformities (e.g., equinovarus, clubfoot).
In such situations, the orthotic goal should be to prevent the deformity by maintain the appropriate alignment of joint to achieve reasonable muscle balance in development stage. This may result into proper weight bearing and movement.