spina bifida treatment _ What is spina bifida and what is its treatment in physiotherapy?

What is spina bifida and what is its treatment in physiotherapy?

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What is spina bifida and what is its treatment in physiotherapy?
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It is a malformation that appears during embryonic life (formation of the fetus). It is the abnormal development of one or more vertebrae at the level of the lamina and the spinous process, leaving the marrow uncovered.

Before the 70s, children born with spina bifida died from hydrocephalus or kidney injuries that are associated with the disease. Hence the importance of early closure of the spinal injury.
In what area does Spina Bifida usually appear?

    The lumbosacral region is the most frequently affected (80%). It is also the most serious.
    Thoracolumbar region (15%)
    Rare involvement in thoracic and cervical region.

What is the cause of this malformation?

The cause is unknown:

Some research points to a deficiency of folic acid. Although it also influences the genetic factor. Possibly the cause is a combination of both.

Folate or folic acid: It is necessary for the production of red blood cells and for the synthesis of DNA (which controls inheritance). It helps with cell growth and functioning. It helps increase appetite when necessary and stimulates the formation of digestive acids.

What is spina bifida and what is its treatment in physiotherapy?

According to Gram, 1999, the administration of folic acid can prevent defects of the neural tube from 50% to 70%.
Classification of the Spina Bifida

    Hidden Bifida Spine: More benign, since it is only a failure in the fusion of the posterior vertebral arches without alteration in the meninges, spinal cord, or nerve roots. It does not usually produce symptoms or neurological signs, and is usually diagnosed late (juvenile or adult stage) after a period of low back pain and X-rays. Sometimes it manifests with a lock of hair in the area where it is.
    Cystic Bifida Spina:

Meningocele:

In the cystic cavity is found Cerebrospinal fluid and meninges. The medulla is still in the spinal canal, so the neurological alterations and symptoms are minimal. The most frequent location in the lumbosacral area.

Myelomeningocele

It is the most serious form of spina bifida, since in the cystic cavity is the spinal cord, nerve roots, meninges and cerebrospinal fluid. Although it is the most serious, it is also the most frequent. It usually affects lumbar or lumbosacral level.
Other complications associated with spina bifida

Spina bifida is a malformation that, besides causing motor disorders and alterations in sensitivity, can cause other problems, such as:
Cognition and perception

    Consciousness of yourself and other people.
    Comprehension problems
    Problems of visual perception.
    Slowness in certain reasoning, solve school problems.

Genitourinary problems

    The majority of children with Spina Bifida of myelomeningocele type have bladder and anal incontinence.
    There are also lesions in kidney function.
    It is a serious social problem in adolescence (integration, personal image).

Problems in manual motor skills

    Present in hydrocephalus and with Arnold-Chiari malformation.
    Clumsiness and incoordination.
    Lack of manual dexterity
    Difficulty in graphic activities and bimanual coordination.

Objectives of physiotherapy and physiotherapeutic treatment in this malformation

The objectives of the physiotherapy treatment will be:

    Development of physical capabilities that make independence possible.
    Independent mobility, walking or in a wheelchair.
    Finally, prevention of secondary deformities

We divide the physiotherapy treatment into 4 phases:
Physiotherapy in the Phase until 6 months

The child can be one or two months in the hospital.

    Postural care in the incubator according to joint deformities. If you have a bypass valve, we will change the position of the head to avoid asymmetric neck contractures (postural torticollis)
    Preparation of splints (plaster or thermoplastic) and padding to avoid friction with the skin (ulcers) No more than 2 or 3 hours in a row and combine it with mobilizations.
    Encourage child contact with parents, excellent sensory stimulation.

Once the child at home:

     Increase cephalic control.
    Stimulation in prone position with forearm support and hand opening.
    Facilitate turning.

Physiotherapy in the Phase of 6 to 12 months

It is important that the child elaborates the internal representation of his body schema. To do this, facilitate the grip of your legs and feet, work in front of a mirror.
Physiotherapy in the Phase of 12 to 18 months:

    Mobilizations of lower limbs to avoid retractions.
    Stimulate trunk control in sitting.
    By 18 months you should start standing through a tilted plane or standing.

Physiotherapy in the Phase from 18 months

    Mobilizations of lower limbs to maintain maximum joint range.
    If the deformity in the feet is irreducible, surgery will be necessary to facilitate standing.
     Adaptation to the orthosis to start the ambulation.
    Reeducation of the march by parallel and in front of the mirror.
    Use of a wheelchair (teaching transfers).

Conclusions about spina bifida

To finish and like many of our other articles, here is a summary of spina bifida, so you have only the most important information on hand:

    Spina bifida is a malformation that occurs in the fetus, in which the vertebrae do not develop completely and the marrow is left unprotected, and can leave through the area of ​​no formation of the vertebrae.
    The non-development of the vertebrae is more common in the lumbosacral region, followed by the thoracolumbar region and the thoracic and cervical region.
    The cause of spina bifida is not known, however there are studies that claim that it is due to a deficiency of folic acid during pregnancy (which is necessary for DNA synthesis).
    Spina bifida is classified as occult (where the tissues of the marrow, nerves or tissues that cover and protect it despite the malformation of the vertebrae are not altered, no symptoms can be manifested) and cystic (in where the marrow, the nerves and the tissues that cover and protect it come out through the malformation and cause symptoms, it is divided into meningocele and myelomeningocele).
    There are some complications associated with spina bifida, such as disorders in cognition and perception, genitourinary problems and problems in manual motor skills that may or may not occur to a greater or lesser extent.
    The physiotherapy treatment in children with spina bifida is divided into phases; specifically in 4 (according to the child's level of development).
    In physiotherapy, objectives are set so that the therapy can achieve the greatest possible independence, that the child is able to move on their own (walking or in a wheelchair on their own if walking is not possible) and the prevention of deformities. associated with spina bifida.

To conclude, we want you to understand that this is a deformity that is not very frequent, but that usually interferes with the psychomotor development of the child who suffers from it in an important way. Physiotherapy plays an important role in these children to achieve a good quality of life.