spina bifida physical therapy treatment

Spina bifida: we can all practice physical activity

Summary

          In this article we intend to develop the basic aspects to know the disease of "Spina bifida", since it is little known. In it, we will work on the definition, its causes, the symptoms it can cause, as well as its diagnosis, treatment and prevention. And finally, we will develop three sessions of physical education aimed at children with spina bifida, varying their difficulty and working on aspects such as: marksmanship, sport, sensitivity and arm hypertrophy.

    1. Introduction

        The human nervous system develops from a small specialized plate of cells along the back of the embryo.

        At the beginning of development, the edges of this plaque begin to coil and move closer together, creating the neural tube, a narrow tube that closes to form the brain and spinal cord of the embryo. As development progresses, the upper part of the tube becomes the brain and the rest becomes the spinal cord.

        This process is usually completed on the 28th day of pregnancy. But if problems occur during this process, the result can be brain disorders called neural tube defects, including spina bifida.

    2. Description

        Spina bifida is the most common congenital defect causing severe disability, although it is also very easy to prevent.

        Spina Bifida is a birth defect of the spine that occurs as a result of a failure in the closure of the neural tube during the first month of pregnancy.

        The spinal cord does not develop normally, resulting in different degrees of injury to the spinal cord and nervous system. This damage is irreversible and permanent. In severe cases, the spinal cord protrudes through the baby's back.

        This birth defect causes several degrees of paralysis and loss of sensation in the lower extremities, as well as various complications in the intestinal and urinary functions.

        Spina bifida in many cases is accompanied by hydrocephalus, which is an accumulation of cerebrospinal fluid (CSF) within the cranial cavity.

    3. Causes

        The specific cause of spina bifida is unknown, since there are multiple factors involved in its appearance. Apparently, this problem is the result of a combination of genetic factors and environmental factors. Although many factors were related to the development of spina bifida, different research routes have found that folic acid can help reduce the risk of suffering from the disease.

        A series of additional risk factors are considered:

        Maternal age (spina bifida is seen more frequently in teenage mothers).

        Antecedents of previous abortion.

        Order of birth (firstborns have a higher risk).

        Socioeconomic status (children born in poor families are more at risk of developing spina bifida).


4. Symptomatology

        Children with spina bifida have different degrees of involvement that cause neurological problems or symptoms to vary.

        The level of importance of the problems that the child may experience is directly related to the level of the spinal cord defect. Generally, the higher the defect level of the tube nerves, the more important are the problems the child may have. Most children have normal intelligence.

        to. Hidden bifid spina

            Part of the vertebra is not completely attached. However, the spinal cord and its covers are intact. Many people spend their entire lives without even knowing they have it. Many people have this condition.

            Women with spina bifida occulta should ask their doctor for a higher dosage of folic acid when planning a pregnancy, to reduce the risk of having their baby affected.

        b. Lipomeningocele

            It is a fat-covered skin tumor located in the lumbo-sacral medulla. Due to the relationship with nervous tissue, children with this involvement often have problems with urinary control and musculoskeletal function of the lower extremities.

            There are two ways

            Meningocele

                In this form, the sac contains the meninges and cerebrospinal fluid. This fluid bathes and protects the brain and spinal cord. The nerves are usually not damaged and can function with relative normality, so it is rare that you become incapacitated. This is the least common way.

            Myelomeningocele (meningomyelocele)

                It is the most important and most common form of presentation of the two forms of spina bifida. Here the cyst contains not only meninges and cerebrospinal fluid but also nerves and part of the spinal cord. As a result, there is always some paralysis and loss of sensation below the damaged region. The level of disability depends a lot on where the damage is. Many people with this form of the disease have bowel and bladder problems due to damage to the nerves that go to the bowel or bladder. It is usually accompanied by hydrocephalus.

        c. Encephalocele

            Encephalocele is a neural tube defect caused by herniation of the brain (cerebellum) and meninges (Encephalocele or meningoencephalocele) through a defect in the skull.

            Although each baby may experience different symptoms, the most common are:

                Abnormal appearance of the back of the baby, ranging from a small patch with hair or a dimple or a birthmark, to a sac that is found along the area of ​​the spine.

                Bowel and bladder problems.

                Loss of sensitivity below the area of ​​the lesion, especially in babies affected with a meningocele or a myelomeningocele

                Inability to move the legs (paralysis).

            The baby may also have other problems related to spina bifida, such as:

                Hydrocephalus (pressure fluid in the brain).

                Heart problems.

                Orthopedic problems (of the bone).

                Intelligence level below normal.

            The most frequent case of spina bifida is myelomeningocele. The defect, whether exposed or covered, should be corrected surgically in the first days of life to avoid complications such as infections in the nervous system.


7. Treatment

        There is no specific curative treatment for spina bifida.

        The first step in a child with spina bifida is the surgical correction of the lesion. The goal is not to restore the neurological deficit. If the child also suffers from hydrocephalus, it must be corrected immediately.

        The fundamental goal of treatment is to prevent infections and preserve the marrow and nerves from external aggressions.

        The measures that your doctor will adopt will be based on:

            Your baby's gestational age, general health status and medical history.

            Degree and type of spina bifida.

            Tolerance of the baby before specific medications.

            Your opinion.

        In many cases, a cesarean is performed to reduce the risk of harm to the baby.

        Babies born with a meningocele or a myelomeningocele usually require care in the neonatal intensive care unit for evaluation and necessary surgical treatment. Surgery may be helpful but can not restore function or sensitivity.

        Surgery may be necessary to:

            Repair and close the injury.

            Treatment of hydrocephalus.

            Orthopedic problems: hip dislocation, ankle and foot deformities, muscle contractions. Children with spina bifida tend to be more susceptible to bone fractures.

            Bowel and bladder problems.

        After surgery it is necessary to practice certain care:

            Careful examination of the skin, especially the contact areas such as the elbows, buttocks, back of the thighs, heel and areas of the foot. Recommendations include frequent change of position.

            Special care for urinary incontinence and bowel function.

            Close monitoring of baby nutrition.

            Stimulate activity and mobility for age-appropriate growth and development.

        Not all babies will require surgical treatment and care can be:

            Rehabilitation, placement of prostheses that help the child to sit, etc.

            Devices that prevent deformities or that serve as protection.

            Medication.

        Babies with spina bifida have a high risk of developing a latex allergy. The health teams will take the necessary precautions to avoid this problem as much as possible.

        Many children with myelomeningocele need training to control incontinence. Some require a catheter, or a tube that is inserted through the lower end of the urethra into the bladder, to allow urine to flow freely through the tube and the stream of urine can be directed to a container.

        Since spina bifida has no cure, all our activities have to be aimed at minimizing deformities and maximizing the child's abilities. A positive reinforcement will increase your self-esteem and promote your independence.

        The complexity of the problem is not understood immediately after birth, but is revealed as the child grows and develops.

    8. Prevention

        To prevent failures in the closure of the neural tube, it is recommended that every woman of reproductive age and that can become pregnant, consume folic acid, in order to reduce the risk of having an affected child with spina bifida or other defects of the tube. neural.

        Although folic acid can be found in certain foods such as fruits, vegetables, grains, etc., it is difficult to obtain the necessary amount of this vitamin from the diet alone. The common diet of many women does not contribute in any case more than 200 micrograms of folic acid. Therefore, the daily use of a multivitamin complex containing 400 micrograms of folic acid in its synthetic form is recommended. The synthetic form of folic acid is also easier to assimilate by the organism than said vitamin in its natural form.


. Physical education sessions aimed at children with spina bifida

        Next, we will develop three sessions, the first of a simpler level for children most affected by the disease, the second of a medium level and the third with a difficult level for children with a lower degree of affectation. In each session will work aspects such as: the aim, sports, sensitivity and arm hypertrophy.

        Session 1, easy level

            Adapted table tennis: It consists of passing the ball in an open space in the net, which will be identified by two tapes between which the ball must pass. The player loses so much that he is not able to return the ball. (Sport).

            Obstacle circuit: consists of a circuit that will have to finish in the shortest possible time going through various activities, as well as zigzag between cones, marksmanship ... etc. (Aim).

            The rhythm: it consists of marking a rhythm that the tutor sends with the different parts of the body, palms, hands to belly, legs, chest, etc. So the child with this activity, for example: two claps first, two more claps on the knees, two more claps on the knee and chest, etc. will develop or improve your perception and sensitivity, coordination, etc. (Sensitivity).

            We will form a circle with the children and we will give them objects of different sizes and weights so they can go through it. They should pass it as quickly as possible because at the teacher's signal every child who has an object in his hands will be "injured". After wounded he will come grave and finally dead. We will continue until there is only one player, who will be the winner (arm hypertrophy).

        Session 2, medium level

            Badminton: game that consists in hitting the wheel with a special racket, before it contacts the ground. A game adapted from the previous one is the one that consists of replacing the habitual steering wheel for a balloon and the rackets for pallets of table tennis. (Sport).

            Play sensitivity of different surfaces to touch with your hand blindfolded to guess what kind of material is. That one this morning. (Sensitivity).

            We will form groups of 5 students that will line up. Each group will take objects like those from session one, of different sizes and weight, to launch them. The teams that exceed the line that we will trace at a certain distance will win. Once finished we will change the objects for others to vary (Hypertrophy of arms).

            Shot to the target, each student with a plastic ball will try to strain it by the ring that his partner will hold. They will take turns every 5 shots. (Aim).

        Session 3, difficult level

            Billiards: practice on a rectangular table that has six holes placed on the bands; four in the corners and two in the middle of the longer bands. The game consists in introducing the balls by any hole. It does not take great energetic force but yes aim and affinity in the movements. (Sport).

            Draw a human body pointing to the main muscles and cut them out and then paste them on a poster board. Then we will form ranks and we will aim with darts at parts previously set by the teacher for aiming. (Aim).

            We will play the drunk bottle game. We will form groups of 6 people, it will be one. The one who keeps it will be in the middle of the circle formed by the rest and will have to drop to one side so that the companion located in that place where it is going will take it before falling and send it to another side.

                The children who form the circle will not be very far from the child who keeps it (arm hypertrophy).

            All blindfolded children should move in a small, protected space so there are no accidents. When they find a partner they should stop to touch it with their hands and thus try to guess who it is, first they will say one and then the other, they will open their eyes and check (Sensitivity).