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 onthe spine out side the body.Thatmay or may not comprise the Spinal Cord inside. TYPES OFSPINA BIFIDA There are threetypes of spina bifida: i.
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Myelomeningocele ii. Meningocele 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 ofspinal cord and nerves, outside the opening, somewhere on the spine at the backof baby. · This causes the damage of spinal cord and neves in the sackto get damage. Childrenwith myelomeningocele:· They have physical disabilities · The intensity of disabilities may range from moderate tosever.
· disabilities may include:o Movement inability o Inability to feel their legs or feeto incontinenceo Feel difficulty in going to the bathroom ii. Meningocele· also contains Fluid filled sack in the back of baby outsidean opening. · IN this condition there is not any part of the spinal cordpresent 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 asHidden spina Bifida· May not produce any disability and go unnoticed till laterin life.
· There is only a gap in spine and commonly no oprning in theback of baby. · No damage to the spine or spinal cord in this type CHILDRENWITH SPINA BIFIDA· Treatment focus in children with Spina Bifida is todetermine the extent of the symptoms and the development of disabilities.· This also focuses on how to prevent those disabilitieswhich can be prevented.· This requires the suitable and exact rehabilitation programand medical treatment which carry along the development of the child. · Positive attitude is mandatory for parents and clinicalprofessionals to mange the situation for longer time. This will develop thepositive outlook of the child. FACTORSAFFECTING THE EVENTUAL AMBULATORY STATUS OF CHILDREN WITH SPINA BIFIDAFactors which mayaffect 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 arethe basic measures to achieve the certain degree of functional and ambulationcapability.· It is very important to consider that the factors like o Contractures o Limited sitting balanceo Obesity maystrongly effect the walking ability of child either with or without orthosis.
· These factors along with the mother function level of childcan toughly influence the effectiveness of the orthotic management · As this is a complex major birth defect so the orthoticmanagement is challenging for orthosist. · A complete understanding of the Spina bifida can onlydevelop the achievable and considerable goals. · This must be very clear to the family to understand thetreatment 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).
Insuch situations, the orthotic goal should be to prevent the deformity bymaintain the appropriate alignment of joint to achieve reasonable musclebalance in development stage. This may result into proper weight bearing andmovement.