Spina Bifida

Spina bifida

Spina bifida, a neural tube defect, is the result of the defective fusion of one or more posterior vertebral arches with results in protrusion of the contents of the spinal canal.

Classification

1. Spina bifida occulta

2. Spina bifida cystica
(a) Meningocoele
(b) Myelomeningocoele

1. spina bifida occulta
 The presence of an overlying midline skin defect, such as haemangioma, lipoma or a tuft of hair, points to an underlying spina bifida occulta.
It is rarely associated with neurological deficit.


2. spina bifida cystica
 there is a developmental deficiency of laminae, spinous processes and the overlying muscles and skin.

(a) Meningocoele: In this variety, usually the spinal cord and its nerve roots are intact, only the covering membrane (meninges) projects as a dural sac.

(b) Myelomeningocoele: the spinal cord is exposed to the surface as a plaque or nervous tissue.
 It is associated with muscle paralysis, sensory loss and paralytic deformities of the lower limbs.

Physiotherapeutic management 

Physiotherapeutic management includes the following:

1. Prevention and management of deformities
2. Management of muscle paralysis
3. Care of skin and joints
4. Management of bladder and bowel incontinence
5. Education in ambulation, and self-care

1. Prevention and management of deformities:
passive stretching and the use of night splints.
2. Management of muscle paralysis:

(a) Arm and shoulder girdle muscles. These should be developed for crutch walking and transfers.

(b) Functionally important weight-bearing muscles such as hip abductors and extensors