Spina Bifida

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors -Ally O'Bryan & Stephanie Smith from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Definition/Description

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Prevalence

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Characteristics/Clinical Presentation

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Associated Co-morbidities

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Medications

No specific medications are prescribed for the treatment of Spina Bifida.  Depending on the location of the protruding sac, the individual may require the use of an assistive device to aid in walking- such as braces, walker, crutches, or even a wheelchair

Diagnostic Tests/Lab Tests/Lab Values

Before Birth

• Alpha-fetoprotein blood test when 16-18 weeks pregnant  
• Ultra-sound of the spine  
• Maternal amneocentesis- amniotic fluid taken during pregnancy

After Birth

• X-ray, MRI, CT scan
• Meningocele and myelomeningocele are visible on physical exam  (path 840)
• Meningocele: protruding sac is transilluminated
• Myelomeningocele: no light shines through the protruding sac
  
  

Etiology/Causes

Pathology:

• Neural groove develops to form the neural tube around day 20 after conception. In normal development the upper end is supposed to close at day 25 and the lower end is supposed to close at day 27. Three opportunities could cause abnormal closure of the neural tube. If the hyaluronic acid matrix or actin microfilaments have abnormalities early on the neural tube will not close. If an overgrowth occurs over the caudal end the neural tube will not close, but this occurs later in development. The last chance occurs when the glycoproteins that typically hold the cells together during closure fail to adhere the tube together the tube will not properly close. (path 837)
  

There is no exact reason known for the cause of Spina Bifida, but there are a variety of environmental and gentic factors that may be potential risk factors.

Mother’s nutrition:

• Folic acid- less than 400 µg of folic acid per day - (neuro, spina bifida web)
• Increase of: Vitamin A, valproic acid, solvents, lead herbicides, glycol ether, clomiphene, carbamazepine, aminopterin, alcohol (pathology 837)

Genetic:

• 1.6%-3.3% increase of a child having spina bifida if the parents already have one child with the disease (path 837)

Environmental Factors:

• Radiation and viruses may have an impact on developing fetus
  

Systemic Involvement

Occulta and Meningocele: no neurological dysfunction typically present

Myelomeningocele: permanent neurological and musculoskeletal deficits present (all path 837) 

• Neurological: muscle weakness, bowel and bladder problems, seizures, paralysis  
• Musculoskeletal: hip dislocation, syringomyelgia, scoliosis, foot and ankle deformities 
  

Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

• Spina Bifida Association: www.spinabifidaassociation.org
  
• National Institute of Neurological Disorders and Stroke: disorders/spina_bifida/spina_bifida.htm
• Spina Bifida Resource Network: www.thesbrn.org/
• March of Dimes: www.marchofdimes.com/

Recent Related Research (from Pubmed)

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References

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