Spina Bifida - spinal levels with equipment needed and muscles innervated

For T-spine level lesions, will these kids walk?

no - if they do walk, it will only be supervised in PT for the purpose of exercise and they will need RGOs plus a reverse standing walker

For T-spine level lesions, what device will they need for mobility?

w/c for both community and household mobility

What is important to include in a PT PoC for T-spine lesions?

- standing program

- focus on achieving a straight spine, level pelvis, and symmetrical LEs

What do we expect if the lesion is at T10 or lower?

Good UE, neck, and upper thoracic strength - can self-propel w/c

Is the risk for cognitive involvement higher or lower for kids with T-spine lesions?

higher - think closer to the brain

Will L1 and/or L2 lesion require a w/c for mobility?

yes - both will need a w/c for community ambulation

What are needed for L1 and L2 lesions for household mobility?

KAFOs + walker or forearm crutches

- the KAFOs will keep knees in extension

What do we need to include in a PT PoC for lesions at L1 and L2?

standing program!

What muscles are innervated for a L1 lesion?

psoas major has some innervation, but is a MMT < 3/5

What muscles are innervated for a L2 lesion?

Psoas major, iliacus, sartorius, and pectineus are all now > 3/5 MMT

What equipment is needed for a L3 lesion?

- w/c might be needed for community mobility longer distances

- if quads are < 4/5 MMT, will need KAFOs

- if quads are =/> 4/5 MMT, need AFOs

- walker or forearm crutches

Do we need a standing program/stander for a L3 lesion?

no!

What muscles are innervated in a L3 lesion?

- hip flexors are strong

- hip rotators are weak

- knee extensors are at least 3/5 MMT

- sartorious, gracilis, quads are partially innervated

What equipment is needed for a L4 lesion?

- NO w/c

- NO stander

- AFO with posterior stop

- forearm crutches or canes

What muscles are innervated for a L4 lesion?

- knee extension is =/> 4/5 MMT

- some ankle DF and inversion (weak)

- tibialis anterior, fibularis tertius, TFL, glute med, and glute min are all partially innervated

What equipment is needed for a L5 lesion?

- NO w/c or stander

- canes

- AFOs with posterior stop

What muscles are innervated for a L5 lesion?

- hamstrings are partially innervated

- tibialis posterior, fibularis longus & brevis, extensor hallicus longus, flexor digitorum longus, flexor hallicus longus are all partially innervated

- fibularis tertius and extensor digitorum longus are almost fully innervated

What equipment is needed for a S1 lesion?

- no w/c

- no AD

- FO or AFO maybe

What muscles are innervated for a S1 lesion?

- hamstrings are almost fully innervated

- glute max, gastroc, and soleus are all partially innervated

What equipment is needed for a S2 lesion?

none!

- no w/c, AD, or orthotics