spina bifida & peabody motor scale

______ ______ is a birth defect / congenital malformation in which the vertebral column is open; often with spinal cord involvement

spina bifida

spina bifida occurs in utero around ___-___ weeks gestation

3-4

the degree to which neural elements are involved & the level of the spinal cord affected define the _______ of the loss of motor & sensory function around and below that level

severity

diagnosis during pregnancy → _______ ________ = a protein produced by the baby & measured by the amount in the mother's blood

alpha-fetoprotein (AFP)

true or false: low levels of AFP indicate spina bifida

false - high

diagnosis during pregnancy → ultrasound imaging displays either _____ sign or _____ sign

banana; lemon

(banana / lemon) sign displayed on ultrasound:

- chiari II malformation

- cerebellum is tightly wrapped around brainstem

- form of SB tethering that prevents downward migration of posterior brain

banana

(banana / lemon) sign displayed on ultrasound:

- chiari II malformation

- concavity of the frontal lobe

- also called scalloping of the frontal lobes

lemon

_________ is another procedure used to diagnose SB during pregnancy where a sample of the amniotic fluid can be taken & levels of AFP are measured

amniocentesis

exposed spinal cords are exposed to the toxicity of the ______ ______ which can result in the degradation of the arteries supplying the spinal cord

amniotic fluid

true or false: damage to the spinal cord is progressive, so the earlier the intervention, the better

true

true or false: early intervention cannot stop the leak of CSF from the spinal cord

false

what is the main risk factor for spina bifida?

reduced folic acid intake

the following are _____ _____ for spina bifida:

- maternal anticonvulsant therapy

- maternal obesity

- diabetes mellitus

- fungal infection

risk factors

which type of spina bifida?

- least serious & most common

- discovered only on xray or scan

- most people never become aware

occulta

which type of spina bifida?

- next most serious type

- meninges pass back through the opening of the spine

- cyst-like swelling forms

meningocele

which type of spina bifida?

- most serious type

- spinal cord is enclosed in the cyst

myelomeningocele

_________ is the clinically most significant type in which the spinal neural tube fails to close during embryonic development

myelomeningocele

in myelomeningocele, the vertebrae at the level of the lesion lack ______ ______, and so are incomplete dorsally

neural arches

in myelomeningocele, the protruding sac contains _____ fluid, _______ and ______ tissue

spinal; meninges; neural

true or false: the etiology of myelomeningocele is unknown, but may be due to a combination of genetics & environment

true

there appears to be a link between limited ______ and _____ _____ intake and neural tube defects such as MMC

vitamin; folic acid

a lesion in the spinal cord continues to leak CSF which causes a congenital brain malformation → _____ _____ ________

chiari II malformation

chiari II malformation → when the _______ is displaced inferiorly beyond the foramen magnum, causing partial blockage of CSF

brainstem

excessive CSF builds up in the ventricles, causing pressure on the CNS tissue that can further compromise brain development → which ventricle is build up commonly seen in?

4th ventricle

________ → an excessive accumulation of CSF dilating the cerebral ventricles after the primary spinal site is closed

hydrocephalus

effects of _______ include impairments in:

- speed of processing

- immediate registration

- learning & memory

- organization

- high level language

hydrocephalus

hydrocephalus → the cumulative pattern of ______ deficits over time becomes apparent as the child is expected to be more functionally independent

cognitive

________ - ________ ______ → plastic catheter that routes excessive CSF from ventricles to the peritoneal cavity to be reabsorbed

ventricular-peritoneal shunt

true or false: a VP shunt can become clogged, shift, or become dysfunctional because of child's growth

true

_________ → abnormal widening of the central canal due to increased pressure of the CSF over the spinal cord or a result of the chiari II malformation

hydromyelia

hydromyelia results in increased weakness in the ____ muscles; particularly in the _____

UE; hands

during growth, the spinal cord may _____ as a result of the development of adhesions or bony spurs at the lesion closure site

tether

spinal cord tethering → excessive ______ to the spinal cord can cause metabolic changes & ischemia of neural tissue with degeneration of muscle function

stretch

the following are signs of _____ ______ ________:

- change in sensation or continence

- inability to perform tasks that child was previously capable of

- spasticity in muscles with sacral nerve root innervation

- development of scoliosis at a young age

- reduced activity tolerance

spinal cord tethering

surgical intervention → the protruding tissue is removed & spinal opening is closed either in-utero (_______ repair) or shortly after birth (______ repair)

prenatal; postnatal

in-utero / prenatal repair at ____ weeks of gestation was found to decrease need for postnatal VP shunting & improve motor function

26

the following are risks after ______ repair:

- ruptured membranes

- preterm delivery

- unknown urologic function

prenatal

_________ → result of a spastic bladder wall; pressure from this spasticity causes urine to reflux toward the kidney

hydronephoresis

true or false: pressure injuries are common complications of spina bifida due to impaired sensation

true

in SB, there may be decreased cardiorespiratory endurance and apnea which may be caused by _______ dysfunction & limited mobility

postural

impairments to the ______ ______ in SB include:

- balance

- sensation in trunk, UE, and LE

- innervation to UE or LE (weakness or paralysis)

- bowel & bladder control

- proprioception

- visual deficits including decreased depth perception

nervous system

impairments to the ______ _____ in SB include:

- impaired posture & gait

- decreased UE & LE strength

- LE paralysis

- contractures

- scoliosis or kyphosis

- hip dislocation

musculoskeletal system

______ ______ ______ → superior dislocation of the talonavicular joint; also known as rocker-bottom foot deformity

congenital vertical talus

orthopedic abnormalities associated with SB include knee flexion or extension contractures & (varus / valgus) deformities in addition to IR or ER of the hips

valgus

cessation of ambulation occurs during the later years of the _____ ______ of life

first decade

true or false: the level of the lesion is a large factor in ambulation cessation

true

typically, the more _____ the lesion, the later ambulation cessation occurs

caudal

children with ______- level lesions should be encouraged to ambulate with appropriate orthoses and assistive devices

lumbar

physical therapy interventions focus on strengthening innervated muscles & teaching ________ movement patterns along with postural control

compensatory

which outcome measure is used to determine if discrepancy is present and to monitor motor skills?

peabody developmental motor scales -2 (PDMS-2)

the PDMS-2 assess _____ and _____ motor development

gross; fine

what is the age range for the PDMS-2?

birth - 5 years

which type of test is the PDMS-2?

norm-referenced