Neural Tube Defects and Cerebral Palsy

Development

The sequence of physical, psychosocial, and cognitive developmental changes that take place over the human lifespan

1. growth

2. differentiation

3. maturation

three aspects of change in development

neural tube defects

Abnormalities that derive from the embryonic neural tube

Failure of closure of the neural tube

Neural tube defect main abnormality:

4-6 weeks gestation

When doneural tube defects typically occur?

any part of the neural tube

Where can neural tube defects occur?

Genetic mutation

Main reason for neural tube defects

Antiepileptic (seizure) medications

What medications can contribute to neural tube defects?

Folic acid

Suppliment that can prevent neural tube defects. Regulated in food in canada.

At chilbearing age, before trying to start to conceive

When to start taking folic acid?

•Maternal obesity

•Maternal diabetes mellitus (uncontrolled)

•Low B₁₂ status

•Maternal hyperthermia

•Use of antiepileptic drugs (AEDs) in pregnancy

additional factors for neural tube defects [5]

Cranioschisis

NTD when the skull fails to close completely

Exencephaly

NTD when the brain forms outside of the skull

anencephaly

NTD with Absense of a large portion of the brain, skull, and scalp.

Rachischisis or spina bifida

NTD when sac on the skull forms that can have part of brain and nerve in it

Folic acid supplements (sufficient in multi-vitamin)

How to prevent neural tube defects

if history of pregnancies with spina bifida

when to increase folic acid dose (more than in mulitvitamin)

Spina bifida

congenital neural tube defect when failure of the neural tube to close during embryonic development at @ 28 days after conception

1. Spina bifida occulta

2. spina bifida cystica

two types of spina bifida

Spina bifida occulta

Spina bifida that is not visible externally

Spina bifida cystica

spina bifida with a sac-like protrusion on the back

1. skin depression or dimple

2. port-wine angiomatous nevus

3. tufts of dark hair

4. soft subcutaneous lipomas

Signs of spina bifida occulta:

1. problems potty training (weaker sphincters)

2. difficult learning to walk (altered gait, weaker feet, deformities)

later signs of spina bifida occulta, seen in 2-3 years: [2]

1. meningocele

2. myelomeningocele

Two types of spina bifida cystica

meningocele

Sac containing meninges and spinal fluid but no neural elements or neurological deficits

myelomeningocele

Sac contains meninges, spinal fluid, and nerves, even sometimes part of the spinal cord.

The location and magnitude of the defect, how big the sac is and how much is in the sac

How does myelomeningocele vary?

C-section to avoid rupturing the sac

how are myelomeningocele babies delivered?

infection

What is the priority nursing diagnosis if myelomeningocele sac ruptures?

ON their bellies in a warmed isolet to avoid rupture of the sac

How are myelomeningocele babies placed down?

Infection (iv antibiotics and rush to surgery)

What does it mean if the sac is green/yellow?

necrosis, dying (no oxygen)

What does it mean if the sac is black?

Wet dressing with plastic wrap over it to prevent it from drying out

dressing formyelomeningocele sac:

every 2-4 hours

How often to check the myelomeningocele sac:

Rectal prolapse

Why can’t myelomeningocele babies have rectal thermometer?

1. headache (crying)

2. seizure

3. projectile vomit

S+S of hydrocephalus in babies [3]

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can become constipated. Fiber, fluids, moement, may need fiber suppliments.

start a bowel regime/regular schedule so they can have a bowel movement

How to care for bowels of myelomeningocele baby

May need in and out catheter every 4 hours

How to care for bladder of myelomeningocele baby

•because of repeated exposure to latex products from multiple surgeries and repeated urinary catheterizations

Why might spina bifida babies have latex allergy?

1. banana

2. avocado

3. kiwi

4. chestnuts

Foods latex allergies might also be allergic to:

cerebral palsy

A group of permanent disorders of the development of movement and postures, causing activity limitations attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain

Children will not keep getting worse

What does it mean that CP is a non-progressie disorder?

CP

most common permanent physical disability in childhood

Existing prenatal brain abnormalities

CP is believed to result from:

Epilepsy

Children with CP may also likely have which condition?

1. Preterm babies

2. chorionamionitis

3. Brain injury

4. shaken baby syndrome

Babies more likely to have CP: [4]

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1. Neurological examination and history

2. neuroimaging

3. metabolic and genetic testing

How CP is diagnosed: [3]

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3 months (later could be a sign of CP)

When should babies be able to hold their head up and look around?

1. CP

2. reflux

an arched back in babies can indicate [2]

1. CP

2. autism

Failure to smile by 3 months can be a sign of [2]

6 months (later than 8 months could indicate CP)

When should babies be able to sit up?

8 months to one year. After this might be a sign of CP

When do primitive reflexes disappear?

Athetoid/dyskinetic CP

CP with Slow, wormlike movements of extremities, trunk, face, tongue and sometimes drool

Chorea

jerky involuntary movements worsen with emotional stress

1. hypertonicity

2. primitive reflexes

3. inadequate protective reflexes

4. altered speech quality

5. poor coordination

6. leg scissoring

7. persistent muscle contraction

Characteristics of spastic CP: [7]

leg scissoring

When legs are crossed tightly because muscles are so tight

Ataxic CP

CP with unsteady, wide gait and poor equilibrium and muscle coordination

Dystonic CP

CP with slow, twisting movements of the trunk or extremeties. Drooling and abnormal posture

Spastic

most common type of CP

1. delay in gross motor development

2. abnormal motor performance

3. alterations in muscle tone

4. abnormal posture

5. reflex abnormalities

6. associated disablities

Clinical manifestations of CP: [6]

1. vision problems

2. hearing problems

3. seizures

4. intellectual disabilities

5. epilepsy

Associated disabilities with CP: [5]

1. ID high risk infants

2. assess presence of primitive reflexes

3. neuro exam

4. developmental exam

CP assessment: [4]

Premature babies

babies at highest risk for CP

To correct contracture or foot drop

Possible surgery with CP:

1. Anti-spasm

2. pain meds

MEdications that may be needed with CP: [2]

More choking, lack of gag reflex. May need to physically support th jaw

Why might CP patients need a feeding tube?

new technologies, want them to go to school to be functioning adults

How to optimize education potential for atients with CP

1. hip dislocation

2. scoliosis

3. malnourishment

Complications of CP: [3]

1. establish locomotion, communication, and self-help skills

2. gain optimal appearance and integration of motor functions

3. correct associated defects as effetively as possible

4. provide educatinoal opportunities adapted to the childs capabilities

5. promote socialization experiences

Goals of CP therapy [5]

Diplegia

paralysis of both arms or both legs

Monoplegia

paralysis of one extremety

Triplegia

paralysis in three extremeties

Paraplegia

Pure cerebral paraplegia of lower extremeties

May clench jaw and grind teeth

Why focus on dental hygiene when patient has CP?

Help with drooling and tight spastic vessels

How can botox help with CP?

1. Low bed

2. bedrails

3. suction

4. oxygen

5. maybe helmet to bed

Seizure precautions: [5]

Assist the family in devising and modifying equipment/activities.

Medication administration

Safety precautions

Recreational activities

Support family

nursing care for CP: [5]