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LEARNING OBJECTIVES
Upon completion of this chapter, the reader will be able to:
Understand the etiology, incidence, and prevalence of spina bifida.
Understand the medical and surgical management of spina bifida throughout the life span and identify key factors that prompt referral to medical provider.
Understand neurologic, cognitive, musculoskeletal, and urologic problems associated with spina bifida.
Understand the role of the physical therapist throughout the life span for an individual with spina bifida.
Identify components of physical therapy evaluation and prioritize aspects of the evaluation based on age, setting, and medical status.
Understand anticipated functional outcomes and prognosis based on neurologic levels and identify factors that may have an impact on prognosis.
Recommend appropriate orthoses, assistive devices, and adaptive equipment for individuals with myelomeningocele based on level of lesion.
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Spina bifida is a complex, congenital condition associated with abnormalities of the brain and spinal cord with neurologic, cognitive, musculoskeletal, and urologic involvement. With improvements in prenatal screening, management of hydrocephalus, bowel and bladder function, and surgical techniques, people with spina bifida can live well into adulthood.1 Comprehensive multidisciplinary care has also led to improved health and quality of life for individuals with spina bifida. Multidisciplinary care may include, but is not limited to, medical providers, therapists, and mental health professionals. See Table 9-1 for members who may be a part of a multidisciplinary team. It is essential for the physical therapist to have an understanding of the multisystem involvement associated with spina bifida to provide comprehensive care. The body systems are interrelated, and changes in clinical presentation may be indicative of a change in medical status. It is beneficial for the physical therapist to have knowledge of the patient’s baseline level of function in order to identify any changes and potential need for referral to other medical providers. Understanding anticipated functional levels can guide treatment interventions to optimize participation in purposeful life activities. There is a shift from primarily managing medical conditions to focusing on long-term outcomes and quality of life for individuals with spina bifida.2-7 The physical therapist can support prevention of secondary impairments and promote independent participation in physical activities for a healthy lifestyle and improved quality of life.2,8
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A neural tube defect (NTD) occurs when there is a failure of the neural tube to close or a disruption in neurulation of the spinal placode during fetal development. Neurulation occurs within the first 28 days of gestation.4,9-11 The neural tube will eventually form the brain, spinal cord, and spinal column. Failure to ...