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Chiari malformation

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    AMA Citation
    Chiari malformation. In: Shamus E. Shamus E(Ed.),Ed. Eric Shamus.eds. Quick Answers: Physiotherapy. McGraw-Hill; Accessed July 02, 2020. https://accessphysiotherapy.mhmedical.com/content.aspx?bookid=855&sectionid=49734315
    APA Citation
    Chiari malformation. Shamus E. Shamus E(Ed.),Ed. Eric Shamus. (2012). Quick Answers: Physiotherapy. McGraw-Hill. https://accessphysiotherapy.mhmedical.com/content.aspx?bookid=855&sectionid=49734315
    MLA Citation
    "Chiari malformation." Quick Answers: Physiotherapy Shamus E. Shamus E(Ed.),Ed. Eric Shamus. McGraw-Hill, 2012, https://accessphysiotherapy.mhmedical.com/content.aspx?bookid=855&sectionid=49734315.

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  • Arnold-Chiari malformation
  • Chiari II malformation
  • Arnold-Chiari II

  • 348.4 Compression of brain
  • 742.2 Congenital reduction for deformities of brain

Description

  • Defect in cephalad portion of spinal column
  • Herniation of portions of the brainstem and spinal cord through the foramen magnum, including the cerebellum, medulla, and cervical spinal cord

Essentials of Diagnosis

  • Characteristic signs and symptoms with diagnosis confirmed by MRI

General Considerations

Demographics

  • 90% of patients with Chiari malformation also have hydrocephalus
  • Three times more common in females than males2

Signs and Symptoms

Functional Implications

  • Delayed motor development
  • Difficulty swallowing
  • Poor balance

Possible Contributing Causes

  • Abnormality during fetal development
  • Teratogens
  • Possible genetic link
  • Infection
  • Insufficient maternal vitamins or minerals during gestation

Differential Diagnosis

Imaging

Medical Procedures

  • Geneticist
  • Neurologist
  • Orthopedic surgeon
  • Occupational therapist
  • Speech therapist
  • Admittance for surgical procedures, such as
    • Tracheostomy
    • Gastrostomy
    • Posterior fossa decompression
    • Cervical laminectomy

  • Delayed motor milestones
    • Rolling
    • Sitting
  • Decreased balance in sitting
  • Additional impairments typically associated with spina bifida

  • Therapy
  • Child should avoid activities associated with risk for cervical injury
  • Developmental activities to facilitate gross motor development
    • Prone on elbows
    • Rolling
    • Sitting
  • Balance training

  • Patient will be able to:
    • Stay prone on elbows for 30 seconds to increase strength in 2 months
    • Roll prone-to-supine and supine-to-prone independently to increase mobility in 3 months
    • Prop self with hands on floor for 30 seconds with stand-by assistance to increase upright activities in 4 months
    • Sit independently for 1 minute with stand-by assistance to improve balance in 1 month

  • No effect on lifespan following surgical repair

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1. The American Physical Therapy ...

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