Introduction:
One in a thousand pregnancies results in neural tube defects. Spina bifida mostly results from a familial history of neural tube defects or lack of folate levels in pregnant women. This condition can result in physical and intellectual disabilities. Physiotherapy plays an important role in managing Spina bifida, which can help patients make efficient and purposeful movements to render their daily tasks. By improving mobility, physical therapy can help build an independent future for patients. This article will discuss the role of physiotherapy in treating Spina bifida in detail.
What Is Spina Bifida?
A split or a gap in the spine (backbone) is referred to as Spina bifida and is an incomplete spinal cord formation due to the improper closure of the neural tube during the third and fourth weeks of pregnancy. This condition is normally diagnosed during the 20-week scan. It can result in open or closed spinal birth defects. The clinical presentation of open Spina bifida is generally severe and may result in lower limb weakness and paralysis, and lack of sensations. Types of Spina bifida are meningocele, myelomeningocele, and spina bifida occulta.
Spina Bifida Occulta:
This condition causes a split or gap in one or more spine bones. This condition often results in a closed spinal lesion. The symptoms of this condition are mild and often asymptomatic. They are often present with a visible mark over the lower back region, such as hair or a lump or purplish patches.
Myelomeningocele:
This condition is a severe Spina bifida with an open spinal lesion that protrudes through the back. The protruding sac contains cerebrospinal fluid and major blood vessels exposed without skin protection. Most patients with myelomeningocele develop hydrocephalus, a neurological disorder caused by excess cerebrospinal fluid build-up in the brain. Patients with this condition often develop paralysis and weakness of the lower extremities.
Meningocele:
This rare condition is characterized by open spinal lesions with a lump or sac in the back region. Surgical management of this condition can be performed without damaging any nerves.
What Are the Complications of Spina Bifida?
Spina bifida can result in various complications, such as
- Osteoporosis (this condition is caused when bone density and mass decrease).
- Obesity.
- Tethered cord syndrome (a neurological condition caused due to tissue attachment that results in restricted spinal cord movements).
- Urinary tract infection.
- Hydrocephalus (a neurological condition that develops due to the accumulation of cerebrospinal fluid in the brain cavities).
- Learning disabilities.
- Leg and core muscle weakness.
- Skin ulcers.
- Depression.
What Is the Physiotherapy Management of Spina Bifida?
Early management of children with this condition is important since the physical therapist can optimize the mobility of these patients and enable them to have an independent future. The physical therapist will thoroughly assess the patient's range of motion and muscle strength. This will allow the therapist to predict the type of problems the individual patients will face and the type of assistive devices they might require. The primary aims of physiotherapy management are
- Range of Motion: Once the surgical management of the condition is completed, physical therapy management is initiated in these patients, which will be performed twice to thrice daily. The therapist will tailor a home-based exercise program depending on the patient's extent of symptoms. Progression of these exercises will include more functional training to educate and train the patients on performing daily tasks. All these exercises are organized depending on the patient's age and clinical state. The exercise program will help maintain the range of motion of joints and flexibility in these patients, which can prevent the occurrence of muscle contractures.
- Muscle Strength: Physical therapy management involves resistance training exercises in patients with spina bifida to strengthen the weak muscles. Enhancing the strength and endurance of muscles with strengthening exercises has been shown to improve the functional abilities of patients.
- Handling Technique: Infant handling and positioning immediately after surgical management is important. The therapist will educate the patient's caretaker or parents on properly handling the infants. This technique may encourage the infant to lift his head, enhancing neck and head control.
- Mobility: The location of the split in the spine can determine the mobility impairment in patients with Spina bifida. The patients' mobility is affected more in cases of spina bifida in the thoracic spine (upper back) than in the lumbar spine (lower back). This can determine the need for assistive devices in these patients. The therapist encourages the parents to avoid assistive devices such as walkers that might delay motor development and educates them to hold them to support physically, and this can promote the control of the legs and the body.
Physical therapy management aims to promote the child's independence as they grow and perform their daily activities. The exercise program carried out by the physical therapist will be slowly educated to the caregiver and the parents. The physical therapy management and education to the caregiver or parents will promote confidence in their ability to manage the children with spina bifida.
What Are the Supportive Devices Required for Patients With Spina Bifida?
Once the child begins to mobilize independently, they are introduced to braces or splints to address the impairments of the muscle and joints. Orthoses such as braces and splints guide the patient's posture while standing and walking; therefore, they are introduced in the earlier stages. Patients with Spina bifida in the thoracic region may require orthosis that extends from the leg up to the level of the hip or chest (Hip-Knee-Ankle-Foot Orthoses). Other supportive devices, such as Knee-ankle-foot orthoses and Reciprocal Gait Orthoses, are provided to stabilize the knee, ankle, and foot and improve the normal rhythmic walking pattern.
Some children might require casting, which helps to improve the range of motion in tight joints. Some require crutches to aid in walking and to take off some stress in the legs. Wheelchairs may be introduced to patients with difficulties and limitations in walking.
Conclusion:
Spina bifida is a congenital condition characterized by incomplete spine formation due to improper neural tube closure. The gap or split in the spine can occur anywhere along the spine. The severity of the condition depends on the location of the gap and the involvement of the spinal cord and nerves. Treatment for spina bifida needs a multidisciplinary treatment approach. Physiotherapy is important in the management of this condition. The primary aim of physiotherapy is to improve the range of motion in joints, enhance muscle strength, Focus on motor development, and parent or caregiver education, encouraging independent mobility and participation in normal activities.
