Spina Bifida

Total Page：16

File Type：pdf, Size：1020Kb

SPINA BIFIDA Case Study: This case study aims to bring together the components of physiotherapy assessment important for monitoring for neurological stability. Name: Trisha Age: 8 years Video Time: 45.40 – 57.26 Watch the following video of Trisha. Write out a summary of assessment findings for Trisha: Functional abilities: Gait: (with GRAFOs) Overuse of upper limbs when walking. Decrease pelvic control. Lateral trunk sway. Bilateral intoeing. Hips remain flexed throughout. Decreased active hip extension bilaterally Lumbar lordosis throughout gait cycle. Hip hitching of both legs to assist with foot clearance during swing. (Without GRAFOs) Further decrease in pelvic control and increased use of upper limbs. Increased base of support to accommodate the increase in intoeing when GRAFOs are removed. Increase hip and knee flexion throughout gait cycle. No heel strike (foot drop evident) Standing: (With GRAFOs) Flexion of hips and knees. Lordotic posture of lumbar spine. Reduced pelvic control and stability (Without GRAFOs) Increase in hip and knee flexion (crouch in stand). Decreased stability and control particularly at the ankle. Considerable difficulty standing still and maintaining her balance. Active flexion and extension of knees due to difficulty maintaining a static position and to assist with balance. SLS: (With GRAFOs) (L) & (R) Momentary only. Poor pelvic control and stability. Unable to maintain a level pelvis. (Without GRAFOs) unable to SLS Musculoskeletal Findings: Hips: (L) FFD 5 – 10 degrees (R) FFD 0-5 degrees Knees: NAD Feet: Reach plantargrade Internal Tibial Torsion (L) > (R) Spine: Lumbar Lordosis – not fixed Potential Problem Areas: 1. Need to monitor hip ROM and muscle length 2. Need to monitor spine and lumbar lordosis 3. Internal tibial torsion can make ambulation difficult, but at present is controlled by her orthotics. 4. Potential for knee problems due to trunk sway when walking 5. Significant energy expenditure when walking 6. Lower limb joint integrity due to gait pattern 7. Potential difficulty with participation in exercise and recreational acitivites. Plan: 1. Review 12 months unless concerns arise earlier 2. Education regarding monitoring for neurological stability and signs of deterioration 3. Skin care education 4. Education and discussion re appropriate mobility incorporating a balance between walking and use of wheelchair 5. Education re long term mobility and how to minimise the potential deterioration of lower limb joint integrity 6. Encourage participation in active recreational activities and maintaining fitness. .

Copy Link

Recommended publications

Spinal Deformity Study Group
Spinal Deformity Study Group Editors in Chief Radiographic Michael F. O’Brien, MD Timothy R. Kuklo, MD Kathy M. Blanke, RN Measurement Lawrence G. Lenke, MD Manual B T2 T5 T2–T12 CSVL T5–T12 +X° -X +X° C7PL T12 L2 A S1 ©2008 Medtronic Sofamor Danek USA, Inc. – 0 + Radiographic Measurement Manual Editors in Chief Michael F. O’Brien, MD Timothy R. Kuklo, MD Kathy M. Blanke, RN Lawrence G. Lenke, MD Section Editors Keith H. Bridwell, MD Kathy M. Blanke, RN Christopher L. Hamill, MD William C. Horton, MD Timothy R. Kuklo, MD Hubert B. Labelle, MD Lawrence G. Lenke, MD Michael F. O’Brien, MD David W. Polly Jr, MD B. Stephens Richards III, MD Pierre Roussouly, MD James O. Sanders, MD ©2008 Medtronic Sofamor Danek USA, Inc. Acknowledgements Radiographic Measurement Manual The radiographic measurement manual has been developed to present standardized techniques for radiographic measurement. In addition, this manual will serve as a complimentary guide for the Spinal Deformity Study Group’s radiographic measurement software. Special thanks to the following members of the Spinal Deformity Study Group in the development of this manual. Sigurd Berven, MD Hubert B. Labelle, MD Randal Betz, MD Lawrence G. Lenke, MD Fabien D. Bitan, MD Thomas G. Lowe, MD John T. Braun, MD John P. Lubicky, MD Keith H. Bridwell, MD Steven M. Mardjetko, MD Courtney W. Brown, MD Richard E. McCarthy, MD Daniel H. Chopin, MD Andrew A. Merola, MD Edgar G. Dawson, MD Michael Neuwirth, MD Christopher DeWald, MD Peter O. Newton, MD Mohammad Diab, MD Michael F.
[Show full text]
Lordosis, Kyphosis, and Scoliosis
SPINAL CURVATURES: LORDOSIS, KYPHOSIS, AND SCOLIOSIS The human spine normally curves to aid in stability or balance and to assist in absorbing shock during movement. These gentle curves can be seen from the side or lateral view of the spine. When viewed from the back, the spine should run straight down the middle of the back. When there are abnormalities or changes in the natural spinal curvature, these abnormalities are named with the following conditions and include the following symptoms. LORDOSIS Some lordosis is normal in the lower portion or, lumbar section, of the human spine. A decreased or exaggerated amount of lordosis that is causing spinal instability is a condition that may affect some patients. Symptoms of Lordosis include: ● Appearance of sway back where the lower back region has a pronounced curve and looks hollow with a pronounced buttock area ● Difficulty with movement in certain directions ● Low back pain KYPHOSIS This condition is diagnosed when the patient has a rounded upper back and the spine is bent over or curved more than 50 degrees. Symptoms of Kyphosis include: ● Curved or hunched upper back ● Patient’s head that leans forward ● May have upper back pain ● Experiences upper back discomfort after movement or exercise SCOLIOSIS The most common of the three curvatures. This condition is diagnosed when the spine looks like a “s” or “c” from the back. The spine is not straight up and down but has a curve or two running side-to-side. Sagittal Balance Definition • Sagittal= front-to-back direction (sagittal plane) • Imbalance= Lack of harmony or balance Etiology • Excessive lordosis (backwards lean) or kyphosis (forward lean) • Traumatic injury • Previous spinal fusion that disrupted sagittal balance Effects • Low back pain • Difficulty walking • Inability to look straight ahead when upright The most ergonomic and natural posture is to maintain neutral balance, with the head positioned over the shoulders and pelvis.
[Show full text]
The Genetic Heterogeneity of Brachydactyly Type A1: Identifying the Molecular Pathways
The genetic heterogeneity of brachydactyly type A1: Identifying the molecular pathways Lemuel Jean Racacho Thesis submitted to the Faculty of Graduate Studies and Postdoctoral Studies in partial fulfillment of the requirements for the Doctorate in Philosophy degree in Biochemistry Specialization in Human and Molecular Genetics Department of Biochemistry, Microbiology and Immunology Faculty of Medicine University of Ottawa © Lemuel Jean Racacho, Ottawa, Canada, 2015 Abstract Brachydactyly type A1 (BDA1) is a rare autosomal dominant trait characterized by the shortening of the middle phalanges of digits 2-5 and of the proximal phalange of digit 1 in both hands and feet. Many of the brachymesophalangies including BDA1 have been associated with genetic perturbations along the BMP-SMAD signaling pathway. The goal of this thesis is to identify the molecular pathways that are associated with the BDA1 phenotype through the genetic assessment of BDA1-affected families. We identified four missense mutations that are clustered with other reported BDA1 mutations in the central region of the N-terminal signaling peptide of IHH. We also identified a missense mutation in GDF5 cosegregating with a semi-dominant form of BDA1. In two families we reported two novel BDA1-associated sequence variants in BMPR1B, the gene which codes for the receptor of GDF5. In 2002, we reported a BDA1 trait linked to chromosome 5p13.3 in a Canadian kindred (BDA1B; MIM %607004) but we did not discover a BDA1-causal variant in any of the protein coding genes within the 2.8 Mb critical region. To provide a higher sensitivity of detection, we performed a targeted enrichment of the BDA1B locus followed by high-throughput sequencing.
[Show full text]
Osteodystrophy-Like Syndrome Localized to 2Q37
Am. J. Hum. Genet. 56:400-407, 1995 Brachydactyly and Mental Retardation: An Albright Hereditary Osteodystrophy-like Syndrome Localized to 2q37 L. C. Wilson,"7 K. Leverton,3 M. E. M. Oude Luttikhuis,' C. A. Oley,4 J. Flint,5 J. Wolstenholme,4 D. P. Duckett,2 M. A. Barrow,2 J. V. Leonard,6 A. P. Read,3 and R. C. Trembath' 'Departments of Genetics and Medicine, University of Leicester, and 2Leicestershire Genetics Centre, Leicester Royal Infirmary, Leicester, 3Department of Medical Genetics, St Mary's Hospital, Manchester. 4Department of Human Genetics, University of Newcastle upon Tyne, Newcastle upon Tyne; 5MRC Molecular Haematology Unit, Institute of Molecular Medicine, Oxford; and 6Medical Unit and 7Mothercare Unit for Clinical Genetics and Fetal Medicine, Institute of Child Health, London Summary The physical feature brachymetaphalangia refers to shortening of either the metacarpals and phalanges of the We report five patients with a combination ofbrachymeta- hands or of the equivalent bones in the feet. The combina- phalangia and mental retardation, similar to that observed tion of brachymetaphalangia and mental retardation occurs in Albright hereditary osteodystrophy (AHO). Four pa- in Albright hereditary osteodystrophy (AHO) (Albright et tients had cytogenetically visible de novo deletions of chro- al. 1942), a dysmorphic syndrome that is also associated mosome 2q37. The fifth patient was cytogenetically nor- with cutaneous ossification (in si60% of cases [reviewed by mal and had normal bioactivity of the a subunit of Gs Fitch 1982]); round face; and short, stocky build. Affected (Gsa), the protein that is defective in AHO. In this patient, individuals with AHO may have either pseudohypopara- we have used a combination of highly polymorphic molec- thyroidism (PHP), with end organ resistance to parathyroid ular markers and FISH to demonstrate a microdeletion at hormone (PTH) and certain other cAMP-dependent hor- 2q37.
[Show full text]
Failure to Maintain Segmental Lordosis During TLIF for One-Level
European Spine Journal (2019) 28:745–750 https://doi.org/10.1007/s00586-019-05890-w ORIGINAL ARTICLE Failure to maintain segmental lordosis during TLIF for one‑level degenerative spondylolisthesis negatively afects clinical outcome 5 years postoperatively: a prospective cohort of 57 patients Matevž Kuhta1 · Klemen Bošnjak2 · Rok Vengust2 Received: 14 June 2018 / Revised: 28 November 2018 / Accepted: 13 January 2019 / Published online: 24 January 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Purpose The present study aimed to determine whether obtaining adequate lumbar (LL) or segmental (SL) lordosis during instrumented TLIF for one-level degenerative spondylolisthesis afects midterm clinical outcome. Methods The study was designed as a prospective one, including 57 patients who underwent single-level TLIF surgery for degenerative spondylolisthesis. Patients were analyzed globally with additional subgroup analysis according to pelvic incidence (PI). Radiographic analysis of spinopelvic sagittal parameters was conducted pre- and postoperatively. Clinical examination including ODI score was performed preoperatively, 1 and 5 years postoperatively. Results Signifcant improvement in ODI scores at 1 and 5 years postoperatively (p < 0.001) was demonstrated. There was a signifcant correlation between anterior shift of SVA and failure to improve SL (p = 0.046). Moreover, anterior SVA shift correlated with increased values of ODI score both 1 and 5 years postoperatively. In low-PI group, failure to correct LL correlated with high ODI scores 5 years postoperatively (r = − 0.499, p = 0.005). Conclusions Failure to correct segmental lordosis during surgery for one-level degenerative spondylolisthesis resulted in anterior displacement of the center of gravity, which in turn correlated with unfavorable clinical outcome 1 and 5 years postoperatively.
[Show full text]
Scoliosis in Paraplegia
Paraplegia (1974), II, 290-292 SCOLIOSIS IN PARAPLEGIA By JOHN A. ODOM, JR., M.D. and COURTN EY W. BROWN, M.D. Children's Hospital, Denver, Colorado in conjunction with ROBERT R. JACKSON, M.D., HARRY R. HA HN, M.D. and TERRY V. CARLE, M.D. Craig Rehabilitation Hospital, Englewood, Colorado WITH the increasing instance of excellent medical care, more children with traumatic paraplegia and myelomeningocele with paraplegia live to adulthood. In these two groups of patients there is a high instance of scoliosis, kyphosis and lordosis. Much attention in the past years has been placed on hips and feet but only in the last decade has there been much attention concentrated on the treatment of the spines of these patients. Most of this attention has been toward the patient with a traumatic paraplegia with development of scoliosis. Some attempts have been made at fusing the scoliotic spine of myelomeningo celes by Harrington Instrumentation but with a rather high instance of complica tions and failures. With the event of anterior instrumentation by Dr. Alan Dwyer of Sydney, Australia, the anterior approach to the spine is becoming widely accepted and very successfully used. This is especially valuable in the correction and fusion of the spine with no posterior elements from birth. MATERIAL FOR STUDY Between March of 1971 and June of 1973, there have been 26 paraplegics with scoliosis who have been cared for by the authors. All of these patients have either been myelomeningoceles with paraplegia or spinal cord injuries, all of whom have had scoliosis, kyphosis, or severe lordosis.
[Show full text]
Physical Assessment of the Newborn: Part 3
Physical Assessment of the Newborn: Part 3 ® Evaluate facial symmetry and features Glabella Nasal bridge Inner canthus Outer canthus Nasal alae (or Nare) Columella Philtrum Vermillion border of lip © K. Karlsen 2013 © K. Karlsen 2013 Forceps Marks Assess for symmetry when crying . Asymmetry cranial nerve injury Extent of injury . Eye involvement ophthalmology evaluation © David A. ClarkMD © David A. ClarkMD © K. Karlsen 2013 © K. Karlsen 2013 The S.T.A.B.L.E® Program © 2013. Handout may be reproduced for educational purposes. 1 Physical Assessment of the Newborn: Part 3 Bruising Moebius Syndrome Congenital facial paralysis 7th cranial nerve (facial) commonly Face presentation involved delivery . Affects facial expression, sense of taste, salivary and lacrimal gland innervation Other cranial nerves may also be © David A. ClarkMD involved © David A. ClarkMD . 5th (trigeminal – muscles of mastication) . 6th (eye movement) . 8th (balance, movement, hearing) © K. Karlsen 2013 © K. Karlsen 2013 Position, Size, Distance Outer canthal distance Position, Size, Distance Outer canthal distance Normal eye spacing Normal eye spacing inner canthal distance = inner canthal distance = palpebral fissure length Inner canthal distance palpebral fissure length Inner canthal distance Interpupillary distance (midpoints of pupils) distance of eyes from each other Interpupillary distance Palpebral fissure length (size of eye) Palpebral fissure length (size of eye) © K. Karlsen 2013 © K. Karlsen 2013 Position, Size, Distance Outer canthal distance
[Show full text]
Diastematomyelia: a Treatable Lesion in Infancy and Childhood with Case Report J
Henry Ford Hospital Medical Journal Volume 3 | Number 3 Article 5 9-1955 Diastematomyelia: A Treatable Lesion In Infancy And Childhood With Case Report J. Dana Darnley Follow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournal Part of the Life Sciences Commons, Medical Specialties Commons, and the Public Health Commons Recommended Citation Darnley, J. Dana (1955) "Diastematomyelia: A Treatable Lesion In Infancy And Childhood With Case Report," Henry Ford Hospital Medical Bulletin : Vol. 3 : No. 3 , 130-135. Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol3/iss3/5 This Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Henry Ford Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons. For more information, please contact [email protected]. DIASTEMATOMYELIA: A TREATABLE LESION IN INFANCY AND CHILDHOOD WITH CASE REPORT J. DANA DARNLEY, M.D.'' It is our purpose to call attention to the tell-tale clinical and radiologic features of the above-named entity since, as expressed by Matson et al,^ "it constitutes good preventive medicine to carry out surgical treatment of diastematomyelia associated with spina bifida occulta at any time the diagnosis is made during infancy and early childhood." Early diagnosis and treatment is imperative, for what constitutes sound and successful prophylactic surgery on a patient of that age becomes more of an academic surgical exercise on the adult patient in whom fufl disability has long since been present. Diastematomyelia, by definition, means any fissuring of the cord, regardless of cause, extent, or internal appearance.2 Other terms, actually more specific, but used synonymously, include: diplomyelia, doubling, duplication, and pseudo-duplication of the cord—afl conveying Herren and Edwards' idea of form fruste twinning as the underlying pathogenesis.
[Show full text]
Reliability of Measuring Thoracic Kyphosis Angle, Lumbar Lordosis Angle and Straight Leg Raise with an Inclinometer
10 The Open Spine Journal, 2012, 4, 10-15 Open Access Reliability of Measuring Thoracic Kyphosis Angle, Lumbar Lordosis Angle and Straight Leg Raise with an Inclinometer Andrew S. Van Blommestein1, Jeremy S. Lewis2,3,4, Matthew C. Morrissey5, and Sian MacRae1,2,* 1Division of Applied Biomedical Research, School of Biomedical and Health Sciences; 2Therapy Department, Chelsea and Westminster NHS Foundation Trust, London, UK; and 3Physiotherapy Department, St George's Healthcare NHS Trust, London, UK; 4Musculoskeletal Services, Central London Community Healthcare, London, UK; 5Faculty of Health Sciences, University of Ljubljana, Slovenia Abstract: Purpose: Several non-invasive measurement methods have been described in the literature for recording thoracic kyphosis, lumbar lordosis and straight leg raise (SLR). However, attempts to quantify the reliability of the inclinometer in these measurements are scarce. In addition, existing reliability studies within the literature were found to use small sample sizes. The aim of this investigation was to examine the intra-rater reliability of the chief investigator (SM), in order to provide clinicians with data that will allow them to better measure sagittal spinal posture and SLR. A blinded test-retest design was performed to determine the intra-rater reliability of thoracic kyphosis, lumbar lordosis and SLR when assessed using an Isomed inclinometer in normals. Methods. Thirty asymptomatic subjects were assessed on two occasions separated by a time interval of 1 hour to reduce investigator memory bias. Thoracic and lumbar measurements were recorded in a relaxed standing position using an inclinometer; SLR of the dominant leg was assessed with subjects in the supine position. Intraclass correlation coefficients (ICC), 95% confidence intervals (CI), and standard errors of measurement (SEM) were analysed to determine measurement reliability.
[Show full text]
Complications and Radiographic Correction in Adult Scoliosis
Neurosurg Focus 28 (3):E7, 2010 Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation MATTHEW J. TOR M ENTI , M.D., MATTHEW B. MASERATI , M.D., CHRISTOPHER M. BONFIEL D , M.D., DAVI D O. OKONKWO , M.D., PH.D., AN D AD A M S. KANTER , M.D. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania Object. The authors recently used a combined approach of minimally invasive transpsoas extreme lateral in- terbody fusion (XLIF) and open posterior segmental pedicle screw instrumentation with transforaminal lumbar in- terbody fusion (TLIF) for the correction of coronal deformity. The complications and radiographic outcomes were compared with a posterior-only approach for scoliosis correction. Methods. The authors retrospectively reviewed all deformity cases that were surgically corrected at the Uni- versity of Pittsburgh Medical Center Presbyterian Hospital between June 2007 and August 2009. Eight patients underwent combined transpsoas and posterior approaches for adult degenerative thoracolumbar scoliosis. The com- parison group consisted of 4 adult patients who underwent a posterior-only scoliosis correction. Data on intra- and postoperative complications were collected. The pre- and postoperative posterior-anterior and lateral scoliosis series radiographic films were reviewed, and comparisons were made for coronal deformity, apical vertebral translation (AVT), and lumbar lordosis. Clinical outcomes were evaluated by comparing pre- and postoperative visual analog scale scores. Results. The median preoperative coronal Cobb angle in the combined approach was 38.5° (range 18–80°). Fol- lowing surgery, the median Cobb angle was 10° (p < 0.0001). The mean preoperative AVT was 3.6 cm, improving to 1.8 cm postoperatively (p = 0.031).
[Show full text]
Developmental Deviations in Posture
0350 ch 09-Box 10/11/04 05:31 PM Page 171 Chapter 9: Impaired Posture and Movement 171 DISPLAY 9-3 Developmental Deviations in Posture Feet • Flat arches are normal in the small child. • By age 6 or 7, expect good arch formation. Knees • Genu valgum is normal in a small child (about 2 inches between ankles is normal for an average-height child). • By age 6 or 7, genu valgum should be diminished or gone. • Postural genu varum in the school-age child is not acceptable, and corrective measures should be taken, because it is difficult to change in the young adult. • Genu varum may be compensatory for genu valgum by hyperextension of the knees. Hips • Femur medial rotation is the most common and often result from hip anteversion, foot pronation, knee hyperextension, postural genu varum, and, less often, genu valgum. Check for structural sources and treat with the appropriate corrective measures. • By adolescence, the femur should be in near-neutral alignment. • Femur lateral rotation is more common in young boys. • Persistent lateral rotation should be treated, because it can be detrimental in adulthood. Lumbopelvic Region • A protruding abdomen is normal for a child. • By the age of 10 to 12, the abdomen should no longer be protruding. • Lordosis peaks at age 9 to 10 and should gradually diminish thereafter. • Handedness patterns emerge in school-age children, most commonly with the hip high and shoulder low on the dominant side. This should be monitored if it is borderline or excessive. Shoulder Girdle • Scapular tilting is normal in school-age children.
[Show full text]
Issn: 2277–4998
IJBPAS, August, 2015, 4(8), Special Issue: 373-380 ISSN: 2277–4998 THE COMMON POSITIONAL ABNORMALITIES IN MALE STUDENTS UPPER AND LOWER LIMBS IN ELEMENTARY SCOOLS’ IN URMIA TOHID NEKOUKHAH*1, AMIR FIROUZI2, BEHZAD MAHMOUDIAN3, AFSHIN VALI LOU GEZELBASH4 AND KIYARASH MALEKI5 1Teacher of Physical Education, Khoy, Iran 2ShahidRajaee teacher trainingUniversity, Urmia, Iran 3Teacher of Physical Education, Urmia, Iran 4Department of Physical Education, Aliabad-e katul branch, Imam Khomeini technical faculty, Golestan, Iran 5Department of Physical Education, Jolfa International Branch, Islamic Azad University, Eest Azerbaijan, Iran *Corresponding Author: E Mail: [email protected] ABSTRACT The research suggests that the postural abnormalities are increasing, especially in young people. The spinal cord is known as main part of body and it has crucial and important role. However, any damage and deformation in this part of body will lead to dysfunction in function of body and lower limbs. This study aimed to investigate the common positional abnormalities in male and female students’ upper and lower limbs in elementary schools in Urmia. This was a descriptive-cross sectional study. The population consisted of 1462 male students in elementary schools in Urmia province. After screening the primary schoolchildren in Urmia in terms of physical abnormalities, the suspected students for deformity were selected as sample and were evaluated. The Adam's forward bend Test, mirror box, Caliper, the distance between disks in the knee, the distance between disks in inner ankle of foot, and checkerboard were used for checking scoliosis, checking PesCavus and PesPlanus, measuring Navi bone height, diagnosing Genu Varum, diagnosing Genu Valgum, and checking other abnormalities, 373 IJBPAS, August, 2015, Special Issue, 4(8) Tohid NeKoukhah et al Research Article respectively.
[Show full text]