• of spina bifida: i. Myelomeningocele ii. Meningocele iii.

•                    A neural tube defect

•                    Due to the incomplete development of the spinal cord , brain or meninges.

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•                    Occurs during development prior to birth.

•                    Commonly visible on back of newborn baby at birth.

•                    Can happen anywhere along side of Spine.

•                    It may also visible as an out growth, fluid filled sack on the spine out side the body.

 

That may or may not comprise the Spinal Cord inside.

 

TYPES OF SPINA BIFIDA

 

There are three types of spina bifida:

i.              Myelomeningocele

ii.             Meningocele

iii.            Spina bifida occulta

 

i.              Myelomeningocele : 

•                    severe type of spina bifida also termed as open spina bifia

•                    most common

•                    This condition includes a sack that contains the parts of spinal cord and nerves, outside the opening, somewhere on the spine at the back of baby.

•                    This causes the damage of spinal cord and neves in the sack to get damage.

 

Children with myelomeningocele:

•                    They have physical disabilities

•                    The intensity of disabilities may range from moderate to sever.

•                    disabilities may include:

o   Movement inability

o   Inability to feel their legs or feet

o   incontinence

o   Feel difficulty in going to the bathroom

 

ii.             Meningocele

•                    Also contains Fluid filled sack in the back of baby outside an opening.

•                    IN this condition, there is not any part of the spinal cord present in the sack.

•                    Due to this factor, there are not much nerve damages.

•                    This causes just minor disabilities among children.

 

iii.            Spina bifida occulta

•                    A mild kind of spina bifida.

•                    Sometime  termed as Hidden spina Bifida

•                    May not produce any disability and go unnoticed till later in life.

•                    There is only a gap in spine and commonly no oprning in the back of baby.

•                    No damage to the spine or spinal cord in this type

 

CHILDREN WITH SPINA BIFIDA

•                    Treatment focus in children with Spina Bifida is to determine the extent of the symptoms and the development of disabilities.

•                    This also focuses on how to prevent those disabilities which can be prevented.

•                    This requires the suitable and exact rehabilitation program and medical treatment which carry along the development of the child.

•                    Positive attitude is mandatory for parents and clinical professionals to mange the situation for longer time. This will develop the positive outlook of the child.

 

Factors which may affect the children with spina bifida and their treatment outcomes are:

(1)    visual and motor perception impairment

(2)    musculoskeletal deformity degree

(3)    sensory impairment

(4)    acquired obesity

(5)    existing muscle strength

(6)    neurological involvement level

(7)    patient motivation

(8)    family support

 

•                    Level of the motor function and the functional mobility are the basic measures to achieve the certain degree of functional and ambulation capability.

•                    It is needed to consider that the factors like

o   Contractures

o   Limited sitting balance

o   Obesity

may strongly effect the walking ability of child either with or without orthosis.

•                    These factors along with the mother function level of child can toughly influence the effectiveness of the orthotic management

•                    As this is a complex major birth defect so the orthotic management is challenging for orthosist.

•                    A complete understanding of the Spina bifida can only develop the achievable and considerable goals.

•                    This must be very clear to the family to understand the treatment process as well as role of the orthosis.

•                    Following are the specific factors

                                                                     i.            hip disorders (e.g., dislocation, subluxation, contractures),

                                                                   ii.            knee flexion/extension contractures,

                                                                  iii.            foot/ankle deformities (e.g., equinovarus, clubfoot).

•                    In such situations, the orthotic goal should be to prevent the deformity by maintain the appropriate alignment of joint to achieve reasonable muscle balance in development stage. This may result into proper weight bearing and movement.

 

                       

b.         Define congenital displacement of the hip and describe appropriate orthotic intervention.             (10)

 

•                    Also known as congenital hip dislocation or hip dysplasia.

•                    A condition in which the “Ball and Socket Joint of hip ” are not developed properly in babies and young children.

•                    Anatomically, the thigh bone is attached to the pelvis with the help of Hip joint. The head of the Femur (ball shaped round) sits inside the hip Socket ( Cup Shaped).

•                    When the hip socket is too shallow and it is not able to hold the femoral head tighly at place, the hip joint is loose which in server cases can cause the dislocation of the femoral head.

•                    One or both hips can be affected

•                    Left hip is more commonly involved

•                    More common in first born children and girls

•                    An early diagnosis and treatment of the problem can enable the most of children for normal development and max range of hip movement.

•                    If this condition left untreated, it may lead to multiple issues later on , which include:

o   Limping

o   Pain in the hip

o   Osteoarthritis / painful joints

 

CAUSES

•                    When Babies born in the breech position especially in the cases with feet up by the shoulders. DDH Ultrasound screeing is now recommended by the American Academy of Pediatrics for all female breech babies Family history of DDH (parents or siblings)

•                    Oligohydramnios – low levels of amniotic fluid

 

ORTHOTIC TREATMENTS:

For successful treatment of the CDH it is mandatory to understand the natural history of the disease. For abnormal neonatal hips , following are the possible outcomes:

1.                   May normalize

2.                   Dysplasia – may stabilize with abnormal development of acetabulam or femoral head

3.                   Subluxation

4.                   Dislocation

The treatment goals for CDH is

•                    To produce normal development of acetabulum and femoral head

•                    To achieve the concentric reduction of hip

•                    To reduce or avoid the associated complications due to treatment like infection, stiffness and Avascular necrosis of Femoral head

•                    To minimize and avoid the hardship to parents and the patient either, physical/emotional/financial.

Orthotic Interventions:

o   Frejka Pillow

•                    Used for abduction and flexion of the femurs

•                    Can be wear like diapers and harness by the straps and velcors

•                    Easy to use

•                    The out wared rotated postion keep the head of femur in  acetabulum.

o   Pavlik harness

•                    It’s a light weight soft fabric harness

•                    Can be put on under the babys vest next to skin

•                    Consists of chest strap, two shoulder straps and four leg straps

•                    This can be attached to the shoes of baby

•                    Used from birth to six month age

 

o   Von Rosen Orthosis

•                    passive restraining/positioning device.

•                    It is a malleableframe which was originally made with metal but now available in  plastic with straps around the shoulders, waist, and thighs.

o   Ilfled Orthosis

•                    A passive positioning device that holds  the hips in abduction but does not create significant hip flexion.

•                    More effective as postoperative abduction device than DDH Brace

•                    Two thigh cuffs attached to an adjustable cross bar.

•                    A waist strp to maintain positioning

 

o   Plastazote Hip Abduction Orthosis

•                    Made up of plastazote

•                    Light weight and easy to use

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