SPINA BIFIDASPINA BIFIDA

By: Adam BibbsBy: Adam Bibbs

Outline for PresentationOutline for Presentation Life story of JimmyLife story of Jimmy What is Spina Bifida?What is Spina Bifida? Signs and SymptomsSigns and Symptoms TypesTypes When to seek medical attention?When to seek medical attention? Screening and DiagnosisScreening and Diagnosis TreatmentTreatment Educational AssessmentEducational Assessment ConsiderationsConsiderations QuizQuiz

What is Spina Bifida?What is Spina Bifida? A condition that A condition that

refers to a refers to a developmental defect developmental defect of the spinal column of the spinal column in which the arches of in which the arches of one or more of the one or more of the spinal vertebrae fail spinal vertebrae fail to fuse. to fuse.

Failure of closure in Failure of closure in the midline or lower the midline or lower end of the neural end of the neural tube. (Cleft Spine)tube. (Cleft Spine)

Signs and SymptomsSigns and Symptoms SwellingSwelling Dimple in skinDimple in skin Truft of hairTruft of hair Muscle weaknessMuscle weakness Paralysis Paralysis Loss of a sensationLoss of a sensation Fluid build up (hydrocephalus)Fluid build up (hydrocephalus) Brain damageBrain damage SeizuresSeizures BlindnessBlindness Possibly none at allPossibly none at all

Secondary ComplicationsSecondary Complications

Low fitnessLow fitness ObesityObesity Poor functional strengthPoor functional strength Pressure soresPressure sores Respiratory difficultiesRespiratory difficulties Learning and Perceptual difficultiesLearning and Perceptual difficulties Motor functioning seizuresMotor functioning seizures

Types of Spina BifidaTypes of Spina Bifida

3 in 1,000 births3 in 1,000 births

1. Spina Bifida Occulta – an abnormality 1. Spina Bifida Occulta – an abnormality is confined to the vertebrae only and is confined to the vertebrae only and is due to an unclosed posterior is due to an unclosed posterior vertebral arch.vertebral arch.

2. Spina Bifida Cystica – A more severe 2. Spina Bifida Cystica – A more severe type of spina bifida that has two type of spina bifida that has two classifications.classifications.

OccultaOcculta

Approximately 40% of all Americans Approximately 40% of all Americans may have spina bifida occulta, but may have spina bifida occulta, but because they experience little or no because they experience little or no symptoms, very few of them ever symptoms, very few of them ever know that they have it.know that they have it.

CysticaCystica

Meningocele – Where the meninges Meningocele – Where the meninges protrude through the defect. (4%)protrude through the defect. (4%)

Myelomeningocele – Elements of the Myelomeningocele – Elements of the cord also protrude through the defect, cord also protrude through the defect, resulting in severe neural deficits. resulting in severe neural deficits. (96%)(96%)

1 out of 1,000 births 1 out of 1,000 births

What is Hydrocephalus?What is Hydrocephalus?

A common disease that occurs when A common disease that occurs when there is a build up of CNS fluid inside there is a build up of CNS fluid inside the brain that occurs when normal the brain that occurs when normal circulation is obstructed because the circulation is obstructed because the open spine permits the lower portion open spine permits the lower portion of the brain to slip through the of the brain to slip through the opening of the spinal cord.opening of the spinal cord.

Skull is stretchedSkull is stretched Damages brain cellsDamages brain cells

Causes of Spina BifidaCauses of Spina Bifida

Genetics and environmental factors.Genetics and environmental factors.

Low folic acid consumption by the Low folic acid consumption by the mother during pregnancy.mother during pregnancy.

When to seek medical attention?When to seek medical attention?

Before PregnancyBefore Pregnancy

During Pregnancy During Pregnancy

Right after birthRight after birth

When the doctor feels it is necessaryWhen the doctor feels it is necessary

Screening and DiagnosisScreening and Diagnosis Prenatal TestsPrenatal Tests

AFPAFPUltrasoundUltrasoundTesting of Amniotic fluidTesting of Amniotic fluid

EvaluationEvaluationAnalysis of individual medial historyAnalysis of individual medial historyPhysical examinationPhysical examinationEvaluation of critical body systemsEvaluation of critical body systems

Imaging StudiesImaging StudiesX-raysX-raysUltrasoundUltrasoundCT scanCT scanMRIMRI

Gait AnalysisGait Analysis

PreventionPrevention Recent studies have shown that one factor that increases the Recent studies have shown that one factor that increases the

risk of having an NTD baby is low folic acid status before risk of having an NTD baby is low folic acid status before conception and during the first few weeks of pregnancy. If all conception and during the first few weeks of pregnancy. If all women of childbearing age were to consume 0.4 mg of folic women of childbearing age were to consume 0.4 mg of folic acid prior to becoming pregnant and during the first trimester acid prior to becoming pregnant and during the first trimester of pregnancy, the incidence of folic acid preventable spina of pregnancy, the incidence of folic acid preventable spina bifida and anencephaly could be reduced by up to 75%.bifida and anencephaly could be reduced by up to 75%.

Folic acid, a common water soluble B vitamin, is essential for Folic acid, a common water soluble B vitamin, is essential for the functioning of the human body. During periods of rapid the functioning of the human body. During periods of rapid growth, such as pregnancy and fetal development, the body’s growth, such as pregnancy and fetal development, the body’s requirement for this vitamin increases. Folic acid can be requirement for this vitamin increases. Folic acid can be found in multivitamins, fortified breakfast cereals, dark green found in multivitamins, fortified breakfast cereals, dark green leafy vegetables such as broccoli and spinach, egg yolks, and leafy vegetables such as broccoli and spinach, egg yolks, and some fruits and fruit juices. However, the average American some fruits and fruit juices. However, the average American diet does not supply the recommended level of folic acid.diet does not supply the recommended level of folic acid.

With proper care, most children with SB live well into With proper care, most children with SB live well into adulthood.adulthood.

TreatmentTreatment No cureNo cure

Regular check ups Regular check ups with physicianwith physician

Surgery (24 hours Surgery (24 hours after birth)after birth)

MedicationMedication

PhysiotherapyPhysiotherapy

Assistive DevicesAssistive Devices

BracesBraces

CrutchesCrutches

Wheel chairsWheel chairs

SurgerySurgery

Usually performed with in 24 hours Usually performed with in 24 hours after birth.after birth.

They remove the infected area and They remove the infected area and replace it with muscle tissue and replace it with muscle tissue and skin.skin.

Helps protect against hydrocephalus.Helps protect against hydrocephalus.

Educational AssessmentsEducational Assessments IEPIEP

Children may have difficulty paying attention.Children may have difficulty paying attention.

Early intervention with children who experience learning problems Early intervention with children who experience learning problems can help considerably to prepare them for school.can help considerably to prepare them for school.

Successful integration of a child with spina bifida into a school Successful integration of a child with spina bifida into a school sometimes requires changes in school equipment or the curriculum.sometimes requires changes in school equipment or the curriculum.

Architectural factors should be considered.Architectural factors should be considered.

The child should be put in the least restrictive environment.The child should be put in the least restrictive environment.

To promote personal growth, families and teachers should To promote personal growth, families and teachers should encourage children, within the limits of safety and health, to be encourage children, within the limits of safety and health, to be independent and to participate in activities with their non-disabled independent and to participate in activities with their non-disabled classmates.classmates.

Physical/Health Educator Physical/Health Educator ConsiderationsConsiderations

Try to include students in all activities.Try to include students in all activities. Be aware of the students abilities and Be aware of the students abilities and

limitations.limitations. Plan for their needs.Plan for their needs. Make sure activities are age Make sure activities are age

appropriate.appropriate. Allow opportunities for self directed Allow opportunities for self directed

learning and experimentation.learning and experimentation.

Special ConsiderationsSpecial Considerations Be aware that there may be some times where Be aware that there may be some times where

the child can cause distractions and you will the child can cause distractions and you will need an aid to help control the class.need an aid to help control the class.

Be sensitive to bowel and bladder problems, Be sensitive to bowel and bladder problems, these can cause embarrassing situations.these can cause embarrassing situations.

Make sure students are involved because it is Make sure students are involved because it is often that children with this condition become often that children with this condition become over weight.over weight.

Focus on upper body activities because of the Focus on upper body activities because of the little or no mobility in the legs.little or no mobility in the legs.

Development depends largely on Development depends largely on environmental factors and setbacks that may environmental factors and setbacks that may disrupt functioning such as lengthy hospital disrupt functioning such as lengthy hospital stays, dependence, and poor self esteem.stays, dependence, and poor self esteem.

ExerciseExercise

A comprehensive program of physical A comprehensive program of physical activity is needed to maintain a activity is needed to maintain a healthy lifehealthy life

Intervention should occur as early as Intervention should occur as early as possible.possible.

Home based programs are needed to Home based programs are needed to teach parents how to exercise their teach parents how to exercise their baby’s feet and legs so they can walk baby’s feet and legs so they can walk with crutches, braces, and exercise is with crutches, braces, and exercise is also important for use of a wheel chair.also important for use of a wheel chair.

Activities and ExerciseActivities and Exercise

Body AwarenessBody Awareness Group PlayGroup Play Parachute activitiesParachute activities Upper body activitiesUpper body activities Strength trainingStrength training AquaticsAquatics FlexibilityFlexibility Relays Relays Wheel chair activitiesWheel chair activities

Goals of InterventionGoals of Intervention Teaching gross motor and spatial skills to Teaching gross motor and spatial skills to

facilitate coordination.facilitate coordination. Developing and maintaining fitness and flexibility Developing and maintaining fitness and flexibility

to emphasize self sufficiency.to emphasize self sufficiency. Encouraging movement and fitness to overcome Encouraging movement and fitness to overcome

susceptibility to obesity.susceptibility to obesity. Developing physical skills that generalize to Developing physical skills that generalize to

activities of daily living and vocational skills.activities of daily living and vocational skills. Promoting social development in recreational and Promoting social development in recreational and

group play activities, such as aquatics.group play activities, such as aquatics. Providing appropriate social outlets for enjoyment Providing appropriate social outlets for enjoyment

and self satisfaction on an individual basis as well and self satisfaction on an individual basis as well as with family or peers within the community.as with family or peers within the community.

Research being performedResearch being performed

The NINDS supports a broad range of The NINDS supports a broad range of research on neural tube defects such as SB research on neural tube defects such as SB aimed at finding way to treat, prevent, and, aimed at finding way to treat, prevent, and, ultimately, cure these disorders. Recent ultimately, cure these disorders. Recent studies have shown that the addition of folic studies have shown that the addition of folic acid to the diet of women of child bearing acid to the diet of women of child bearing age may significantly reduce the incidence age may significantly reduce the incidence of neural tube defects. Therefore it is of neural tube defects. Therefore it is recommended that all women of child recommended that all women of child bearing age consume 0.4 mg of folic acid bearing age consume 0.4 mg of folic acid daily.daily.

Organizations and further Organizations and further informationinformation

To see organizations and to get more To see organizations and to get more information visit:information visit:

(www.waisman.wiisc.edu/(www.waisman.wiisc.edu/~rowley/sb-~rowley/sb- kids/orgs.html)kids/orgs.html)

QuizQuiz

Directions: take out a blank sheet of Directions: take out a blank sheet of paper, number 1-5, and then answer paper, number 1-5, and then answer the questions below.the questions below.

1.1. What is spina bifida?What is spina bifida?2.2. What is the most common type of SB?What is the most common type of SB?3.3. Name 2 signs or symptoms of SB?Name 2 signs or symptoms of SB?4.4. Name 2 ways SB is treated?Name 2 ways SB is treated?5.5. Identify 4 considerations or things to Identify 4 considerations or things to

keep in mind with a child that has SB.keep in mind with a child that has SB.

ReferencesReferences Horvat, M., Eichstaedt, C., Kalakian, L., & Croce, Horvat, M., Eichstaedt, C., Kalakian, L., & Croce,

R. (2003). Develpmental/Adapted Physical R. (2003). Develpmental/Adapted Physical Education. Benjamin Cummings: San Francisco, Education. Benjamin Cummings: San Francisco, CA.CA.

Google images: Google images: www.goole.comwww.goole.com www.waisman.wisc.edu/~rowley/sb-kids/orgs.htmwww.waisman.wisc.edu/~rowley/sb-kids/orgs.htm

ll www.nichcy.org/pubs/factshe/fs12txt.htmwww.nichcy.org/pubs/factshe/fs12txt.htm www.emedicinehealth.com/articles/34669-4.aspwww.emedicinehealth.com/articles/34669-4.asp www.fortuneciity.com/miillenium/plumpton/268/swww.fortuneciity.com/miillenium/plumpton/268/s

b.htmb.htm www.niinds.nih.gov/disorders/spina_bifiida/spina_www.niinds.nih.gov/disorders/spina_bifiida/spina_

bifida.htmbifida.htm