Spina Bifida Rehabilitation

What is Spina Bifida?

Spina Bifida; means split or open spine. It is one of the most common congenital diseases. The baby is born with an opening on the back. Different degrees of paralysis may occur depending on the location of the opening. The higher the opening, the more severe the paralysis will be. For this reason, some patients with Spina Bifida need less assistive devices (some do not use them at all), while others may even have to use a wheelchair.

Affected muscles may not only be muscles that allow movement. In the muscles that control urine and stool, they can participate in many patients.

More than 85% of patients with Spina Bifida experience a collection of fluid in the brain (big head). Since the skull bones in babies have not hardened yet, the head grows and tries to reduce the pressure. For this reason, if hydrocephalus is intervened before brain damage occurs, generally the intelligence levels of children with spina Bifida will not be affected.

What Causes Spina Bifida?

Spina Bifida is an anomaly that occurs in the first month of pregnancy in the womb. While the baby’s spine is taking shape, it does not fully close and for this reason, the picture known as “split spine disease” occurs among the people. It is not known exactly what causes it.

In Spina Bifida, nerves and membranes protrude through the open vertebrae, forming a lump on the baby’s back.

First of all, folic acid deficiency is blamed. Therefore, precautions should be taken in women and pregnant women who may become pregnant.

Spina Bifida is more common in caucasians and more common in women. The higher incidence of spina Bifida in the family brings to mind hereditary causes. The risk of giving birth to a baby with spina bifida again in future pregnancies is 15%. Some drugs used in epilepsy, such as valproic acid, are said to increase the risk of giving birth to a baby with Spina Bifida.

How Many Types of Spina Bifida Are There?

Spina Bifida occurs in the first 3 weeks of pregnancy and its incidence is approximately 0.15-0.3%. Although there are three types according to the severity of the disease and the problems it causes, when Spina Bifida is mentioned, myelomeningocele, the most severe type, comes to mind first.

• Spina Bifida Occulta is the most common and mildest form of the disease. Many people are not even aware of the disease. Often it is noticed as a result of an x-ray had for another purpose. A small portion of the bones in the spine are open and is also called closed spina Bifida. Usually it does not cause any discomfort and does not require surgery.

In rare cases, the spinal cord can be compressed and stretched. As a result, weakness in leg movements and urinary incontinence may occur. This is called tethered spinal cord syndrome.

• Meningocele is the rarest type of Spina Bifida. Since there are no nerves in this part, which comes out in the form of a sac, it does not cause serious problems. Some babies may have bladder and bowel problems, and rarely hydrocephalus.
• Myelomeningocele is the most serious and common type of Spina Bifida. The sac that comes out of the spinal bones also contains the spinal nerves. As a result, it may cause some problems such as partial paralysis, walking difficulty, hydrocephalus, urinary / fecal incontinence, advanced renal failure, and scoliosis.

What Are the Symptoms of Spina Bifida?

The involvement of the affected area, spinal cord membranes and nerves are among the factors that will determine the clinical symptoms.

Spina Bifida Occult is usually asymptomatic. Occasionally, visible findings can be found above the defect, such as an abnormal strand of hair, a small depression or a birthmark at the anomaly site.

In the meningocele, the membranes around the spinal cord protrude through the opening in the spine. Because the sac contains only liquid, it can rarely cause hydrocephalus and rarely bladder and bowel problems.

In myelomeningocele, the spinal canal remains open in the lower or middle part of the back, along many vertebrae. Inside this sac are both the membranes surrounding the spinal cord and the spinal cord or nerves. In the later stages of life, serious symptoms such as walking problems, leg deformities and bladder control may occur. Symptoms are characteristic according to the localization in patients. Partial paralysis, walking difficulty and hydrocephalus can be seen.

How Is Spina Bifida Diagnosed?

Spina Bifida can be diagnosed by amniocentesis, ultrasound and blood tests. In the triple test, AFP (alpha feto protein) values are higher than expected, increasing the possibility of Spina Bifida.

The triple test is applied between the 16th and 18th week of pregnancy. Also, Spina Bifida can be detected with a detailed ultrasound test to be performed in these weeks. When Spina Bifida is diagnosed, the skull, spine and other organs should also be examined thoroughly.

How Is Spina Bifida Treated?

If the birth of a baby with Spina Bifida is allowed, it should usually be operated within 36 hours after birth. With the operation, the sac on the back should be closed. In those who develop hydrocephalus, a drainage system called shunt operation should be applied to drain excess fluid from the brain into the blood circulation.

Surgeries are often applied to protect the current situation and prevent further problems. It is not possible for patients to recover completely after the operation. However, even if patients with Spina Bifida cannot become completely healthy, it is possible for them to live independently.

The application of some physiotherapy methods in the postoperative period will be especially beneficial in terms of strengthening the leg and waist muscles.

In rehabilitation, exercises (sitting, balance, walking exercises) should be done to strengthen muscles and prevent joint stiffness. Measures should be taken to prevent pressure wounds, and devices called orthoses to relieve leg weakness should be made. Urinary disorders (urinary incontinence and inadequate ejaculation) may occur in patients. In these cases, urine should be evacuated regularly with a catheter. In terms of kidney health, care should be taken against urine infections and leakage of urine into the kidney. Patients may also develop constipation and precautions should be taken.

Since the event is particularly in the lower spinal cord, there are paralysis of the legs and feet. However, these strokes are often loose. However, there may be defects in the hands due to the occurrence of hydrocephalus. The paralysis can become contractive.

Since these children are prone to obesity, attention should be paid to their diet, and foods such as soda, sugar, chocolate and wafers should not be given.