Occupational & Physical Therapy Treatment for Spina Bifida

Rehabilitation for SB includes physical therapy, occupational therapy, and recreational therapy. Speech therapy may be suggested for patients with speech and swallowing difficulties. Physical therapy programs are designed to parallel the normal achievement of complete motor markers. Occupational therapy should be started early to compensate for motor skill deficits and should strengthen the normal developmental sequence. Recreational therapy is helpful to encourage independence by increasing play and recreational skills [1].

Spina Bifida Physical Therapy

General functional expectations have been developed for patients in each lesion-level group to help direct physical therapy targets appropriately from early childhood through maturity [1]. When dealing with cases of newborns with SB, the physical therapist makes a baseline of muscle function. As the child develops, the physical therapist monitors joint alignment, muscle imbalances, muscle contractions, posture, and signs of gradually increasing neurologic deficits. The physical therapist also provides caretakers with instruction in handling and positioning techniques, and recommends orthotic positioning instruments to stop the soft tissue contractures.

Video of some exercises for treatment of SB.

Different factors can affect the ability to ambulate for individuals with SB. The most salient factor found other than socioeconomic and therapeutic factors is the location of the malformation. Individuals who had a higher wound in the thoracic and upper lumbar spine are more likely to be in wheelchairs in comparison to those with lower lumbar and sacral malformations. Another important factor that affects the individual’s walking ability is the use of assistive instruments, whether it is a brace, crutches or a walker. In order to promote walking capability, an assistive device may be essential [2].

Spina Bifida Occupational Therapy

occupational therapy spina bifida, spina bifida occupational therapy treatment

Children with SB often have deficits in motor skills and in conducting activities of daily living (ADL). Early training to correct these deficits is beneficial. Upper-extremity stabilization and dexterous hand use require proper postural control of the head and trunk. In the first year of life, promotion of growth of these postural mechanisms or the use of passive support, if necessary, is needed to promote eye-hand coordination and manipulatory skills. When proper fine motor skills are attained the occupational therapist educates patients in the use of adaptive instruments and other methods of self-care. Other ADL programs for preschool- and school-aged children are also affective.

Spina Bifida Recreational Therapy

recreational therapy treatment spina bifida

Children with SB often experience limited play and recreational opportunities because of limited movements and physical restrictions[3]. This lack of activity decreases the urge for normal development in all areas and it can produce a negative effect on the patient’s dignity. For the infant and toddler with SB, recreational therapy increases chances for environmental exploration and interaction with other children. For the school-aged child, recreational therapy provides chances for participation in accommodated sports and exercise programs, which may result in a long-term interest in personal fitness and health. Recreational and physical fitness targets include enculturation, weight control, and improved fitness (e.g., flexibility, strength, working capacity, CVS fitness and coordination). Recreational therapy is helpful for encouraging independence with adult living skills and often is used to help the patient with shopping for and purchasing personal things, use of public transportation, and development of suitable activities [2].

Spina Bifida Speech Therapy

It is necessary to provide specialized care to patients who require rehabilitation services for a speech deficit due to SB. The latest techniques in manual therapy and neuromuscular electrical stimulation may be integrated as part of a comprehensive treatment plan for various speech deficits. A speech and language therapist is the trained person who evaluates and treats acute and chronic deficits in the areas of speech and language, cognitive-linguistic, and swallowing skills using the latest advances and methods of practice. Visits for evaluation should be according to the following schedule:

Visit no. Age
1st Newborn to 1-2 month
2nd 6 months
3rd 10-12 months
4th 18 months
5th 24 months
6th 3 years
7th 4 years
8th 5 years
9th 6 years
10th 10-17 years

 

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Reference

  1. Verhoef M, Barf HA, Post MW, van Asbeck FW, Gooskens RH, Prevo AJ. Functional independence among young adults with spina bifida, in relation to hydrocephalus and level of lesion. Dev Med Child Neurol 2006;48(2):114-9.
  2. Fujisawa D, Gois M, Dias J, Alves E, Tavares M, Cardoso J. Intervening factors in the walking of children presenting myelomeningocele. Fisioter 2011;24:275-83.
  3.  Bier JA, Prince A, Tremont M, Msall M. Medical, functional, and social determinants of health-related quality of life in individuals with myelomeningocele. Dev Med Child Neurol 2005;47(9):609-12.