spina bifida

I am doing exercises with one girl. She is seven years old, and when she was born she had operation on the spine (dg: spina bifida).
She was in rehabilitation program for a year and her parents stop that.

I am working with her one year without improvement.
She has discrete paresis (weaknes) on the upper extremitie.
Her leg is worse, she has paresis of nervus peroneus and nervus tibialis.
I see improvement only on her posture (she had lordosis and "scapula alata"), but nothing more.
What to expect?
Do you have any ideas, maybe functional stimulation....?

Hi there !

You didn't really mention any previous functional goals, but from the bit of info I'd say that improved posture is not bad alredy! We don't even know whether she walks or not... so I assume she does but got a wheelchair as well...

I'd look at whether her orthotic prescription needs updating (she would at least have a foot-drop I guess), as well as her walking aids (walker, crutches, canes, any?), the usual gait and balance training, riding a trike, how functional is her walking, is she better off with a good wc? Then wheelchair positioning and mobility, if you got a "whirl-a-wheel" that's great fun, then scooting on the mat, mat PNF program, getting on and off the wc on her own, then hydro, pulley and ball throwing (heavy ones) for UL, send for hippo for even better posture...

Then of course a good rapport with the parents, reasonable expectations on outcome (common goals), then the kid having fun with you during therapy and there you go!

OK, Regards,

Henner

Henner,

I wasn't clear (you are right).
She can walk but with paretic way of walking (foot drop). And in that part of therapy I can't see improvement.
Her walking is as much bad as she has walked when first came to me.
I am doing PNF for strenght and Bobath for balance (her hip, knee and foot coordination in standing and walking) but maybe there is nothing more to do, or?
What is a "whirl-a-wheel"?
Parents don't want to go to hippo therapy but they are taking her to swim.
Any help about paretic walking?
Thank you very much

Hi!
You can't expect to get any better with the limping, that's the problem with spina bifida: she was probably having the worse type of, which means this part of the nerve(s) is not connected!
I suggest balance exercizes with orthopaedic boots made for her, to stabilize the ankles/feet, training of the remaining muscles on the same chain (see Kapandji). PNF is a good idea, add a lot of exercizes for hip and knee control.

Can Anyone answer this question?
One month old child with myelomeningocele in L3-L4. What voluntary movements she would present in supine?

dear collleague,

By googling spontaneous motor function infants spina bifida you will be able to find a lot of information on this subject.

Neonatal Loss of Motor Function in Human Spina Bifida Aperta -- Sival et al. 114 (2): 427 -- Pediatrics
is a full text article on neonatal loss of motor function
Evaluation of Motor Function in Young Infants by Means of th... : Pediatric Physical Therapy for information about the GM's (general movements)
An older article Elsevier and a recent one Elsevier by the same author

The general movements you may see will be dependent of the support the child is given.
For lots of information on SB I recommend going to Home-IF Spina Bifida Hydrocephalus /Hydrocefalie

kind regards

Esther