W1 PPT- Neuro2 - Neuroanatomy, SCI, & Myelomeningocele PDF

9/26/2024 Neurologic Interventions II (PTA 1015) Neuroanatomy PPT 1 Spinal Cord Injury and Myelomeningocele ©Stanbridge University 2024 1  9/26/2024...

9/26/2024 Neurologic Interventions II (PTA 1015) Neuroanatomy PPT 1 Spinal Cord Injury and Myelomeningocele ©Stanbridge University 2024 1  9/26/2024  At the completion of this chapter, the student will be able to: Neuroanatomy  Identify significant structures and functions within the spinal cord in the central nervous Lecture system. Objectives  Identify significant structures and functions within the peripheral nervous system ©Stanbridge University 2024 2  9/26/2024 Nervous System Peripheral Central Neuroanatomy Nervous System Components Autonomic Somatic Sympathetic Parasympathetic ©Stanbridge University 2024 3  9/26/2024 What lies beneath the arachnoid layer and what does that space contain? a) Subarachnoid Space – pia mater Quiz #1 b) Subdural Space – CSF c) Subarachnoid space – CSF d) Subdural Space - circulation ©Stanbridge University 2024 4  9/26/2024 Spinal Cord Meninges Martin & Kessler, 2016 ©Stanbridge University 2022 ©Stanbridge University 2024 5  9/26/2024 Spinal Cord Cross Section Image Via: https://aclandanatomy.com/MultimediaPlayer.aspx?multimediaid=10528251 ©Stanbridge University 2024 6  9/26/2024 Spinal Cord Communicates information (sensory and motor) between the brain and peripheral nerves Continuous with brain stem Housed in the vertebral column Below the conus medullaris (at L1) lies the cauda equina (nerve roots L2-S5) (Marieb, 2019) ©Stanbridge University 2022 Neuroanatomy Central Nervous System(CNS) ©Stanbridge University 2024 7  9/26/2024 Spinal Cord Composed of white and gray matter Contains tracts of nerve fibers that ascend and descend to and from the brain Dorsal/Posterior Horn= transmits sensory information Anterior/Ventral Horn= transmits motor information Neuroanatomy Central Nervous System(CNS) (Martin & ©Stanbridge University 2022 Kessler, 2016) ©Stanbridge University 2024 8  9/26/2024 Nerve Tracts Afferent tracts ▪ Carry information from the body to the brain i.e. Lateral Spinothalamic Tract Neuroanatomy Nervous System Efferent Tracts Components ▪ Carry information from the brain to the body i.e. Corticospinal Tract Information travels in fiber tracts via the nerves ©Stanbridge University 2024 9  9/26/2024 Tracts Group of nerve fibers that are similar in origin, destination, and function Travel in the white matter Neuroanatomy Afferent Tracts Central Nervous -Sensory System (CNS) Efferent Tracts - Motor ©Stanbridge University 2022 (Marieb, 2019) ©Stanbridge University 2024 10  9/26/2024 Neuroanatomy Central Nervous System(CNS) Fig 2-11 (Martin & Kessler, 2016) ©Stanbridge University 2022 ©Stanbridge University 2024 11  9/26/2024 Tracts Afferent Sensory Neuroanatomy Carries information about Central Nervous proprioception (position sense), System(CNS) vibration, two-point discrimination, deep touch, pain, light touch temperature, pressure ©Stanbridge University 2024 12  9/26/2024 Tracts- Afferent/ Sensory Neuroanatomy Dorsal Columns = carry information about Central Nervous proprioception (position sense), vibration, System(CNS) two-point discrimination, and deep touch Anterior/Lateral Spinothalamic tract = carry info re: pain and temperature ©Stanbridge University 2024 13  9/26/2024 Neuroanatomy Central Nervous System(CNS) Fig 2-11 (Martin & Kessler, 2016) ©Stanbridge University 2022 ©Stanbridge University 2024 14  9/26/2024  Tracts  Efferent  Motor  Primary motor pathway = Neuroanatomy Corticospinal Tract Central Nervous  Controls skilled movements of the extremities System(CNS)  Originates in the frontal lobe in the primary/premotor cortex, descends, and then synapses on the anterior horn cell of the spinal cord  Crosses from one side to another in the brain stem ©Stanbridge University 2024 15  9/26/2024 Neuroanatomy Central Nervous System(CNS) Fig 2-11 (Martin & Kessler, 2016) ©Stanbridge University 2022 ©Stanbridge University 2024 16  9/26/2024 Anterior Horn Cell A large neuron located in the gray matter of the spinal cord Activation of an anterior horn Neuroanatomy cell stimulates a muscle contraction Central Nervous 2 types: 1. Alpha motor neurons System(CNS) Innervates skeletal muscle 2. Gamma motor neurons Transmits impulses to the muscle spindle (Martin & ©Stanbridge University 2022 Kessler, 2016) ©Stanbridge University 2024 17  9/26/2024  Muscle Spindle  Sensory organ found in skeletal muscle that responds to stretch and provides feedback to the CNS re: muscle length  Example: Stretch Reflex Mechanism  Sensation = patellar tap  Neuroanatomy  Info taken to the dorsal root Synapses with anterior horn cell Central Nervous  Stimulation of the anterior horn cell = motor response = reflex contraction of the quads= knee ext System(CNS) ©Stanbridge University 2024 18  9/26/2024 Spinal Cord Injury (SCI) Central Nervous System Injury  Image Via: https://detiina.com/brain-spinal- cord-nervous-system/brain- spinal-cord-nervous-system- main-parts-of-the-cns-from-the- dvd-dissection-of-the-brain-and/ ©Stanbridge University 2024 19  9/26/2024 Discuss the causes, clinical manifestations, and possible complications of spinal cord injury Spinal Cord Differentiate between complete and incomplete types of Injury (SCI) spinal cord injuries Lecture Discuss the various levels of spinal cord injury Objectives Differentiate between various types of medication used in this population and their impact on therapy ©Stanbridge University 2024 20  9/26/2024 Spinal Cord Injury (SCI) Spinal Cord Circulation  Image Via: http://medicinespecifics.com/anterior- spinal-artery-syndrome/ ©Stanbridge University 2024 21  9/26/2024 Spinal Cord Injury (SCI) Spinal Cord Coverings Martin & Kessler, 2016 ©Stanbridge University 2024 22  9/26/2024 Etiology Spinal cord is severed most often due to a traumatic injury (MVA, sports injuries, gunshot wound, fall) Spinal Cord Injury (SCI) C1-C2, C5-C7, T12-L2 are the most often injured Movement (rotation) is greatest at these three segments leaving instability in these regions ©Stanbridge University 2024 23  9/26/2024 Traumatic= most often the result of direct or Mechanism of Injury indirect high velocity impact forces Spinal Cord Injury (SCI) Types of Injury: Cervical Flexion/ Rotation Cervical Hyperflexion Cervical Hyperextension Compression ©Stanbridge University 2024 24  9/26/2024 Types of Injury: 1. Cervical Flexion/Rotation Posterior spinal ligaments rupture Upper vertebrae displaced over lower vertebrae Transection of spinal cord Spinal Cord Rupture of intervertebral disc and anterior longitudinal ligament Injury (SCI) Martin & Kessler, 2016 ©Stanbridge University 2022 ©Stanbridge University 2024 25  9/26/2024 Types of injury: 2. Cervical hyperflexion Anterior compression fracture Stretching of posterior longitudinal ligament (not rupture) Wedge fracture severs anterior Spinal Cord spinal artery Causes incomplete anterior cord Injury (SCI) syndrome Martin & Kessler, 2016 ©Stanbridge University 2022 ©Stanbridge University 2024 26  9/26/2024 Types of injury: 3. Cervical Hyperextension Central cord type injury Compression of spinal cord between ligamentum flavum and vertebral body Spinal Cord Injury (SCI) Martin & Kessler, 2016 ©Stanbridge University 2022 ©Stanbridge University 2024 27  9/26/2024 Types of injury: 4. Compression Fracture of vertebral end plates Movement of nucleus pulposus into vertebral body Can also be caused from Spinal Cord osteoporosis, osteoarthritis, or RA Injury (SCI) Martin & Kessler, 2016 ©Stanbridge University 2022 ©Stanbridge University 2024 28  9/26/2024 Classification of SCI Tetraplegia (quadriplegia) Spinal Cord Injury (SCI) Injury to the cervical region Loss of motor and/or sensory function in the UE’s, LE’s, trunk and pelvis ©Stanbridge University 2024 29  9/26/2024 Classification of SCI Paraplegia Spinal Cord Injury to the thoracic spine Loss of motor and/or sensory function below the level of the injury Injury (SCI) Function in the UE’s is normal C. Cauda Equina InjuriesInjury to L1 vertebrae or below ©Stanbridge University 2024 30  9/26/2024 Neurological Level Definition: The most caudal segment of the spinal cord Spinal Cord with normal/intact sensory and anti-gravity motor Injury (SCI) function on both sides determined by testing dermatomes and myotomes “Normal” muscle function is defined by the lowest key muscle group with a grade of fair (3) as long as the key muscles above this are good(4) to normal(5) ©Stanbridge University 2024 31  9/26/2024 Neurological Level cont’d Table 12-1 p. 380, lists key muscles for for UE’s and LE’s (American Spinal Cord Spinal Injury association, known as ASIA, chose these m’s because they are consistently innervated by the designated Injury (SCI) segments of the spinal cord and easily tested in clinic setting) An individual may have partial innervation to up to 3 segments below the injury site ©Stanbridge University 2024 32  9/26/2024 Level Key Muscles C5 Elbow flexors (Biceps Brachii, Brachialis) C6 Wrist extensors (ECRL, ECRB) C7 Elbow extensors (Triceps Brachii) C8 Finger flexors (FDP) ASIA Key T1 Finger abductors (Abductor Digiti Minimi) Muscles L2 Hip flexors (Iliacus, Psoas Major) L3 Knee extensors (Quadriceps) L4 Ankle dorsiflexors (Tibialis Anterior) L5 Big Toe extensors (EHL) S1 Ankle plantar flexors (Gastrocnemius) ©Stanbridge University 2024 33  9/26/2024 Neurological Level cont’d The ASIA Standard Neurological Classification of Spinal Cord Spinal Cord Injury helps the clinician assess the extent Injury (SCI) and level of the injury – Figure 12-3 p. 381 Zone of preservation = the most caudal segment with some sensory or motor function (or both) Applies only to complete injuries ©Stanbridge University 2024 34  9/26/2024 ©Stanbridge University 2024 35  9/26/2024 Grade Impairment A = Complete No motor or sensory function is preserved in the sacral segments S4-5. B = Sensory Incomplete Sensory but no motor function is preserved below the neurologic level and includes the sacral segments S4-5. No motor is preserved more than three levels below the motor level on either side of the body. ASIA C = Motor Incomplete Motor function is preserved below the neurologic level, and more than half of key muscle functions below the Impairment neurologic level have a muscle grade less than 3/5. Scale D = Motor Incomplete Motor function is preserved below the neurologic level, and at least half of key muscle functions below the neurologic level have a muscle grade of 3/5 or more. E = Normal Motor and sensory functions are normal in all segments, and the patient had prior deficits. ©Stanbridge University 2024 36  9/26/2024 Complete = sensory and ASIA motor function Spinal Cord ABSENT below Injury (SCI) =A the level of the injury and in S4/5 ©Stanbridge University 2024 37  9/26/2024 Types of Lesions cont’d Incomplete =preservation of of some motor and some sensory below the neurological level and in S4/5 Sacral sparing =sacral tracts salvages allowing for perianal sensation and voluntary rectal control Spinal Cord Abnormal tone Injury (SCI) Spasticity ASIA B, C, D ** Perianal sensation must be present for a lesion to be incomplete ©Stanbridge University 2024 38  9/26/2024 Brown-Sequard Syndrome Results from half of the spinal cord being injured Spinal Cord Loss of motor function, proprioception, and vibration on the Injury (SCI) same side of the injury Loss of pain and temperature on Spinal Cord the opposite side of the injury a few Martin & Kessler, 2016 Syndromes - levels below Good prognosis Incomplete Potential for independence with ADL’s and continent with bowel and bladder ©Stanbridge University 2024 39  9/26/2024 Anterior Cord Syndrome Results from a flexion injury to the cervical spine Spinal Cord Loss of motor, pain and Injury (SCI) temperature sensation bilaterally below the level of the injury Spinal Cord Position sense and vibration Syndromes - remains intact below the level of Incomplete the injury Prognosis is poor because all voluntary motor function is lost Martin & Kessler, 2016 ©Stanbridge University 2024 40  9/26/2024 Central Cord Syndrome Most common incomplete injury Results from progressive stenosis or compression as a result of a Spinal Cord hyperextension injury, bleeding into the central gray matter Injury (SCI) UEs are more affected than the LE’s Spinal Cord Motor impairment Sensory more variable Syndromes- Bowel, bladder and sexual function are Incomplete preserved if the sacral portions are spared Functional independence depends on the amount of UE innervation the Martin & Kessler, 2016 patient regains ©Stanbridge University 2024 41  9/26/2024 Posterior Cord/Dorsal Column Syndrome Rare incomplete injury Spinal Cord Results from damage to the Injury (SCI) posterior spinal artery by a Spinal Cord tumor or vascular infarct Syndromes - Loss of ability to perceive proprioception and vibration Incomplete Ability to move and perceive pain remains intact Martin & Kessler, 2016 ©Stanbridge University 2024 42  9/26/2024 Cauda Equina Injury Results from a direct trauma from a fracture- Spinal Cord dislocation below L1 Injury (SCI) Results in an incomplete lower motor neuron Spinal Cord (LMN) injury Syndromes Flaccidity, areflexia, loss of bowel and bladder * Regeneration of involved peripheral nerve root is possible, depending on extent of initial damage. ©Stanbridge University 2024 43  9/26/2024 Spinal Cord Injury (SCI) Conus Medullaris Syndrome Spinal  Flaccid paralysis  Areflexic bowel and bladder Cord  Sometimes sacral reflexes are present Syndromes ©Stanbridge University 2024 44  9/26/2024 Spinal Cord Injury Review Table 12-4 page Functional outcomes 406 following SCI depend on (SCI) motor/sensory function Functional “Key Muscles by preserved, level of injury, & Outcomes Segmental Innervation” type of injury in addition to many other factors including: – Age Innervation of key – Patient’s general health muscle groups allows prior patients to achieve a – Body build – Support Systems certain amount of skill – Financial security and functional – Motivation independence – Pre-existing personality traits ©Stanbridge University 2024 45  9/26/2024 Spinal Cord Injury (SCI) Potential for Function Functional Strength of a muscle must be Fair (3/5) in Outcomes order to perform a functional activity Table 12-5 provides a review of functional potentials based on level of injury (refer to book) ©Stanbridge University 2024 46  9/26/2024 Spinal Cord Injury (SCI) C1-3 Functional Little (C3) to no (C1, C2) innervation to Outcomes the diaphragm- will require mechanical ventilation Totally dependent for ADL’s requiring fulltime caregiver Will need a power w/c which can be operated chin cuff ©Stanbridge University 2024 47  9/26/2024 http://www.yo utube.com/wa tch?v=Vbwz6 t-ojJU ©Stanbridge University 2024 48  9/26/2024 C4 Spinal Cord Injury Some innervation to the diaphragm and (SCI) therefore may not need a ventilator Functional Will need a power w/c that can be operated Outcomes with a chin cup/chin control/mouth stick & should have enough neck ROM (at least 30 degrees of cervical motion) Continue to require full time caregiver because they are dependent for transfers and ADL’s (maxA for bed mobility) ©Stanbridge University 2024 49  9/26/2024 https://www.y outube.com/w atch?v=RR8 mdrh3bRE ©Stanbridge University 2024 50  9/26/2024 C5 Innervation to deltoid, biceps brachii, brachialis, lateral shoulder rotators and rhomboids present, however may not have 5/5 strength Spinal Cord Injury in all muscles (SCI) Functional Should be able to flex and abduct the shoulders, flex the elbows, and Outcomes adduct the scapulae which should allow the patient to: ▪ Raise arms to assist with rolling ▪ Bring hands to mouth Able to operate power w/c with hand control or manual w/c with rim projections May be indep. with some self care act’s but will need set up from a caregiver Will need adaptive equipment including splints and built up ADL devices to perform ADL’s Moderate assistance for bed mobility Maximal assistance with sliding board or sit pivot transfer Can perform independent pressure relief by leaning forward in w/c with loops attached to back of w/c ©Stanbridge University 2024 51  9/26/2024 https://www.y outube.com/w atch?v=7Vgc WWkEdL4 ©Stanbridge University 2024 52  9/26/2024 Spinal Cord Injury C6 (SCI) Functional Innervation to the wrist Ext Carpi Radialis Longus and Brevis, Outcomes Pec Major (clavicular portion) and Teres Major, allows for independent rolling, feeding, and UE dressing Can propel manual wheelchair with rim projections Potential for independent sliding board transfers and pressure relief via weight shift side to side May need assist in am/ pm with ADL’s and with commode transfer Assist needed for LE dressing Able to drive a vehicle with adaptive controls and work outside the home ©Stanbridge University 2024 53  9/26/2024 https://www.y outube.com/w atch?v=Hzw9c ZDhYRo ©Stanbridge University 2024 54  9/26/2024 https://www.y outube.com/w atch?v=0zcsyE gsBUo ©Stanbridge University 2024 55  9/26/2024 https://www.y outube.com/w atch?v=yDDS H3hbdPc ©Stanbridge University 2024 56  9/26/2024 C7 Spinal Cord Injury Potential to live independently (SCI) Functional Triceps, latissimus dorsi and pronator teres innervation therefore can lift themselves up during transfers and do Outcomes w/c push-up for pressure relief Independent w/ self care act’s is possible including UE & LE dressing Can be independent with all transfers with and without a sliding board Able to perform self ROM on LE’s ©Stanbridge University 2024 57  9/26/2024 https://www.y outube.com/w atch?v=6XPB 2jWScIM ©Stanbridge University 2024 58  9/26/2024 Spinal Cord Injury (SCI) C8 Functional Flexor carpi ulnaris, extensor carpi ulnaris, hand intrinsic Outcomes innervation present, flexor digitorum profundus In addition to all the things a C7 injury patient can perform, this patient can perform wheelies and negotiate a 2-4 inch curbs in the w/c ©Stanbridge University 2024 59  9/26/2024 Spinal Cord Injury (SCI) T1-8 Functional Hand intrinsics, top half of intercostals, pectoralis major Outcomes (sternal portion) innervation is present Increased motor return in thoracic region allowing for improved trunk control, posture, breathing capabilities Can transfer to the floor from w/c Able to perform therapeutic ambulation = walking for physiologic benefits that standing and weight bearing provides ©Stanbridge University 2024 60  9/26/2024 https://www.yout ube.com/watch? v=O3FDqTyVfqI ©Stanbridge University 2024 61  9/26/2024 Spinal Cord Injury (SCI) T9-11 Functional Outcomes Abdominals innervated In addition to the functional abilities of all of the above, these patients are able to initiate a cough Therapeutic ambulation with orthoses and assistive devices may be possible ©Stanbridge University 2024 62  9/26/2024 https://www.yout ube.com/watch? v=sZg0Mrag9g Q ©Stanbridge University 2024 63  9/26/2024 Spinal Cord Injury (SCI) T12-L2 Functional Quadratus lumborum, Iliacus, Psoas Outcomes Major partially innervated Household ambulation with orthoses and assistive devices may be possible Wheelchair for community mobility ©Stanbridge University 2024 64  9/26/2024 Spinal Cord Injury L3 (SCI) Presence of full Iliopsoas innervation improves Functional patient’s capability to ambulate Outcomes Should be independent with household ambulation with orthoses and device May be independent at community ambulation with orthoses and device KAFO will be necessary – only partial quadriceps innervation ©Stanbridge University 2024 65  9/26/2024 https://www.youtube.com/wat ch?v=8djXFiM2oQg&t=5s ©Stanbridge University 2024 66  9/26/2024 Spinal Cord Injury (SCI) Functional Outcomes L4-5 Quadriceps and medial hamstrings innervation present Independence with all ADL’s, functional act’s and gait Can ambulate (may be independent) in the community with assistive device and orthotics (AFO) ©Stanbridge University 2024 67  9/26/2024 Spinal Cord Injury (SCI) S1-2 Functional Plantar flexor and gluteus maximus innervation present Outcomes Independence with all ADL’s, functional act’s and gait Can ambulate (may be independent) in the community with or without assistive device and orthotics (articulated AFO) ©Stanbridge University 2024 68  9/26/2024 A patient has a loss of proprioception and vibrational sense below the level of lesion. What type of spinal cord injury does this patient have? A) Central Cord Syndrome Quiz 1 B) Dorsal Column Syndrome C) Anterior Cord Syndrome D) Brown-Sequard Syndrome ©Stanbridge University 2024 69  9/26/2024  Someone with a C7 SCI will have the functional potential to be which of the following: Quiz #2  A) Independent with household ambulation with orthoses and AD  B) Independent with wheelchair wheelies and curb negotiation  C) Independent with transfers without a sliding board  D) Independent with transferring to and from wheelchair to floor ©Stanbridge University 2024 70  9/26/2024  A person with a T12-L2 SCI will have the functional potential to do which of the following: Quiz #3  A) Household ambulation with an AD and HKAFO or RGO  B) Community ambulation with an AD and HKAFO or RGO  C) Community ambulation with or without an AD and/or an AFO  D) Household ambulation with a KAFO and an AD ©Stanbridge University 2024 71  9/26/2024 Medication – vasopressors and mineralocorticoids – for Orthostatic Hypotension Medications (NSAIDs, Spinal Cord Medical acetaminophen, gabapentin (treats nerve pain), Lyrica (treats nerve pain), Injury (SCI) Management analgesics) Common Side Effects: drowsiness, loss of appetite, dizziness, decreased coordination, upset stomach ©Stanbridge University 2024 72  9/26/2024 Anticoagulants such as Coumadin/Heparin Side Effects: severe bleeding, red or brown urine, black or bloody stool, severe headache, stomach pain, joint pain, swelling in the joints, dizziness and Spinal Cord Medical weakness, vision changes Injury (SCI) Management Drug therapy – NSAIDs for prevention; Bisphosphonates for reduction of existing HO Side Effects of Bisphosphonates – bone/joint/muscle pain, nausea, difficulty swallowing, heartburn, gastric ulcer ©Stanbridge University 2024 73  9/26/2024 Spinal Cord Medical Interventions Injury (SCI) Stabilization of the spine to prevent further spinal cord damage Stabilization could be through surgery or through external fixation, cervical collar, or a rigid body jacket ©Stanbridge University 2024 74  9/26/2024 After stabilization, surgery is indicated in the following cases: 1.To restore alignment of body structures 2.To decompress neural tissue 3.To stabilize the spine by fusion or instrumentation Spinal Cord 4.To minimize deformities Injury (SCI) 5.To allow the individual earlier opportunities for mobilization ** Bony fusion occurs in 6-8 weeks ©Stanbridge University 2024 75  9/26/2024 Aspen Collar Halo Vest Philadelphia Custom-made Collar body jacket Martin & Kessler, 2016 ©Stanbridge University 2024 76  9/26/2024  Image Via: Myelomeningocele https://commons.wikimedia.org/wiki/File:Typesofspinabifida.jpg ©Stanbridge University 2024 77  9/26/2024  Describe the incidence, prevalence, etiology, and Myelomening clinical manifestations of myelomeningocele. ocele  Describe common complications seen in children with myelomeningocele. Lecture  Discuss the medical and surgical management of Objectives children with myelomeningocele. ©Stanbridge University 2024 78  9/26/2024 Definition: a complex congenital anomaly that primarily affects the nervous system Caudal end of the neural tube fails to close the 28th day of gestation resulting in abnormal tissue growth In addition, the posterior vertebral arches fail to close Myelomeningocele in midline to form a spinous process = Spina Bifida (MMC) Review from PTA 1011 – Review on Your Own ©Stanbridge University 2024 79  9/26/2024 Spina bifida = both the bony defect and the various forms of myelodysplasia Spina bifida occulta = bifid spine in isolation with no involvement of the spinal cord or meninges Types of Spina bifida cystica = visible cyst protruding from Spinal the opening caused by the bony defect Defects Spinal bifida aperta = cyst protrudes from the opening caused by the bony defect, but is covered with skin or meninges Review from PTA 1011 – Review on Your Own ©Stanbridge University 2024 80  9/26/2024 Meningocele = cyst is covered by meninges and contains only CSF Myelomeningocele = spinal cord is present in the cyst Types of Anencephaly = failure of brain to develop past the Spinal brain stem (usually results in death) Encephalocele = brain tissue protrudes from the Defects skull (occipital regions = visual impairments) Review from PTA 1011 – Review on Your Own ©Stanbridge University 2024 81  9/26/2024 Martin & Kessler, 2016 ©Stanbridge University 2024 82  9/26/2024 3.4 in 10,000 live births in U.S. Risk of recurrence is 2-3 percent if a sibling was born with it Myelomeningocele(MMC) Incidence China has highest rate in live births Review from PTA 1011 – Review on Your Own ©Stanbridge University 2024 83  9/26/2024 Review from PTA 1011 – Review on Your Own Correlations include: Genetic pre-disposure Exposure to alcohol Myelomeningocele(MMC) Etiology Seizure Acne medications Obesity Lack of folic acid ©Stanbridge University 2024 84  9/26/2024 Review from PTA 1011 – Review on Your Own Can be dx’d prenatally by testing for levels of alpha- fetoprotein If levels are too high, it may mean that there is an open neural tube defect Myelomeningocele Fetal surgery to correct the defect is being performed (MMC) in select centers Diagnosis Surgery can be performed btwn 24-30 wks. gestation ©Stanbridge University 2024 85  9/26/2024 Review from PTA 1011 – Review on Your Own Neurological Defects & Impairments Motor Deficits Sensory Deficits Myelomeningocele Spinal cord may be partially formed or malformed (MMC) If spinal cord below MMC is intact, potential for spastic motor paralysis (UMN) Clinical If nerve roots damaged will present with flaccid motor paralysis Features and lack of sensation (LMN) ©Stanbridge University 2024 86  9/26/2024 Musculoskeletal Impairments Muscle paralysis results in lack of voluntary movement Deformities such as hip dislocation, subluxation, genu varus/valgus, *clubfoot, flatfoot, etc. are common Myelomeningocele Clinical Features Review from PTA 1011 – Review on Your Own ©Stanbridge University 2024 87  9/26/2024 Level of Lesion Muscle Function Potential Deformity Thoracic Trunk Weakness Potential deformities of hips, knees and ankles secondary to frog- T7-T9 Upper abdominals leg posture T9-T12 Lower abdominals T12 has weak quadratus lumborum High Lumbar (L1 – L2) Unopposed hip flexors and some adductors Hip flexion, adduction Hip dislocation Lumbar lordosis Knee flexion and PF Midlumbar (L3) Strong hip flexors, adductors Hip dislocation, subluxation Weak hip rotators Genu recurvatum Antigravity knee extension Low Lumbar (L4) Strong quadriceps, medial knee flexors against gravity, ankle DF Equinovarus, calcaneovarus, or calcaneocavus foot and inversion Low Lumbar (L5) Weak hip extension, abduction Equinovarus, calcaneovalgus or calcaneocavus foot Good knee flexion against gravity Weak plantar flexion with eversion Sacral (S1) Good hip abductors, weak plantarflexors - Sacral (S2-S3) Good hip extensors and ankle PF - ©Stanbridge University 2024 88  9/26/2024  Martin & Kessler, 2016 ©Stanbridge University 2024 89  9/26/2024 Spinal Deformities Congenital scoliosis = related to vertebral anomalies Myelomeningocele Acquired scoliosis = causes from muscle imbalance in the Clinical trunk producing a flexible scoliosis Features Kyphosis Lordosis ©Stanbridge University 2024 90  9/26/2024 A child with L3 MMC will likely have which of the following deformities? A) Genu recurvatum Quiz 4 B) Equinovarus C) Frog-leg posture ©Stanbridge University 2024 91  9/26/2024  Identify significant structures and functions within the spinal cord in the central nervous system.  Describe the incidence, prevalence, etiology, and clinical manifestations of myelomeningocele.  Describe common complications seen in children with myelomeningocele. ©Stanbridge University 2024 92