Spina Bifida

Spina bifida occurs when the neural tube fails to close completely in early pregnancy, leaving the spinal cord incompletely formed and, in the more significant forms, exposed. What function is affected depends on the level: the higher the lesion, the more of the legs and trunk are involved.

What it affects

Weakness or paralysis below the affected level, reduced or absent sensation, and bladder and bowel involvement in most cases. Hydrocephalus is common and usually managed with a shunt. Foot deformities, hip displacement and scoliosis develop in many children.

What physiotherapy contributes

• Maximising mobility — from independent walking with orthoses for lower lesions, to wheelchair skills and independence for higher ones. Both are legitimate goals; the aim is independence, not walking for its own sake
• Preventing contracture and deformity through stretching, positioning and splinting
• Strengthening whatever muscle is innervated, which is often more than initially assumed
• Orthotic assessment and gait training
• Standing programmes for bone density and organ positioning where walking is not achievable
• Skin care education, which is critical and often underestimated

The skin point deserves emphasis

Reduced sensation means pressure sores develop without any warning pain. Families learn to check skin daily, particularly over the feet, buttocks and anywhere an orthosis contacts. A pressure sore can cost months of function and is almost entirely preventable.

Latex allergy

Children with spina bifida have a substantially raised rate of latex allergy from repeated early exposure. We use latex-free equipment as standard.

The long view

Needs change through childhood, adolescence and adulthood. Growth spurts, weight change and the transition to adult services are all points where reassessment matters.