Spina bifida is a birth defect of the neural tube. The neural tube eventually develops to form the spine and nervous system. If it doesn’t form correctly damage to the spinal cord can occur, causing neurological dysfunctions, such as lower limb paralysis, sensory impairment and incontinence.
The cause is unknown, however lack of folic acid during early pregnancy can increase the risk of this birth defect occurring.
There are three different types of spins bifida: occulta, meningocele and myelomeningocele. Symptoms vary according to the type. In spina bifida occulta, there are rarely long-term health problems. Myelomeningocele is the most severe type and results in lower limb paralysis, sensory impairment and incontinence. Hydrocephalus is also common with these babies.
Spina bifida is usually diagnosed prenatally during standard ultrasounds and blood tests that are carried out in pregnancy. To confirm the diagnosis, an MRI or CT scan may be carried out within three months of birth.
Again, treatment depends on the severity of the condition. With the more severe types, surgery is now indicated in infancy to protect the exposed spine and central nervous system. If detected early on in pregnancy, surgery can be carried out in the second trimester.
If lower limb paralysis is present, this is managed with physiotherapy to maintain good range at the hips, knee and ankle. Lower limb orthotics are used to provide stability and aid mobility.
Typically in spina bifida, orthotic intervention would be either ankle foot orthoses (AFO's) or knee ankle foot orthoses (KAFO's).
Initially, AFOs are used in young children to prevent contractures and provide stability to help children learn to stand. When children are learning to walk, fixed AFOs or ground reaction AFOs (GRAFO's) can be used to provide sufficient force for push off in stance phase and stabilise the knee joints.
As children grow and become more mobile, they may require additional control at the hip and knee and a KAFO may be indicated with locked knees to facilitate mobility.
Although permanent, this condition requires continued reassessment as each child grows, to ensure their orthotic prescription is optimal for their needs. At LOC, we work closely with the neuro team, such as physios, occupational therapists and parents to complement the therapy that they are receiving with advanced orthotic treatment for each child. As they grow so do the complexities of their gait with increased height and weight. The orthotist will adjust and redesign your orthotic prescription using our Gait Lab facility to optimise effectiveness.