Rehabilitation for Spina Bifida 

Rehabilitation for spina bifida includes physical therapy, occupational therapy, and recreational therapy. Speech therapy may be indicated for patients with speech and/or swallowing difficulties. Physical therapy programs are designed to parallel the normal achievement of gross motor milestones. Occupational therapy should be initiated early to compensate for motor skill deficits and should progress along the normal developmental sequence. Recreational therapy is helpful for promoting independence by enhancing play and recreational opportunities.

For further information on this topic, see the Medscape Reference article Spina Bifida.

General functional expectations have been developed for patients in each lesion-level group to help direct physical therapy goals within an appropriate developmental context from infancy through adulthood.^[1] The therapy programs should be designed to parallel the normal achievement of gross motor milestones.

In managing the cases of newborns with myelomeningocele, the physical therapist establishes a baseline of muscle function. As the child develops, the physical therapist monitors joint alignment, muscle imbalances, contractures, posture, and signs of progressive neurologic dysfunction. The physical therapist also provides caregivers with instruction in handling and positioning techniques and recommends orthotic positioning devices to prevent soft tissue contractures.

Provide the infant with sitting opportunities to facilitate the development of head and trunk control. Near the end of the first year of life, provide the child with an effective means of independent mobility in conjunction with therapeutic exercises that promote trunk control and balance.

For patients who are not likely to become ambulatory, place emphasis on developing proficiency in wheelchair skills. For patients who are predicted to ambulate, pregait training should begin with use of a parapodium or swivel walker. Exercise or household-distance ambulation may be pursued with use of traditional long leg braces (eg, hip-knee-ankle-foot orthosis, knee-ankle-foot orthosis) or the reciprocating gait orthosis [RGO]).

Teach the school-aged child community-level wheelchair mobility skills, emphasizing efficiency and safety. The physical therapist assists with assessment of the community, home, and school environments to determine whether architectural barriers exist that may interfere with the child's daily activities.

Children with spina bifida often have impairment in fine motor skills and conducting activities of daily living (ADL). Initiate training early to compensate for these deficits and progress along the developmental sequence as closely as possible.

Upper-extremity stabilization and dexterous hand use require adequate postural control of the head and trunk. In the first year of life, encourage development of these postural mechanisms or substitute passive support, if necessary, to promote eye-hand coordination and manipulatory skills. When adequate fine motor skills have been achieved, the occupational therapist provides instructions for use of adaptive equipment and alternative methods for self-care and other ADL for preschool- and school-aged children.

Children with myelomeningocele often experience restricted play and recreational opportunities because of limited mobility and physical limitations.^[2] This inactivity decreases the potential for normal development in all spheres and can exert a negative impact on self-esteem.

For the infant and toddler with myelomeningocele, recreational therapy enhances opportunities for environmental exploration and interaction with other children. For the school-aged child, recreational therapy provides opportunities for participation in adapted sports and exercise programs, which can result in long-term interest in personal fitness and health.

Recreational and physical fitness goals include socialization, weight control, and improved fitness (eg, flexibility, strength, aerobic capacity, cardiovascular fitness, coordination). Recreational therapy is helpful for promoting independence with adult living skills and often is used to assist the patient with shopping for and purchasing personal items, use of public transportation, and development of appropriate leisure activities.^{[1, 2]}