The physiotherapist's role in the early therapy of children with spina bifida is critical because it assists the kid in developing efficient and purposeful movement that may be integrated into everyday routines. By optimizing and sustaining mobility, children can become more autonomous as they grow older. The physiotherapist will do an initial examination of the infant's muscular strength and range of motion at several joints. This allows the physiotherapist to assess which muscles are strong and which are weak. This will provide them with a baseline measurement to utilize as the youngster develops.This will also help the physiotherapist to assess what challenges the newborn may have as they get older, as well as what sort of assistive devices or splints they may need when they begin to move. The physiotherapist will be involved in the following activities:

Range of Motion of Joints

The physiotherapist will begin passive range of motion exercises on the infant's legs shortly after surgery. This is usually done 2-3 times each day. They will also show this approach to parents or caregivers so that they may continue to conduct these exercises at home after the baby is released. They may progress these workouts to simulate more functional motions that are associated with regular daily movement patterns. For example, when bending the left knee and hip, the right side remains straight, as in a regular walking motion. These simple exercises can assist to preserve and maybe expand the available range of motion in joints with modest mobility restrictions. In individuals with more severe restrictions, the physiotherapist may recommend increasing the number of repetitions and holding the action for longer periods of time. The ultimate goal of range of motion exercises is for the youngster to be able to learn and do them on their own as they grow older. It is critical that the kid continues with these activities because when they move freely, the functional muscles may not be operating through their entire range of motion. Passive range of motion exercises will thus aid in the maintenance of flexibility and the prevention of muscular tightenings known as contractures.

Muscular Strength 

Because altered muscle tone is a typical sign of spina bifida, physiotherapists employ resistance training to improve these weaker muscles. This is usually offered when the newborn is mature enough to move on his or her own. A physiotherapist can design a strength and endurance training program that has been shown to enhance functional capacities in children with spina bifida. These training programs can assist enhance upper limb strength and cardiovascular fitness by incorporating a range of exercises for the upper and lower limbs, as well as trunk muscles.

Handling and Positioning

During the first few days following surgery, the newborn is usually placed inside or stomach reclining. As the infant continues to stabilize and recuperate from surgery, the physiotherapist will provide guidance on how to securely handle the newborn kid. This is critical since the child will have had significant surgery, which needs constant handling and positioning. Due to the surgical cut on the infant's back, it may be suggested that parents or caregivers carry the kid beneath the stomach and across their forearm. This method may be done while sitting or walking about. When advised, parents or caregivers may take the newborn for a walk about the hospital while holding the infant over their shoulder. This might assist the infant to start lifting his or her head and developing head and neck control.

Ambulation and Mobility

Mobility issues in children with spina bifida differ depending on the degree of the spine damaged during development. A child with a lower back lesion (Lumbar or Sacral levels) is more likely to be able to move independently than one with an upper thoracic spine injury. This can help establish whether the youngster needs a wheelchair, orthotics, or other assistance aids.

Assistive equipment such as newborn walkers, jumps, and bouncer chairs are frequently opposed by parents and caregivers because they might impair motor development. Infants require active movement as well as sensory input from their surroundings to learn how to move efficiently against gravity and maintain upright sitting and standing positions. This is also true for children with Spina Bifida. Instead of passive sitting devices or chairs, infants with spina bifida benefit from motions that test control of the head, neck, and torso. They may engage in the learning process by moving about. Parents are recommended, for example, to physically hold their kid in a standing posture with as little support as possible to foster the essential control of the legs and torso rather than utilizing a walker. This also helps the youngster to receive feedback from the floor and his or her surroundings.

As the kid gains independence in mobility and ambulation, he or she may be fitted with braces or splints to correct any deformities caused by muscle imbalance or joint constraints. Orthoses, such as braces and splints, are supportive devices that try to improve existing muscle function and provide support where it is needed. The sooner they are installed and made available, the sooner the youngster will be ready for the upright posture essential for standing and walking. As a result, it promotes normal developmental growth and eventually allows the kid to participate in age-appropriate activities. Spina Bifida lesions in the upper thoracic areas of the spine may necessitate bracing or splinting of the whole leg up to the level of the hip and chest in children. This is referred to as a Hip-Knee-Ankle-Foot Orthoses (HKAFO). Others may require orthotics to help with knee, ankle, and foot stability. Knee-Ankle-Foot Orthoses (KAFO) and Ankle-Foot Orthoses (AFO) may also be administered in order to create a normal rhythmic walking pattern in the kid. Children may require the use of crutches in addition to orthoses to relieve tension on the legs. Standing frames and other assistive devices are also utilized to help children with more severe restrictions bear weight through their legs and maintain a complete range of motion at all lower limb joints. Additionally, certain children may require casting to treat and prevent contractures. Casting is a particularly successful way of enhancing range of motion at stiff joints without the need of surgery since it seeks to generate a progressive improvement in the range of motion accessible at a specific joint. Other youngsters may benefit from the usage of a wheelchair since it allows them to move more freely if their walking is limited and laborious. For shorter distances, this can be alternated with the use of orthosis. A wheelchair can also assist youngsters keep up with other able-bodied persons and engage in school-sponsored leisure activities.

Parental/caregiver education

Physiotherapy management will eventually be transferred to the infant's parents or caregivers. They will first be encouraged to witness the physiotherapist doing range of motion exercises as well as handling and positioning tactics before being asked to replicate these treatments on their own. Following these educational sessions, specific duties will be assigned to parents and caregivers. Following release home, and as the kid begins to move more freely, parents and caregivers should actively participate in measuring their child's growth through observations at home while playing, sitting, crawling, and so on. This can aid in the early detection of any variations in the child's movements or sitting postures at home and in the hospital. It may also allow additional potential problems to be recognized early on, allowing for the development of a management strategy. This is especially important when the kid gets more medically stable, since they will not receive as much medical input and interaction as they did when the child was a newborn in the hospital.

The physiotherapist and other members of the healthcare team will be able to offer advise and assist parents and caregivers in developing confidence in their abilities to manage their child's daily routine.

Submaximal and maximal testing is required to appropriately prescribe exercise training. According to research, the greatest techniques to identify change are treadmill speed and a 6-minute walk distance. Heart rate and VO2 peak measurements, on the other hand, are valid approaches to quantify physiological output in ambulatory children with spina bifida, especially when paired with functional outcomes like treadmill speed and 6-minute walk distance. Walking has been demonstrated to aid patients with spina bifida in areas such as urine discharge, bowel function, and peripheral circulation. Individuals with spina bifida have been prescribed the use of several assistive gadgets. A long-term research was conducted on people who were given an ORLAU Parawalker (a Reciprocal Walking Orthosis). According to previous research, the utilization of these orthoses is higher than that of other aids evaluated in the past, such as standard KAFOs. This study reveals that the ORLAU parawalker for children may improve their capacity to ambulate, which may lead to the additional benefits described before. The psychological adjustment to this genetic handicap must be viewed through the eyes of the parents, relatives, and, of course, the kid.

By Recmed Medical - Physical Therapy Center