Case Report of Speech and Ambulation Ability After Five Years Therapy in a Six-Year-Old Boy with Habilitation Sixth Lumbar Spina Bifida with Meningocele Post Resection and Hydrocephalus Post VP Shunt
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Published:
Jun 1, 2022
Keywords:
ambulation, hydrocephalus, meningocele, speech, spina bifida
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Abstract
ABSTRACT
Introduction: Spina bifida, a congenital spinal cord injury, is a complex disability that results from a failure of the caudal neural tube to fuse early in embryonic development. Spina bifida affects about 300.000 newborns each year worldwide. Hydrocephalus is common in children with spina bifida, developing in 80% to 90% of children with myelomeningocele. Anatomical abnormalities in which the myelomeningocele sac occurs is associated with neurological, motor and sensory deficits. They showimpaired speech and ambulation.Case presentation: We report a six-year-old boy was taken to the hospital by his parents because he could not stand and walk since he was born. At birth there was a lump on the lower back, and the patient also had hydrocephalus, then surgery had been performed. The patient was diagnosed with sixth lumbar spina bifida and hydrocephalus with meningocele. He had some delay in gross motor, fine motor and language development. The patient had history of seizures. He received trunk control exercise, pelvic stabilityexercise, positioning and handling, coordination exercises and fine motor skills to increase independence in activities of daily life. The patient obtained 4 years exercises of speaking, comprehension, vocabulary and articulation. The child also received attention and concentration enhancement exercises.Conclusion: A patient with spina bifida requires a lifelong commitment by the patient, family, and the health care personnel involved in the treatment. The medical goal is to maintain stable neurological functioning throughout the patient’s lifetime. The wide range of extensive speech and ambulation impairments and long-term disabilities in patients with spina bifida present a considerable challenge to the management of these patients.Keywords: ambulation, hydrocephalus, meningocele, speech, spina bifida
Introduction: Spina bifida, a congenital spinal cord injury, is a complex disability that results from a failure of the caudal neural tube to fuse early in embryonic development. Spina bifida affects about 300.000 newborns each year worldwide. Hydrocephalus is common in children with spina bifida, developing in 80% to 90% of children with myelomeningocele. Anatomical abnormalities in which the myelomeningocele sac occurs is associated with neurological, motor and sensory deficits. They showimpaired speech and ambulation.Case presentation: We report a six-year-old boy was taken to the hospital by his parents because he could not stand and walk since he was born. At birth there was a lump on the lower back, and the patient also had hydrocephalus, then surgery had been performed. The patient was diagnosed with sixth lumbar spina bifida and hydrocephalus with meningocele. He had some delay in gross motor, fine motor and language development. The patient had history of seizures. He received trunk control exercise, pelvic stabilityexercise, positioning and handling, coordination exercises and fine motor skills to increase independence in activities of daily life. The patient obtained 4 years exercises of speaking, comprehension, vocabulary and articulation. The child also received attention and concentration enhancement exercises.Conclusion: A patient with spina bifida requires a lifelong commitment by the patient, family, and the health care personnel involved in the treatment. The medical goal is to maintain stable neurological functioning throughout the patient’s lifetime. The wide range of extensive speech and ambulation impairments and long-term disabilities in patients with spina bifida present a considerable challenge to the management of these patients.Keywords: ambulation, hydrocephalus, meningocele, speech, spina bifida
Article Details
How to Cite
Naela Munawaroh, Lisa Nurhasanah, & Rahmi Isma AP. (2022). Case Report of Speech and Ambulation Ability After Five Years Therapy in a Six-Year-Old Boy with Habilitation Sixth Lumbar Spina Bifida with Meningocele Post Resection and Hydrocephalus Post VP Shunt. Indonesian Journal of Physical Medicine and Rehabilitation, 11(01), 13 - 23. https://doi.org/10.36803/ijpmr.v11i01.324
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Case Report
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References
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6. Copp AJ, Greene N. Genetics and development of neural tube defects. J Pathol 2010; 220(2): 217-30.
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8. Umphred DA, Lazaro RT, Roller ML, Burton GU. Umphred’s. Neurological Rehabilitation. 7th ed. Canada: Elsevier; 2020.
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10. Fowler JB, Orlando DJ, Mesfin FB. Ventriculoperitoneal Shunt. [Updated 2021 Sep 9] [Internet]. Treasure Island (FL): StarPearls Publishing; 2021. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459351/.
11. Dicianno BE, Karmarkar A, Houtrow A, Crytzer TM, Cushanick KM, McCoy A, et al. Factors associated with mobility outcomes in a national spina bifida patient registry. Am J Phys Med Rehabil [Internet]. 2015; 94(12): 1015–25. Available at:https://pubmed.ncbi.nlm.nih.gov/26488146.
12. Lee A, Harte J, O’ Leary D. Speech Disorders in Children with Spina Bifida. Taipei: The 31st World Congress of the IALP; 2019.
13. Fluss J, Lidzba K. Cognitive and academic profiles in children with cerebral palsy: A narrative review. Ann Phys Rehabil Med [Internet]. 2020; 63(5): 447–56. Available at: https://doi.org/10.1016/j.rehab.2020.01.005
14. Lamare H, Sunilbala K, Singh T, Lytan E, Lalrammuana. Spina bifida in a newborn – A case report. J Med Sci Clin Res 2017;
05(06): 23247–50.
15. Snow-Lisy DC, Yerkes EB, Cheng EY. Update on urological management of spina bifida from prenatal diagnosis to adulthood.J Urol 2015; 194(2): 288–96.
16. Phillips LA, Burton JM, Evans SH. Spina bifida management. Curr Probl Pediatr Adolesc Health Care 2017; 47(7): 173–7.
17. Bartonek A. Motor development toward ambulation in preschool children with myelomeningocele — A prospective study. Pediatr Phys Ther 2010; 22(1): 52-60
18. Thomson J, Segal L. Orthopedic management of spina bifida. Dev Disabil Res Rev 2010; 96–103.
19. Dicianno BE, Kurowski BG, Yang JMJ, Chancellor MB, Bejjani GK, Fairman AD, et al. Rehabilitation and medical management of the adult with spina bifida. Am J Phys Med Rehabil 2008; 87(12): 1026–50.
20. Adzick N, Thom E, Spong C. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Eng J Med 2011; 993–1004.
21. Iddon JL, Morgan DJR, Loveday C, Sahakian BJ, Pickard JD. Neuropsychological profile of young adults with spina bifida with or without hydrocephalus. J Neurol Neurosurg Psychiatry 2004; 75(8): 1112–8.
22. Calhoun CL, Schottler J, Vogel LC. Recommendations for mobility in children with spinal cord injury. Top Spinal Cord Inj Rehabil [Internet]. 2013; 19(2): 142–51. Available at: https://pubmed.ncbi.nlm.nih.gov/23671384
23. Flemmer CL, Flemmer RC. A review of manual wheelchairs. Disabil Rehabil Assist Technol 2016; 11(3): 177–87.
24. Doering M, Doering M. Prognosis for development of early motor milestones in a pediatric patient with myelomeningocele : A case report. Univ Iowa’s Institutional Repos [Internet]. 2018; 1-14. Available
at: https://ir.uiowa.edu/cgi/viewcontent.cgi?article=1044&context=pt_casereports
25. Wright J. Hip and spine surgery is of questionable value in spina bifida: an
evidence-based review. Clin Orthop Relat Res [Internet]. 2011; 1258–64. Available at: doi:10.1007/s11999-010-1595-y
26. Sibinski M, Synder M, Higgs Z, Kujawa J, Grzegorzewski A. Quality of life and functional disability in skeletally mature patients with myelomeningocele-related spinal deformity. J Pediatr Orthop B 2013; 106–9.
27. Patel SK, Staarmann B, Heilman A, Mains A, Woodward J, Bierbrauer KS. Growing up with spina bifida: Bridging the gaps in the transition
of care from childhood to adulthood. Neurosurg Focus 2019; 47(4): E16.
28. Houtrow A, Dicianno BE. Advances in spina bifida care: From the womb to adulthood. Curr Phys Med Rehabil Reports 2014; 2(2):71–8.
2. Brei T, Houtrow A. Spina bifida. J Pediatr Rehabil Med 2017; 10: 1656.
3. Yi Y, Lindemann M, Colligs A, Snowball C. Economic burden of neural tube defects and impact of prevention with folic acid: a literature review. Eur J Pediatr 2011; 1391–400.
4. Parker S, Mai C, Canfield M. Updated national birth prevalence estimates for selected birth defects in the united states, 2004–2006. Birth Defects Res A Clin Mol Teratol 2010; 88(12): 1008–16.
5. Copp A, Greene N. Neural tube defects disorders of neurulation and related embryonic processes. Wiley Interdiscip Rev Dev Biol 2013; 2: 217–30.
6. Copp AJ, Greene N. Genetics and development of neural tube defects. J Pathol 2010; 220(2): 217-30.
7. Juranek J, Salman M. Anomalous development of brain structure and function in spina bifida myelomeningocele. Dev Disabil Res Rev 2010; 16: 23–30.
8. Umphred DA, Lazaro RT, Roller ML, Burton GU. Umphred’s. Neurological Rehabilitation. 7th ed. Canada: Elsevier; 2020.
9. Sealfon S, Stacy C, Motiwala R. Mount Sinai Expert Guides Neurology. USA: Wiley Blackwell; 2016.
10. Fowler JB, Orlando DJ, Mesfin FB. Ventriculoperitoneal Shunt. [Updated 2021 Sep 9] [Internet]. Treasure Island (FL): StarPearls Publishing; 2021. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459351/.
11. Dicianno BE, Karmarkar A, Houtrow A, Crytzer TM, Cushanick KM, McCoy A, et al. Factors associated with mobility outcomes in a national spina bifida patient registry. Am J Phys Med Rehabil [Internet]. 2015; 94(12): 1015–25. Available at:https://pubmed.ncbi.nlm.nih.gov/26488146.
12. Lee A, Harte J, O’ Leary D. Speech Disorders in Children with Spina Bifida. Taipei: The 31st World Congress of the IALP; 2019.
13. Fluss J, Lidzba K. Cognitive and academic profiles in children with cerebral palsy: A narrative review. Ann Phys Rehabil Med [Internet]. 2020; 63(5): 447–56. Available at: https://doi.org/10.1016/j.rehab.2020.01.005
14. Lamare H, Sunilbala K, Singh T, Lytan E, Lalrammuana. Spina bifida in a newborn – A case report. J Med Sci Clin Res 2017;
05(06): 23247–50.
15. Snow-Lisy DC, Yerkes EB, Cheng EY. Update on urological management of spina bifida from prenatal diagnosis to adulthood.J Urol 2015; 194(2): 288–96.
16. Phillips LA, Burton JM, Evans SH. Spina bifida management. Curr Probl Pediatr Adolesc Health Care 2017; 47(7): 173–7.
17. Bartonek A. Motor development toward ambulation in preschool children with myelomeningocele — A prospective study. Pediatr Phys Ther 2010; 22(1): 52-60
18. Thomson J, Segal L. Orthopedic management of spina bifida. Dev Disabil Res Rev 2010; 96–103.
19. Dicianno BE, Kurowski BG, Yang JMJ, Chancellor MB, Bejjani GK, Fairman AD, et al. Rehabilitation and medical management of the adult with spina bifida. Am J Phys Med Rehabil 2008; 87(12): 1026–50.
20. Adzick N, Thom E, Spong C. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N Eng J Med 2011; 993–1004.
21. Iddon JL, Morgan DJR, Loveday C, Sahakian BJ, Pickard JD. Neuropsychological profile of young adults with spina bifida with or without hydrocephalus. J Neurol Neurosurg Psychiatry 2004; 75(8): 1112–8.
22. Calhoun CL, Schottler J, Vogel LC. Recommendations for mobility in children with spinal cord injury. Top Spinal Cord Inj Rehabil [Internet]. 2013; 19(2): 142–51. Available at: https://pubmed.ncbi.nlm.nih.gov/23671384
23. Flemmer CL, Flemmer RC. A review of manual wheelchairs. Disabil Rehabil Assist Technol 2016; 11(3): 177–87.
24. Doering M, Doering M. Prognosis for development of early motor milestones in a pediatric patient with myelomeningocele : A case report. Univ Iowa’s Institutional Repos [Internet]. 2018; 1-14. Available
at: https://ir.uiowa.edu/cgi/viewcontent.cgi?article=1044&context=pt_casereports
25. Wright J. Hip and spine surgery is of questionable value in spina bifida: an
evidence-based review. Clin Orthop Relat Res [Internet]. 2011; 1258–64. Available at: doi:10.1007/s11999-010-1595-y
26. Sibinski M, Synder M, Higgs Z, Kujawa J, Grzegorzewski A. Quality of life and functional disability in skeletally mature patients with myelomeningocele-related spinal deformity. J Pediatr Orthop B 2013; 106–9.
27. Patel SK, Staarmann B, Heilman A, Mains A, Woodward J, Bierbrauer KS. Growing up with spina bifida: Bridging the gaps in the transition
of care from childhood to adulthood. Neurosurg Focus 2019; 47(4): E16.
28. Houtrow A, Dicianno BE. Advances in spina bifida care: From the womb to adulthood. Curr Phys Med Rehabil Reports 2014; 2(2):71–8.