Definition
Spina bifida is a congenital neural tube defect in which the spinal cord and surrounding
structures do not develop properly during early pregnancy. It can cause weakness,
paralysis, sensory loss, and bladder/bowel problems.
Types of Spina Bifida
A. Spina Bifida Occulta
Mildest form
Often no visible symptoms
B. Meningocele
Sac-like protrusion of meninges
Spinal cord usually normal
C. Myelomeningocele (most severe)
Spinal cord and nerves protrude
Significant motor and sensory loss
Clinical Features
Depending on the level of lesion:
I. Flaccid paralysis of lower limbs
II. Muscle weakness
III. Loss of sensation
IV. Foot deformities (clubfoot)
V. Hip dislocation
VI. Scoliosis
VII. Bladder and bowel dysfunction
VIII. Hydrocephalus (in some cases)
Physiotherapy Assessment
Detailed birth & surgical history
Level of lesion (thoracic, lumbar, sacral)
Muscle strength testing
Tone assessment
Range of motion
Reflexes
Functional mobility level
Skin integrity check
Physiotherapy Management
Early Intervention (Infancy)
Proper positioning to prevent deformities
Passive range of motion exercises
Parent education
Tummy time (if medically safe)
Prevention of contractures
Strengthening Program
Strengthen available muscles (especially upper limbs & trunk)
Core stability training
Functional strengthening
Mobility Training
Based on lesion level:
Low lumbar/sacral → May achieve independent walking with orthosis
High lumbar/thoracic → Wheelchair mobility
Training includes:
Gait training
Use of assistive devices (walker, crutches)
Orthotic management (AFO, KAFO)
Deformity Prevention
Regular stretching
Splinting
Postural correction
Monitor scoliosis
Balance & Functional Training
Sitting balance
Transfers training
Stair climbing (if possible)
ADL training
Respiratory Care (if high lesion)
Breathing exercises
Chest physiotherapy
Short-Term Goals
Maintain joint range
Prevent pressure sores
Improve sitting balance
Educate parents
Long-Term Goals
Maximize independence
Achieve optimal mobility
Prevent secondary deformities
Improve quality of life
Role of Family Education
Skin care and pressure sore prevention
Proper positioning
Orthosis care
Home exercise program
