Authors:
Yohan Christian Suisan
and
S.M. Mei Wulan
Affiliation:
Universitas Airlangga, Indonesia
Keyword(s):
Child, congenital, rehabilitation, exercise, ambulation
Abstract:
Introduction: Spina bifida is a congenital abnormality where the neural tube fails to close during embryonic development. It can be seen as the loss of spinous process of the spine. The worldwide incidence of Neural Tube Defect ranges from 1 to 10 per 1,000 births. A 2013 study in the USA showed that hospitalizations related to spina bifida cost more than $600 million in 2013. Case Diagnosis: Spina bifida + CTEV + hydrocephalus. Case Presentation: A 9-month-old boy presented with paraplegia and equinovarus deformities on both feet. He had undergone serial casting and it was planned by an Orthopedic Surgeon to have Achilles tenotomy surgery soon. Pirani score was 3.5/3.5 for both feet. He had a ventriculoperitoneal shunt implanted for his hydrocephalus. He had a ping pong ball-sized mass on his lumbar spine when he was born. It had already been operated on. He had bladder incontinence and bowel retention. He couldn’t maintain his head and trunk in an upright position. Hand function wa
s good. Discussion: The goal for this patient was independent ambulation with a wheelchair. Therefore, it was compulsory for him to be able to maintain a sitting position without holding on. The rehabilitation program included strengthening of neck muscles, back extensors and abdominal muscles, and left and right upper extremities. We also stimulated and facilitated the patient’s transfer ability, starting from rolling, transfer from lying to sitting with help, and then sitting independently. These programs were done for 8 months and now the patient can maintain a sitting position with his arms free. During the process, the patient underwent Achilles tenotomy and we gave him a Dennis-Brown splint. His mother was instructed to give digital stimulation every morning in order to stimulate defecation. Conclusion: A comprehensive rehabilitation program improves development of a child with spina bifida to achieve his full potential despite his limitation
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