ROMMER
Condition

Spina Bifida

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What Is Spina Bifida?

Spina bifida is a neural tube defect that occurs when the spinal column does not close completely during fetal development, leaving part of the spinal cord exposed or incompletely protected. It ranges from a minor bony defect (spina bifida occulta) to a sac protruding through the back containing spinal cord tissue (myelomeningocele). The severity of symptoms depends on the level of the defect and the extent of nerve involvement.

Types of Spina Bifida

  • Spina Bifida Occulta: A small gap in the vertebrae with no visible opening; the spinal cord is usually unaffected. Often discovered incidentally.
  • Meningocele: The protective membranes (meninges) protrude through the gap, but the spinal cord itself is not displaced. Neurological symptoms are generally mild.
  • Myelomeningocele: The most severe form; both the meninges and part of the spinal cord protrude. Results in varying degrees of paralysis, sensory loss, and bladder/bowel dysfunction below the level of the defect.

Rehabilitation at ROMMER

Children with spina bifida (especially myelomeningocele) require lifelong interdisciplinary management. At ROMMER, the rehabilitation programme is tailored to the child's neurological level and functional goals:

  • Mobility Training: Depending on the lesion level, children are supported to achieve the highest possible mobility — standing, walking with orthotics/crutches, or independent wheelchair use.
  • Orthotic Management: Ankle-foot orthoses, knee-ankle-foot orthoses (KAFO), or hip-knee-ankle-foot orthoses (HKAFO) are prescribed and monitored.
  • Neurogenic Bladder and Bowel Programme: Clean intermittent catheterisation (CIC) training, bladder management, and bowel routines are established in collaboration with urology and gastroenterology.
  • Prevention of Secondary Complications: Pressure ulcer prevention, scoliosis monitoring, and hip surveillance are integral parts of the programme.
  • Cognitive and Learning Support: Many children with spina bifida have associated hydrocephalus; educational support and neuropsychological assessment are coordinated.
  • Family and Caregiver Training: Parents receive comprehensive training in positioning, catheterisation, skin care, and home exercise programmes.

Long-Term Management

Spina bifida is a lifelong condition, but with appropriate rehabilitation, many children achieve meaningful functional independence. At ROMMER, goals are regularly reassessed as the child grows, and the programme is updated to meet changing developmental and functional needs.

Frequently Asked Questions

Can children with spina bifida walk?+
Many children with lower-level lesions (L4–S1) can walk independently or with minimal support. Children with higher lesions typically use wheelchairs but can still achieve standing and therapeutic walking with appropriate orthoses. The goal is maximum functional independence for each child.
What is the role of rehabilitation after spina bifida surgery?+
Surgery in the neonatal period closes the spinal defect but does not restore lost nerve function. Rehabilitation begins shortly after surgery to prevent contractures, support motor development, and establish bladder/bowel management programmes.
How is neurogenic bladder managed?+
Clean intermittent catheterisation (CIC) is the gold standard. Families are trained to perform CIC at regular intervals. Urological follow-up, urodynamic studies, and sometimes medication are used to protect kidney function.
Does spina bifida affect cognitive development?+
Spina bifida itself does not directly cause intellectual disability, but associated hydrocephalus and Chern-Arnold Chiari malformation can affect attention, memory, and executive function. Neuropsychological assessment and educational planning are important parts of management.

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