Tuesday, June 30, 2009

Top 10 Things Your Physical Therapist Wishes You Knew About SB

“What should a parent or patient know?”
Submitted by a Physical Therapist at Rady Children's Hospital, San Diego

Physical Therapy Top 10 List

1. Children with spina bifida should be monitored for appropriate development and be provided with physical therapy, gym resources, and adaptive PE while in school, as applicable.

2. Physical Therapists encourage children with spina bifida (within the limits of safety and health) to be independent, to participate in activities with their non-disabled peers and to assume responsibility for their own care.

3. Mobility is a key factor in independence. Kids with spina bifida may use any (or a combination) of these forms of mobility:
- Walking
- Walking with braces
- Walking with an assistive device such as a walker or forearm crutches
- Use a manual wheelchair (one the user pushes)
- Use a power assist wheelchair (one the user pushes, that also has a motor)
- Use a power wheelchair

4. Being involved in regular physical activity is very important for fitness and to prevent obesity. Gaining too much weight can cause the following:
- loss of mobility, including ability to transfer, and loss of independence
- development of arthritis in your legs, arms and spine
- increased work of breathing
- loss of energy

5. For children who have difficulty exploring their environment due to mobility deficits, it is important to provide them with the therapy and equipment to facilitate these activities, in order to help with cognitive and sensory-motor development.

6. San Diego County has many adaptive sports programs. Some examples are:
- San Diego Adaptive Sports Foundation
- City of San Diego Therapeutic Recreation Services
- City of Chula Vista Parks and Recreation Department

7. Children with spina bifida must carefully follow sensory precautions. A child with spina bifida may have sensory deficits. This means that he/she may not be able to feel temperatures (hot/cold,) pain, or pressure, or have an idea where his/her legs are without looking at them. Water temperature for bathing, skin integrity, and leg position must be closely monitored.

8. Skin problems are common in the spina bifida population, especially in wheelchair users.

9. What skin problems occur and why? The major problems are:
- poor mobility
- reduced sensation from impaired nerves
- naturally thin skin
- poor circulation
- difficulty reaching down to clip toenails and staying clean
- poorly fitting or maintained shoes, braces, wheelchairs, and wheelchair cushions.

10. What can be done to lower the risk of skin problems?
- Exercise and maintain mobility
- Weight management
- Regular weight shifts when sitting, and check entire body/skin for telltale signs of a pressure sore.
- Attend Spinal Defects Clinic. The clinic staff will make sure that shoes, aids and wheelchair are OK.
- When you get a skin problem, see your doctor immediately. Never delay.

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