Nerve messaging between the brain and the muscles at or below your child’s functional level has been affected by your child’s myelomeningocele. Nerve signals usually tell muscles to stretch or relax at various times to promote mobility and produce movement. Muscles are also required to keep joints in place and to maintain the skeleton in an upright position. Some muscles may receive no signal at all from the spinal nerves and may be weak and floppy. Other muscles may be tight (contracted) and difficult to relax. One side of the body may be more affected than the other.
In general, the lower the level of the lesion, the more muscle function and sensation your child will have in their trunk and legs. Each of the leg joints- hip, knee and ankle will be examined very carefully when your baby is born. Some joints may be tight or contracted at birth.
Contractures can also develop as a child grows as their muscles are not moving. A programme of treatment which stretches the muscles can help to prevent contractures and further difficulties. As a parent or carer you will be shown how to do these movements when your child is young, but as they get older they should be encouraged to do the activities themselves. The most common contractures are at the hip and ankle.
One or both of the hips may be displaced or out of joint. Treatments for hips may involve a harness or hip brace to keep the joints in place, or even surgery. In some cases no intervention is taken for dislocated hips. This is where experience shows that surgery does not improve function, and the hips are likely to dislocate again. Your orthopaedic surgeon will decide the best course of treatment for your child.
If your child has a Talipes (club foot) this may be treated by casting with Plaster of Paris or soft splints repeatedly over a number of weeks. Sometimes a small surgical procedure is necessary to loosen the tendons of the foot. Sometimes a child will be given special boots connected with a bar after the cast is removed.
Children who do not walk or stand are at risk of having weaker bones in their legs. Bones become stronger when children weight-bear. Weaker bones can break more easily. A diet with sufficient vitamin D and calcium helps to promote healthy bones for your child, but fractures can still happen. Your child’s bone health will be checked at intervals throughout their life. Your child will be encourage your child to stand and may provide a standing frame or aids to help your child stand for longer.
Some children with spina bifida may develop curvature of the spine such as Scoliosis and Kyphosis.