SB and the Spine

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Spine Level

Possible Muscle

Possible Orthopaedic

Possible Orthotics

Possible Equipment
for Functional Mobility

Possible Cognition,
Executive Function


Upper trunk (abdominals) No LE function

Lumbar hyperlordosis
Coxa valga–hip dislocation
Decreased bone density

Hip: abduction, flexion,
external rotation
Knee: flexion, extension
Foot: heelcord, clubfoot

Night splints: body, hip
abduction, KAF, AF

Early: Parapodium, (10
months of age and up to 2

Later: stander, RGO, HKAFO, KAFO

Caution: Preserve UE function with level transfers, stable seated posture.
Maintain strength + flexibility of shoulders/ arms.

Community: Wheelchair/
wheelchair cushion,
transfer board

Home: Walker/Crutches
(for household or exercise
walking), Raised, padded
commode seat.
Bath bench
Mirror for skin checks
Stander: 1 hour/day minimum starting at 10-12 months of age.
Driving with hand controls
Learn public transportation

Executive function impairments can impact educational, social and self help skills.

Cognitive function can vary with the degree of hydrocephalus number of shunt infections, and the involvement of the nervous system. Function may not be related to level of lesion or ability to walk. Support early assessment of attention difficulties, sensorimotor integration, visual perception, visual motor ability, psychosocial development in addition to fine/gross motor + communication ability.

Independent living: Occupational Therapy Goals: Basic activities of daily living (BADLs) or bathing, dressing, grooming, bowel/ bladder program, skin care, moving/transportation in your home/community. Instrumental activities of daily living (IADLs). Shopping, meal preparation, use of home appliances. Early learning/practice of all ADLs is vital.

Physical/ Occupational Therapy/ Gross Motor Goals:

  1. Achieve/maintain full ROM.
  2. Achieve/maintain full strength in intact muscles for ADL's and mobility.
  3. Locomotion activities including ambulation skills (falling down, getting up), walk on various terrains, transfer to various surfaces (chair, car, bed).
  4. Achieve maximal sitting tolerance with skin intact.
  5. Attain cardiovascular endurance for function.
  6. Ability to perform or direct care including care + maintenance of orthotics + equipment.
  7. Obtain recommendations re: home modifications.
  8. Document medical appts, follow up, surgical history. Transition to adult self care begins at birth.


Abdominals + paraspinals = some pelvic control


Complete trunk function
Lower trunk (abdominals)
Hip flexors (weak) 2/5


Hip flexors 3/5
Hip adductors

Scoliosis, Overuse of UE's
Lumbar hyperlordosis
Hip subluxation
Coxa valga–hip dislocation
Decreased bone density

Hip: flexion
Knee: flexion, extension
Foot: Heelcord, clubfoot

Night hip abduction splint

Early: Parapodium (10
months of age up to 2

Later: Stander, RGO, HKAFO, KAFO (if quads are less than 3/5 strength)

L3-5 May be temporarily addressed by twister cables or derotations straps

Community: wheelchair +

Home: Stander: 1 hour/ day

Early: may use walker or

Later: wheelchair in home


3/5 Knee extensors 3/5


Medial knee flexors 3/5
Ankle dorsiflexor 3/5


Lumbar hyperlordosis
Coxa valga

Hip: flexion
Knee: flexion (avoid crouch gait)
Foot: Progressive calcaneus
(tight heelcord)
Paralytic Vertical Talus

Night hip abduction splint

Early: Parapodium


L4-5 Toeing in gait and weak gluteals may be
temporarily addressed by twister cables and/or
rotation straps

Consider shunt malfunction and/or tethered cord

Community: wheelchair,
walker, crutches, cane
Strong medial hamstring needed for community gait

Home: early on may need no support

Later: may require UE support


Hip abductors (weak) 2/5
Lateral knee flexors 3/5
Ankle invertors 3/5
Long toe extensors (palpate at ankle)


Hip abductors 3/5
Hip extensors (weak) 2/5
Plantar flexors (weak) 2/5


Monitor hips closely
Foot: Calcaneus (tight
Pes Cavus,
Toe clawing (flexion)
Heel/foot ulcers

AFO, SMO (supra malleolar orthotics), shoe inserts or no orthotics

S1-2 Toeing out gait

Use of crutches may decrease the valgus forces
at the knee and also improve endurance

Community: walking with walker, crutches, cane.
Gluteus lurch/ Trendelenburg gait aided by cane or crutches.
Long distance alternative:
lite weight wheelchair, bike, scooter

Home: May need no support.


Hip extensors 4/5
Plantar flexors 3/5
Toe flexors 3/5


All muscle activity + bowel/ bladder function may be normal


None or shoe inserts


Shunt malfunction and/or tethered cord:

May cause deterioration of daily living skills, progressive weakness, muscle contractures or orthopaedic deformities of the legs, scoliosis, back pain at the site of closure,
deterioration of gait, changes in bowel and/or bladder function.

Muscle grades:

5 = normal
4 = good
3 = fair
2 = poor
1 = trace

Flexion = bend
Extension = straighten
Adduction = bring toward
Abduction = take away

Invert = move in
Evert = move out
Medial = inner
Lateral = outer

T = thoracic L = lumbar S = sacral O = orthosis
RGO = reciprocating gait orthosis
H = hip K = knee A = ankle F = foot
CC = crouch control Gait = walking style
Coxa = hip Calcaneus = heel bone Talus = ankle bone

UE = upper extremities/arms
LE = lower extremities/legs

Contributing Editors
Tim Brei, MD and Liz Kelly, PT

This information does not constitute medical advice for any individual. As specific cases may vary from the general information presented here, SBA advises readers to consult a qualified medical or other professional on an individual basis.


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