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Diagnostic Protocol

Spina Bifida

Brooklyn Anderson, Connor Lange, Hannah Arthur, Audrey Chandler

Department of Occupation and Recreation Therapy, University of Utah

RECTH 4300: Recreational Therapy and Individuals with Intellectual and Developmental Disabilities

Chad Romoser

October 2, 2023

Fall 2022 | RECTH 4300 Recreational Therapy and Intellectual and Developmental Disabilities
Diagnostic Information:
Diagnostic Grouping:
Developmental Disability
Neural Tube Birth Defect
Specific Diagnosis:
Spina Bifida
Identified Physical Problems:
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Diagnostic Protocol
Definition: “Neural Tube Defects (NTDs) occur when the
neural tube does not close properly. The neural tube forms the
early brain and spine. These types of birth defects develop very
early during pregnancy, often before a woman knows she is
pregnant. The two most common NTDs are spina bifida (a spinal
cord defect) and anencephaly (a brain defect)” (CDC, 2019)
Definition: Spina bifida is a condition that affects the spine and
is usually apparent at birth. It is a type of neural tube defect
(NTD). Spina bifida can happen anywhere along the spine if the
neural tube does not close all the way. When the neural tube
doesn’t close all the way, the backbone that protects the spinal
cord doesn’t form and close as it should. This often results in
damage to the spinal cord and nerves. (CDC, 2019)
Qualifying Symptoms:
Three most common types:
1. Spina bifida occulta (SBO): “hidden spina bifida” 15%
of healthy people have it and do not know it. Usually it
does not cause harm, no visible signs. Spinal cords and
nerves are usually fine. However, in a small group of
people with SBO, pain, and neurological symptoms may
occur. (What, 2021)
2. Meningocele: causes part of the spinal cord to come
through the spine like a sac that is pushed out. Nerve
fluid is in the sac, and there is usually no nerve damage.
Individuals with this condition may have minor
disabilities. (What, 2021)
3. Myelomeningocele (Spina Bifida Cystica): Most severe
form of Spina Bifida. It happens when parts of the spinal
cord and nerves come through the open part of the spine.
It causes nerve damage and other disabilities. 70-90% of
children with the condition also have too much fluid on
the brain. Without treatment, a person’s head may grow
too big, and may have brain damage. (What, 2021)
1. “70-90% of children with myelomeningocele develop

Identified Problems
Related Factors and Etiologies:
Incidence/Prevalence:
Predominant Age:
Causes:
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hydrocephalus, a buildup of fluid in and around the
brain”. (Porter, p. 356)
2. “Nearly all children with myelomeningocele have an
abnormal change in brain position of the brain” (Porter,
p.356)
3. “ Tethered spinal cord: Most children with
myelomeningocele, and a small number with
meningocele or spina bifida occulta have a tethered
spinal cord. This means the spinal cord does not move up
and down as it should with movement, but rather is held
in place by surrounding tissue. This leads to: leg
weakness, worsening leg function, scoliosis, pain in the
back, and changes in bladder function”. (Porter, p. 356)
*Symptoms or results of the illness or disability that are
treatable by Recreational therapeutic Services.
1. Muscle weakness
2. Emotional stress
3. Body aches and pains
4. Depression
5. Feelings of being withdrawn
6. Inactive or sedentary lifestyles
7. Lower frequency of social interactions
“While there is no known cause, it has been shown that women
who are old enough to have babies should take folic acid before
and during the first three months of pregnancy. No one knows
for sure what causes Spina Bifida. Doctors and other scientists
believe that a complex mix of both genetic and environmental
factors act together to cause the condition. It's important to know
that neural tube defects like Spina Bifida are not entirely
understood, and Spina Bifida is not caused by a parent's actions”
(What, 2021).
1. 14000 babies on average in the U.S. are born with spina
bifida
2. Estimated that 1/2500 babies worldwide are born with
spina bifida
(CDC, 2019)
1. Onset at birth. While surgeries are critical to lowering
disabling conditions, it is a lifetime condition.
1. Unknown combination of genetic and environmental
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causes

Systems Affected:
1. Nervous system
● Spine
● Brain
● Spinal Cord
● Meninges
2. Muscular
● Muscle strength
● Neuromuscular coordination
● Fine and gross motor

General Goal(s): Client will work with RT to increase emotional regulation, socializing with peers, and
participation more frequent activities.

Process Criteria: Social Process Criteria:

Choose 3, insert TRS will address socializing with peers through group interventions that encourage play
N/A for the others. and communication.
Outcome Social Outcome Criteria:
Criteria: Patient will increase ability to interact, play, and communicate with peers their age
Choose 3, insert
N/A for the others.
Process Criteria: Behavioral Process Criteria:
Choose 3, insert TRS will encourage self-worth and self-esteem through adaptive art interventions.
N/A for the others. Behavioral Outcome Criteria:
Outcome Patients will increase positive self-image and idea of self-worth through development of
Criteria: a positive self identity to decrease depressive symptoms.
Choose 3, insert
N/A for the others. Spiritual Process Criteria:
Outcome TRS will address secondary factors to diagnosis by introducing mindfulness to support
Criteria: spiritual health with nature, music, art, and self-reflection.
Choose 3, insert Spiritual Outcome Criteria:
N/A for the others. Patient will increase and promote positive self-awareness and self-esteem by use of
Signature: mindful activities and techniques to reduce emotional stress

Physical Process Criteria:

TRS will motivate completing tasks within the patient's ability independently, and
encouraging physical activity and motion.
Physical Outcome Criteria:
Patients will find potential lifetime interests such as hobbies, sports, and maintaining a
healthy lifestyle.
Cognitive Process Criteria: TRS will address decreased attention span and lack of
participation by introducing cognitive stimulation interventions and activities to support
task initiation and sequencing.
Cognitive Outcome Criteria:
Patients will identify and use personal goal setting strategies that work best for them to
promote positive mental health.
Signature: B. Anderson, H. Arthur, C. Lange, A. Chandler RT students, 10/2/2023.
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References

What is Spina Bifida? resources and prevention. Spina Bifida Association. (2021, September 20).

https://www.spinabifidaassociation.org/what-is-spina-bifida-2/

Porter, H. R. (2015). Recreational therapy for specific diagnoses and conditions.

Idyll Arbor, Inc.

‌CDC. (2019, August 29). Facts about Neural Tube Defects. Centers for Disease Control and Prevention.

https://www.cdc.gov/ncbddd/birthdefects/facts-about-neural-tube-defects.html#:~:text=NTDs

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