Exercise for Individuals with Spina Bifida
By: Brittany Hacker

The National Institute of Neurological Disorders and Stroke states that spina bifida is the most common neural tube defect in the United States, which is characterized by an incomplete development of the brain, spinal cord, or the meninges (NINDS, 2005). Spina bifida has four different types that affect individuals; however, all types benefit from regular exercise to reduce pain and increase comfort. The severity of spina bifida an individual experiences is based on the size and location of the malformation, which needs to be taken into consideration when planning and implementing exercises (NINDS, 2005). Individuals with spina bifida experience many reactions to the amount of nerves that are affected and irritated on a daily basis. All of these effects of spina bifida determine what kind of assistance the individual will need, whether it is braces, crutches or a wheelchair (NINDS, 2005). Special exercises for the legs and feet must be done soon after birth to prepare the child for whatever assistive needs he or she will need (NINDS, 2005).

Individuals with spina bifida need to develop upper body strength, endurance and flexibility. It is also important for them to develop balance and coordination that will assist in developing fundamental motor and recreational skills appropriate to their age and lesion level (Stopka & Todorovich, 2005). It is essential that body awareness, positive self-image, and a sense of belonging be incorporated into the lives and activities of individuals with spina bifida's to increase their physical and mental health.

According to the National Center on Physical Activity and Disability, people with spina bifida should exercise five times a week and stretch three to four times a week (NCPAD, 2007).When beginning an exercise regime, it is important for people with spina bifida to only begin when they are healthy and have the approval of their doctors. It is important to keep the exercises fun, varied, and rewarding so that individuals remain active. Exercises promote strength, mobility, and physical development in individuals with spina bifida, especially if you are in a wheelchair (NCPAD, 2007). Exercise is important for people with spinal cord injuries because it can help prevent secondary conditions such as heart disease, obesity, diabetes, pressure sores, carpal tunnel syndrome, hypertension, urinary tract infections, and respiratory disease (PE Central, 2007).

Bones are strengthened, joints are lubricated, and muscles are strengthened when individuals with spina bifida exercise soon after birth and continue throughout their lives (Healthwise, 2005). Parents should incorporate exercises into a daily routine with their babies. It is important to increase their range of motion by rotating the baby's arms and legs at the joints, such as the knees, hips, shoulders, and elbows, to prevent injury and strengthen the muscles around the joints (Healthwise, 2005). It is easy to incorporate range of motion exercises into your day if you make it a part of diaper changing time (Gombash, 1998). Working on range of motion every time you change the baby's diaper makes it easier to remember, and ensures that these exercises will happen a few times a day.

When the child with spina bifida gets a little older, it is good to place them on their stomachs and encourage them to reach for toys, which allows them to use their arms (Healthwise, 2005). It is healthy to encourage babies with spina bifida to try normal developmental skills such as holding their heads up, and pushing their torsos off the ground with their arms (Gombash, 1998). As the child with spina bifida grows older, it is important to continue the range of motion exercises, as well as encouraging them to sit up which promotes balance and good posture. If the individual begins to walk, it is important to emphasize the best way to stand and walk with braces and walkers, to have the maximum amount of support to prevent fractures (Gombash, 1998).

When beginning to exercise, it is important for the individual with spina bifida to have the correct posture. The correct posture when sitting down is to be sitting up as tall as possible with both feet planted on the floor or wheelchair foot rests. The lower back should be supported by a rolled up towel or equivalent in the curve of the individual's lower back (NCPAD, 2007). Once you are positioned properly, it is important to remember to breathe continually throughout all of the exercises. Exercises should not be rigorous enough that the individual cannot carry on a normal conversation (NCPAD, 2007). The maximum heart rate for an person with spinal cord injuries is much lower than those without (PE Central, 2007). If an individual with spina bifida is exercising alone, they should count aloud to confirm that they are not overexerting themselves. It is important to get the right amount of rest after exercises. Doing new exercises may make someone sore for a few days, so it is important to wait until soreness has ended to begin strength exercises again (NCPAD, 2007).

People with spina bifida can do many stretches. It is important to stretch your whole body, including your neck, wrists, arms, triceps, biceps, elbows, trunk, hamstrings, and hips while seated on a chair or in a wheelchair (NCPAD, 2007). Flexibility training is important to increase the range of motion and reduce spasticity (PE Central, 2007). Many of these exercises can be done individually or with the assistance of a Thera-band. Since many people with spina bifida have latex allergies, it is important to check that the equipment the individual will be using is not made of latex. For example, many Thera-band companies make latex free versions, which are important for individuals with spina bifida as well as therapists to look into (NCPAD, 2007).

Strength training should be done at least three days a week to prevent injury and maintain the ability to do routine tasks (PE Central, 2007). Upper body pushing and pulling exercises will help with weight transfers and pushing a wheelchair. Rowing exercises help with posture and preventing shoulder injuries (PE Central, 2007). It is important for people in wheelchairs to do push-ups every 10 to 30 minutes throughout the day, while holding it for 10-30 seconds (PE, 2007). This use of muscle strength will help reduce pressure sores from sitting in the wheelchair. A variety is important with strength training exercises, to keep it fun for the individual with spina bifida, as well as preventing injuries from overuse. Strength activities can use free weights, weight machines, pulleys, balls, and Thera-bands (PE, 2007).

Working out and exercising in the pool is a great way for people with spina bifida to get out of their wheelchairs, braces, and walkers and enjoy the freedom and movement of the water. Once feeding tubes and bowel/bladder devices have been removed or prepared for the water, individuals must be incredibly careful when transferring individuals with spina bifida from their wheelchairs into the pool. Soft mats are an easy transition aid from the wheelchair to the pool deck to the water (Heuttig, 2007). Individuals with spina bifida may have difficultly laying horizontal while swimming, gliding, or floating in the pool. Floatation devices can be added to assist in the comfort and position of these individuals in the pool (|Heuttig, 2007). The water is a great place for therapists to work on the person's development of postural muscles that are required for efficient movement in the wheelchair.

Sitting upright on a floating mat, playing while sitting on a fun noodle, or treading water in an upright position are excellent ways to develop and correct posture (Heuttig, 2007). Swimming can also help prevent pressure sores (Stopka & Todorovich, 2005). When exercising and swimming in the shallow end, individuals with spina bifida should wear socks so that their feet do not drag and scrape on the bottom of the pool, since they do not have as much feeling and sensation in their lower extremities to prevent such incidences (Stopka & Todorovich, 2005). It is important to assist individuals when they need it rolling over or moving in the water; however, independence should be encouraged to get the most out of the time in the water.

Another great way for people with spina bifida to exercise is with a video made by the National Center on Physical Activity and Disability, the Spina Bifida Association of America, and the Rehabilitation Institute of Chicago called "Teens on the move: an exercise video for teens with spina bifida." This video has a complete exercise program with 18 minutes of aerobic exercise, 16 minutes of flexibility, 26 minutes of balance and core strength training, as well as a warm up and cool down (NCPAD, 2006). The video was designed to incorporate physical activity into the daily lives of teens with this disability.

Depression can affect anyone, but individuals with spina bifida can have symptoms of depression from a variety of health ailments, such as a shunt malfunction or infection. (SBA, 2006). According to the Spina Bifida Association, some studies show that there is an increase in depression among individuals with this disorder because they are at higher risk for depression and have lower self worth. Many other studies show that exercise can have a large effect on depression (SBA, 2006). Wheelchair sports programs and other group athletic exercises are great for many people with spina bifida because they provide social contact and physical activity, which leads to a decrease in the individual's depression.

References

Gombash, L. (1998). Spina Bifida Physical Therapy. Retrieved April 7, 2007 from http://harcourtassessment.com/hai/Images/resource/techrpts/TheraNotes/TN_Ped_PT_pdf/SpinaBifida.pdf

Healthwise. (2005, May). Home treatment for the child with spina bifida. Retrieved April 7, 2007 from http://children.webmd.com/tc/Spina-Bifida-Home-Treatment

Heuttig, C. (n.d). Aquatic Program Considerations and Recommendations for Individuals with Disabilities: Spina Bifida. Retrieved April 7, 2007 from http://www.twu.edu/inspire/Aquatics/aqsb.htm

National Center on Physical Activity and Disability, NCPAD. (2007, March). Exercise for Individuals with Spina Bifida. Retrieved April 7, 2007 from http://www.ncpad.org/exercise/fact_sheet.php?sheet=273

National Center on Physical Activity and Disability, NCPAD. (2006, October). Teens on the move: An exercise video for teens with spina bifida. Retrieved April 7, 2007 from http://www.ncpad.org/exercise/fact_sheet.php?sheet=469

National Institute of Neurological Disorders and Stroke, NINDS. (2005, June). Spina Bifida fact sheet. Retrieved April 7, 2007 from http://www.ninds.nih.gov/disorders/spina_bifida/detail_spina_bifida.htm

PE Central. (n.d). Spinal Cord Injury. Retrieved April 7, 2007 from http://www.pecentral.org/adapted/factsheets/spinalcord.htm

Spina Bifida Association, SBA. (2006). An Overview of Depression and Anxiety in Individuals with Spina Bifida. Retrieved April 7, 2007 from http://www.sbaa.org/site/c.gpILKXOEJqG/b.2021119/k.91D0/An_Overview_of_Depression_and_Anxiety_in_Individuals_with_Spina_Bifida.htm

Stopka, C., & Todorovich, J. (2005). Applied Special Physical Education and Exercise Therapy. Massachusetts: Pearson Custom Publishing. pp. 26-28, 212.

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