Multimodal Physiotherapy for Functional Mobility in a Child with L4–L5 Spina Bifida Occulta: A Case Report

Ni Luh Made Reny Wahyu Sari; Putu Ayu Meka Raini; Ni Putu Devi S. Kardha; Ni Wayan Ari Susanthi; I Made Dedy Bagus Astika; Putu Tata Pradnya Dewi

doi:10.24843/

Penulis

Ni Luh Made Reny Wahyu Sari Professional Physiotherapy Study Program, Faculty of Health Sciences, Universitas Dhyana Pura, Badung, Bali, Indonesia Penulis
Putu Ayu Meka Raini Professional Physiotherapy Study Program, Faculty of Health Sciences, Universitas Dhyana Pura, Badung, Bali, Indonesia Penulis
Ni Putu Devi S. Kardha Professional Physiotherapy Study Program, Faculty of Health Sciences, Universitas Dhyana Pura, Badung, Bali, Indonesia Penulis
Ni Wayan Ari Susanthi Professional Physiotherapy Study Program, Faculty of Health Sciences, Universitas Dhyana Pura, Badung, Bali, Indonesia Penulis
I Made Dedy Bagus Astika mahasiswa Penulis
Putu Tata Pradnya Dewi Professional Physiotherapy Study Program, Faculty of Health Sciences, Universitas Dhyana Pura, Badung, Bali, Indonesia Penulis

DOI:

https://doi.org/10.24843/

Kata Kunci:

Spina Bifida, Physical Therapy Modalities, Motor Activity, Postural Balance, Child

Abstrak

Background: Spina bifida occulta may impair motor development, postural control, sensory function, and functional mobility in children. Evidence regarding individualized multimodal physiotherapy for preschool children with this condition remains limited.
Objective: To describe multimodal physiotherapy management and evaluate early clinical changes in motor performance, balance, sensory function, and functional mobility in a child with L4–L5 spina bifida occulta.
Methods: This CARE-compliant case report describes a five-year-old girl with magnetic resonance imaging-confirmed L4–L5 spina bifida occulta who completed three physiotherapy sessions. The intervention combined neuromuscular electrical stimulation, tactile sensory stimulation, stretching, active-assisted range of motion, bridging, crawling training, postural transition training, treadmill gait training, backward walker training, and play-based functional activities. Outcomes were assessed using Manual Muscle Testing, Gross Motor Function Measure-88, Pediatric Balance Scale, International Standards for Neurological Classification of Spinal Cord Injury, and the International Classification of Functioning, Disability and Health for Children and Youth framework.
Results: Gross Motor Function Measure-88 improved from 58.48% to 63.72%, while Pediatric Balance Scale increased from 6/56 to 10/56. Lower-extremity muscle strength improved across most muscle groups, particularly ankle dorsiflexors (0/5 to 2+/5). Partial sensory recovery, improved trunk control, better gait quality, increased exercise tolerance, and greater participation during therapy were also observed. No intervention-related adverse events occurred.
Conclusion: Individualized multimodal physiotherapy was associated with early clinical improvements in motor function, balance, and functional mobility. Given the single-patient design and short follow-up, these findings should be interpreted as preliminary clinical evidence. Larger prospective studies are needed to establish intervention effectiveness.