HANCOCK - As a physical therapist at Portage Health, Monica Aho has helped many children with spina bifida reach their potential.

Spina bifida (coming from the Latin for "split spine") is a relatively common birth defect, with the most common kind occurring in about one out of every 1,000 births. It occurs when the spine fails to close properly early in the fetus' development, leaving an open area through which the spinal cord may go. As a result, the infant may have a range of paralysis depending on where on the back the opening occurs.

The goal, Aho said, is to maximize their function, whether it's crawling for infants or walking for older children. As with a spinal cord injury, how much can be done depends on the degree of paralysis - most typically from waist down, though there is also partial paralysis from the hip or knee.

Aho said her therapy can involve younger kids through teenagers. Often, she said, it will be structured in episodes of care, working intensely until a specific goal is met. A baby might have therapy for crawling, then work on walking when they start school, then come back for crutches to expand their mobility. Ultimately, the goal is for the children to be able to keep up with their peers.

"We can be seeing kids off and on for several years, depending on what the next stage is," Aho said.

The therapy continues until the patient plateaus at a level of function.

"We work until we see they have reached their maximum potential, within the limits of the spinal injury itself," Aho said. "Basically, if a muscle is there, we can make it stronger. If it's not there, there's not a whole lot we can do."

Most of the therapy is smuggled in through play. For balance, the children kick a ball back and forth. To strengthen their trunk, they might sit on a swing and move in different directions.

"Everything we do is through the back door with play, because one way kids naturally strengthen themselves is through play," Aho said.

There's also a lot of work with equipment, such as walkers, leg braces and wheelchairs.

Portage recently started using a partial-weight-bearing treadmill called the LiteGait.

"They're finding that some part of walking is reflexive and that it doesn't necessarily have to communicate with the brain," Aho said. "We can use it to try to improve walking in people that are limited walkers or non-walkers. It's very exciting. It's emerging research, but it's very promising."

The device was responsible for one of the most dramatic cases of improvement Aho has seen, where a girl who could stand, but not walk, in a walker became faster and more efficient.

"Within a few months, she was using that walker all over the place ... it was so much better, and that was really exciting," she said.

Garrett Neese can be reached at gneese@mininggazette.com.