Spina Bifida Sarah Winter, MD Assistant Professor Cincinnati Children’s Division of Developmental Disabilities
Jan 03, 2016
Spina Bifida
Sarah Winter, MD
Assistant Professor
Cincinnati Children’s
Division of Developmental Disabilities
Terminology
• myelomeningocele/meningomyelocele– /myelodysplasia
• meningocele
• lipomeningocele
• spina bifida vs. spina bifida oculta
When Does It Occur?
• Failure of closure of the neural tube occurs within the first 28 days of pregnancy.
Embryo at 21 Days
What is SPINA BIFIDA?
• One of the neural tube defects
• Abnormal development of the spinal cord and brain
Pictures of Spina Bifida
What Causes Spina Bifida?
• Nutrition? Folic acid supplements are protective of neural tube defects
• Genetics? families have higher risk if have had previous child with a neural tube defect
• multifactorial
Who Can Get Spina Bifida ?
• 0.6 out of every 1,000 children has a neural tube defect.
• Highest prevalence in certain ethnic populations.
• Slightly more girls than boys have spina bifida
• Occurs less in African Americans than in white individuals.
Detection of Neural Tube Defects
• Chorionic villous sampling 10-12 weeks
• Alphafetoprotein week 16
• Amniocentesis week 16
• Screening ultrasound
• High resolution ultrasound
Prenatal Intervention
• Genetic Counselling
• Prenatal consultation with neurosurgery and medical director of Spina Bifida clinic
• In-utero repair – approx. 22 - 25 weeks gestation, – normal foot and leg movement.
History of the Treatment of Children with Spina Bifida
• presence of infants with myelomeningocele detected 3000 years ago
• most left untreated until the development of methods to treat hydrocephalus (late1950’s)
• Lorber criteria accepted (1970’s)
• New England Journal of Medicine, 1985: “Early surgical care is now appropriate for most newborns with myelodysplasia”
Treatment
• Immediate repair of spinal defect (<48 hours)
• treatment of hydrocephalus as necessary – 85-90% of all children with SB
Spina Bifida
• Spinal Cord Defect
• Chiari II Malformation
Spinal Cord Defect
• paralysis below the level of the lesion
• neurogenic bladder
• neurogenic bowel
• insensate skin
• sexual dysfunction
• orthopedic deformities
Paralysis below the level of the lesion
Orthopedic concerns
Mobility
• Many people with spina bifida need something to help them move about.– crutches and walkers
– wheelchairs
– leg braces
Insensate Skin
Bladder and Bowel
• Nerves that control the bladder and bowel were damaged before the child with spina bifida was born– this means that the child may have trouble with
urination & bowel movements.– many children with spina bifida need to use
special medicines and treatments, such as catheterizations, to help them void.
Latex
Caution!• Art supplies: paints,
glue, erasers, fabric paints
• Balloons, Balls• Toys• Rubber Bands
Chiari II Malformation
Chiari II Malformation
• hydrocephalus
• learning disability
• swallowing difficulties
• vocal cord paralysis
• cognitive impairment
• central ventilatory dysfunction
Hydrocephalus- continued...
• A shunt is put in the child’s head to help drain the fluid from the brain to an open area around the stomach. Then it is absorbed back into the blood.
Shunt Malfunction
• Headache
• Vomiting
• Decreased level of alertness
• Decline in school performance
School• A lot of children with
spina bifida have trouble with certain parts of school– attention
– memory
– comprehension
– organizing
– writing
Strategies In School
• Early Intervention/Preschool
• Special Education as Needed / IEP
• Regular Classroom Supports
• Physical and Occupational Therapy
• Nursing Services-Catheterizations/Meds
• Adapted Physical Education
School Issues
• Social Isolation• Accessibility Issues• Peer Acceptance• Safety Issues• Recreational
Peer Acceptance
• Education about the Disability
• Differences/ Similarities
• Respect Issues
Encourage parents to allow their children with spina bifida
to experience life.Hold high expectations for their child and encourage them to continue to try new tasks to increase their feeling of
self-competence and confidence .
Children with spina bifida need to overcome many obstacles and deal with issues regarding peer, as well as personal acceptance.
What Does All This Mean cont...
• People with spina bifida can lead long and fulfilling lives.– graduate from high
school, go to college, have successful careers
– get married
– some may have children
Salim,
One Year Old
RESOURCES
• National and Local SBA• Bureau for Children with
Medical Handicaps/SSI• Therapeutic Recreation• Bureau for Vocational
Rehabilitation• Spinabilities• Children with Spina Bifida:A
parent’s Guide Woodbine House 1999
• UACCDD
Questions?