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Dr Carolyn West
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What is spina bifida?
Spina bifida is the most common congenital abnormality involving the development of the brain and spinal cord, occurring in one in 1000 pregnancies. Children born with this condition may have weakness of the legs and problems with control of bladder and bowel.
In the early weeks of pregnancy the sheet of cells destined to become the brain and spinal cord form into a tubular structure that fuses posteriorly. Failure of completion of posterior fusion results in incomplete development of the spinal cord and bones known as spina bifida or myelomeningocoele. The failure of posterior fusion can occur anywhere along the spine but is most common at the lower end of the spine, therefore affecting the control of the legs, bladder and bowel.
Although spina bifida is not a progressive or degenerative condition, significant changes do occur during childhood because of growth and development. These changes are both physical and cognitive, with the two interacting.
Hydrocephalus also occurs in 90% of children with spina bifida. (See the Hydrocephalus article.) This is where cerebro-spinal fluid builds up within the brain because it cannot adequately circulate.
After the baby is born, hydrocephalus is commonly treated with a shunt which is a fine plastic tube which usually redirects fluid from the brain to another part of body, usually the abdominal cavity.
If a child with spina bifida requires a shunt in the neonatal period, it is usually required for life.
Symptoms of a blocked shunt:
If a student with spina bifida has these symptoms or a headache at school, the parent/carer should be contacted.
Participation in sport and physical activities should be encouraged. Shunt function rarely, if ever, is affected by a bump on the head or a fall as part of everyday physical activities
Children with spina bifida and hydrocephalus frequently have some cognitive impairment. Measurement of their basic IQ is insufficient to assess their cognitive skills.
A neuropsychological assessment will be more helpful in understanding the individual learning needs. The IQ often falls within the average range, albeit at the lower end of the average range, with a small percentage falling in the mildly intellectually disabled range.
Hydrocephalus also has a significant effect on executive functioning, which becomes increasingly important as the child grows older and these functions develop. Common deficits in executive functioning include:
Impairment of cognitive skills and executive function means that students may need extra help and support with:
The child with spina bifida at school
There are three main areas of functional impairment in children with spina bifida:
Many students with spina bifida will have some impairment of walking and limitations in other physical tasks and may require support classes such as:
The majority of students with spina bifida will have incontinence, ie they will not know when their bladder or bowel needs to be emptied See the ‘Toileting’ tab under ‘Implications for schools’ in this topic.
Cognitive issues are found in the form of:
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