SPINA BIFIDA
Spina Bifida means cleft spine, which is an
incomplete closure in the spinal column. Spina
Bifida occurs when the spinal cord, surrounding
nerves and/or spinal column fail to develop
normally during the first 28 days of gestation. The
condition can affect the nervous, urinary,
muscular and skeletal systems — often causing
bowel and bladder complications and paralysis
below the spinal defect.
In general, the types of spina bifida (from mild to
severe) are:

Occulta
Often called hidden spina bifida, the spinal cord and the nerves are
usually normal and there is no opening on the back. In this usually
harmless form of spina bifida, there is a small defect or gap in a few of
the small bones (vertebrae) that make up the spine.

There may be no motor or sensory impairments evident at birth,
subtle, progressive neurologic deterioration often becomes evident in
later childhood or adulthood.  

In many instances, spina bifida occulta is so mild that there is no
disturbance of spinal function at all. Occulta can be diagnosed at any
age.

Meningocele
The protective coatings (meninges) come through the open part of
the spine like a sac that is pushed out. Cerebrospinal fluid is in the
sac and there is usually no nerve damage. Individuals may suffer
minor disabilities. New problems can develop later in life.

Myelomeningocele *see picture below
This occurs when the meninges (protective covering of the spinal
cord) and spinal nerves come through the open part of the spine.
This is the most serious type of spina bifida, which causes nerve
damage and more severe disabilities.
Spina Bifida occurs in 7 out of every 10,000 live births in
the United States.  Birth certificate data from the National
Vital Statistics System, a component of the Centers for
Disease Control and Prevention (CDC), National Center for
Health Statistics (NCHS), indicate a drop in the rate of Spina
Bifida; however, Spina Bifida is considered to be
underreported on birth certificates so the drop in the rate
could be due to lack of reporting, not an actual decrease in
occurence.  In addition, a number of Spina Bifida
pregnancies are voluntarily terminated and we cannot be
certain how many pregnancies are terminated versus carried
to term.
Who is at risk for Spina Bifida?

In the United States, there are 60 million women of
childbearing age and each one is potentially at risk of having
a pregnancy affected by Spina Bifida.   Birth defects can
happen in any family.  In fact, 95 percent of neural tube
defects (NTDs) occur in women with no personal or family
history of NTDs.  However, according to the CDC, some risk
factors are known :

~A previous NTD-affected pregnancy increases a woman’s
chance to have another NTD-affected pregnancy
approximately 20 times;  
~Maternal insulin-dependent diabetes;
~Use of certain anti-seizure medication (Valproic
acid/Depakene, and Carbamazapine/Tegretol);
~Medically diagnosed obesity;
~High temperatures in early pregnancy (i.e., prolonged
fevers and hot tub use);
~Race/ethnicity (NTDs are more common among white
women than black women and more common among Hispanic
women than non-Hispanic women); and
~Lower socio-economic status
~possible genetic influence (unproven thusfar)
~radiation
~excess glucose
~congenital rubella
~chromosomal abnormalities
~folic acid deficiencies
Characteristics

The effects of myelomeningocele, the most serious form of spina
bifida, may include muscle weakness or paralysis below the area
of the spine where the incomplete closure (or cleft) occurs, loss of
sensation below the cleft, and loss of bowel and bladder control.
In addition, fluid may build up and cause an accumulation of fluid
in the brain (a condition known as hydrocephalus). A large
percentage (70%-90%) of children born with myelomeningocele
have hydrocephalus. Hydrocephalus is controlled by a surgical
procedure called "shunting," which relieves the fluid buildup in the
brain. If a drain (shunt) is not implanted, the pressure buildup can
cause brain damage, seizures or blindness. Hydrocephalus may
occur without spina bifida, but the two conditions often occur
together.
Educational Implications

Although spina bifida is relatively common, until recently most
children born with a myelomeningocele died shortly after birth.
Now that surgery to drain spinal fluid and protect children against
hydrocephalus can be performed in the first 48 hours of life,
children with myelomeningocele are much more likely to live. Quite
often, however, they must have a series of operations throughout
their childhood. School programs should be flexible to
accommodate these special needs.

Many children with myelomeningocele need training to learn to
manage their bowel and bladder functions. Some require
catheterization, or the insertion of a tube to permit passage of
urine.

The courts have held that clean, intermittent catheterization is
necessary to help the child benefit from and have access to
special education and related services. A successful bladder
management program can be incorporated into the regular school
day. Many children learn to catheterize themselves at a very early
age.

In some cases, children with spina bifida who also have a history
of hydrocephalus experience learning problems. They may have
difficulty with paying attention, expressing or understanding
language, and grasping reading and math. Early intervention with
children who experience learning problems can help considerably
to prepare them for school.

Successful integration of a child with spina bifida into school
sometimes requires changes in school equipment or the
curriculum. In adapting the school setting for the child with spina
bifida, architectural factors should be considered. Section 504 of
the Rehabilitation Act of 1973 requires that programs receiving
federal funds make their facilities accessible. This can occur
through structural changes (for example, adding elevators or
ramps) or through schedule or location changes (for example,
offering a course on the ground floor).

Children with myelomeningocele need to learn mobility skills, and
often require the aid of crutches, braces, or wheelchairs. It is
important that all members of the school team and the parents
understand the child's physical capabilities and limitations.
Physical disabilities like spina bifida can have profound effects on
a child's emotional and social development. To promote personal
growth, families and teachers should encourage children, within
the limits of safety and health, to be independent and to
participate in activities with their nondisabled classmates.
OTHER Spinal Cord Injuries

Spinal cord injury is an injury in which the spinal cord is traumatized
or transected.
Monoplegia -- one limb paralysis
Paraplegia -- paralysis that involves the legs only.
Quadriplegia -- paralysis that involves all four extremities and usually
the trunk also.
Hemiplegia -- paralysis that involves only one side of the body.
Triplegia -- three appendages or limbs, usually both legs and one arm
Diplegia -- legs more affected than arms
Double hemiplegia -- both halves of the body are affected, but one
side more severely.
About 450,000 people in the United States
live with spinal cord injury. From 85% to 90%
of patients treated for spinal cord injuries are
young men between the ages of 16 and 30.
The incidence increases in the summer
months. Injuries typically occur in the early
hours of the morning.

Common causes:
*motor vehicle accidents (38.5%)
*violence (guns) (24.5%)
*falls (21.8%)

25% of spinal cord injuries are alcohol
related.

Only 7.2% of spinal cord injuries are caused
by sporting activities.
POSSIBLE INTERVENTIONS for MYELOMENINGOCELE

  Immediate action needs to be taken when a baby is born with myelomeningocele. It is possible to detect
myelomeningocele before birth via a test of the mother's blood for the presence of alpha-fetoprotein, AFT. This protein
leaks from the developing spine into the amniotic fluid and subsequently into the mother's bloodstream.
 At birth, a baby with myelomeningocele may have an exposed spinal cord (80% of cases) which puts the baby at
immediate risk for developing bacterial meningitis. Surgery to close the spinal opening and lessen the chance of infection
happens pretty quickly.
 Hydrocephalus accompanies myelomeningocele at least 25% of the time. Moreover, 80% to 90% of babies born with
myelomeningocele develop hydrocephalus after they are born. Surgery to alleviate the pressure on the brain from
excess spinal fluid is diverted to the peritoneum via a shunt (ventriculoperitoneal shunt).
  Further, children with myelomeningocele may have paralysis below the site of the lesion. Bowel and bladder control are
an issue to deal with when the child grows older. Also, physical and occupational therapists can help the child deal with
paralysis and can also fit the child with assistive technological devices to aid their education.
ventriculoperitoneal shunt
placement from www.lpch.org
above, Myelomeningocele.
To the right, spina bifida occulta.
Far right, meningocele with a
copyright, so www.fotosearch.com.
Underneath, hydrocephalus