Spinabifida is a birth defect which involves damage to the bony spine and the nervous tissue of the spinal cord.
Some vertebrae of the spine don’t close properly during development and the spinal cord’s nerves don’t develop normally. At birth, they protrude through the gap instead of growing normally down the bony spinal column.
The cause of Spinabifida is unknown, although genetic and environmental factors have been implicated as possible causes.
The malformation of the spine occurs within the first few weeks of pregnancy and in Australia the incidence of spinabifida is two in 1,000. It is one of the most complex of the congenital disabilities.
There are four types of spinabifida: occulta, Closed neural tube defects , meningocele, and myelomeningocele.
Occulta is often called “hidden SpinaBifida” because about 15 percent of healthy people have it and do not know it. SpinaBifida occulta does not cause harm, has no signs and the spinal cord and nerves are fine. People usually find out they have it after having an X-ray of their back .
Closed neural tube defects make up the second type of spinabifida. This form consists of a diverse group of spinal defects in which the spinal cord is marked by a malformation of fat, bone, or membranes. In some patients there are few or no symptoms; in others the malformation causes incomplete paralysis with urinary and bowel dysfunction.
Meningocele is the third type in which the meninges protrude from the spinal opening, and the malformation may or may not be covered by a layer of skin. Some patients with meningocele may have few or no symptoms while others may experience symptoms similar to closed neural tube defects.
The fourth form, Myelomeningocele is the most severe and occurs when the spinal cord is exposed through the opening in the spine, resulting in partial or complete paralysis of the parts of the body below the spinal opening.
The paralysis may be so severe that the affected individual is unable to walk and may have urinary and bowel dysfunction.
Legs and feet – a range of walking difficulties (through to an inability to walk), reduced sensation, proneness to burns and pressure sores.
Bowel and bladder – some level of urinary and faecal incontinence, increased stress on the kidneys, some level of sexual dysfunction.
Brain – in most cases, the baby has hydrocephalus which is a potentially dangerous condition involving the excessive accumulation of spinal fluid within the brain caused either by over production of the fluid or more usually by an obstruction to its normal circulation.
Implications for development
Language Children with spinabifida are often described as sociable and talkative with good vocabulary skills. However, they may have difficulty monitoring what they say for logic, relevance or appropriateness. This poor comprehension may be difficult to identify when associated with articulate presentation. Some 'over talk', perhaps to compensate for their limited mobility or to conceal their inability to do what is asked, may be evident.
Immediate memory for auditory/verbal information may be intact, i.e. the child has an age appropriate capacity to remember instructions or explanations immediately after they are given. However, there is a rapid loss of information over time and difficulty in retrieving the appropriate bit of information from long term memory when it is needed.
Most Children with spinabifida have difficulty with tasks requiring eye-hand coordination.
They may have difficulty with accurately interpreting what they see in terms of shape, size, space, distance and then correctly matching their movements (gross or fine).
Some children may experience confusion differentiating between left and right.
Childcare workers who work with children that have additional needs must possess good communication skills and a willingness to work as a team with parents, therapists, doctors and other professionals.
They must also have the ability to use cooperative learning techniques and to modify teaching strategies and curriculum where necessary.
minimising distractions when a single activity is set
giving instructions that are clear and step by step and repeated when required
Providing adult assistance to redirect the child after lapses in concentration.
encouraging the child to use language for communication of meaning rather than only to manipulate others or to conceal areas of difficulties
routinely checking the child’s understanding of the language they are using (for example, by asking the student to paraphrase what is said to them, particularly instructions).
reducing the amount of information presented at one time and allowing extra opportunity for rehearsal
emphasising key points in a logical sequence and extraneous information should be minimised
reinforcing conceptual learning through practical activities related to the student's interests and life experience.
allowing extra time for simple tasks to be completed
Meningocele, which does not involve the spinal cord, can usually be repaired surgically to preserve normal spinal function.
When a baby is born with the severest form of spinabifida, it usually is operated on within 48 hours after birth.
Doctors surgically release the spinal cord, replace it in the spinal canal and cover it with muscle and skin. Even so, limb paralysis and bowel problems usually remain. Specialists in orthopedics and urology are asked to treat these problems.
If the child develops hydrocephalus, fluid can be drained from the brain through surgical placement of a shunt. The shunt runs under the skin into the chest or abdomen, and the fluid passes harmlessly through the child's body.