Integration of Handicapped Children in Society by James Loring Graham Burn

Author:James Loring, Graham Burn [James Loring, Graham Burn]
Language: eng
Format: epub
ISBN: 9781138122857
Barnesnoble:
Publisher: Taylor & Francis
Published: 2015-12-14T00:00:00+00:00

13

The social and educational problems of the young spina bifida child

K. M. Laurence

and E. R. Laurence

Medical aspects

Spina bifida is part of a family of conditions where the neural tube, which develops during the first four weeks after conception, has failed to close properly. This leads to local maldevelopment and degeneration of the neural tissue. Incomplete closure at the head end of this tube leads to anencephaly, the most serious of these abnormalities. These are always stillborn or die soon after birth. When the abnormality occurs a little lower down the neural tube, an encephalocele results. The encephalocele sac which takes its origin at the base or the head often contains brain tissue (the brain within the skull may also be abnormal), but sometimes such sacs contain fluid only. Especially if the sac is large it has to be removed because of the serious nursing problem it presents. A large proportion of such patients survive but tend to be extremely retarded, and although they do not usually have paralysis or incontinence, some are severely spastic. Defects of closure lower down the neural tube result in the common form of spina bifida cystica, which includes the myelocoele, sometimes known as the myelomeningocele, and the much less common meningocele. In the former the spinal cord is not properly formed at the point of the lesion and the cord tissue usually lies exposed on the surface. Such patients tend to suffer from varying degrees of leg paralysis and incontinence. The meningocele is a less serious condition, where no nerve elements are included in the sac. These patients are usually normal, or nearly so, and they have no paralysis or incontinence, and no hydrocephalus. The least serious of this family of conditions is spina bifida occulta which is very common, and is found radiologically in about 20 per cent of the population. It is usually of no clinical significance, though a few cases may have leg or urinary difficulties.

Multiple problems are often presented by a child born with the common and serious form, the myelocele. The head may be frankly hydrocephalic. Some hydrocephalus is present in nearly 68 per cent of these children even at birth, even though the head may not be obviously enlarged. This is due to an abnormality at the base of the brain, the Arnold-Chiari malformation, or it may be caused by other maldevelopments of the brain. The arms are usually normal at this stage, though as the child gets older inco-ordination or even paralysis, due in part to the malformation at the base of the brain, or due to the hydrocephalus, may develop. As well as paralysis of the legs and loss of sensation from the abnormal spinal cord with its myelocele, the legs and feet are frequently deformed. This is due to partial paralysis, where some muscles function while their antagonists do not, and this tends to pull the joints out of shape which results in such abnormalities as dislocation of the hip and club foot. Complete paralysis, on the other hand, does not cause deformity.

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