Modifying the self-injurious behavior of an infant with spina bifida and diminished pain sensitivity

Self-injurious behavior in children and adolescents with spinal cord injuries

STUDY DESIGN

A case report of self-injurious behavior in four children and adolescents with spinal cord injuries (SCI).

OBJECTIVES

To report a relatively unusual complication of pediatric-onset SCI, focusing on the potential role that dysesthesia may play in self-injurious behavior.

SETTING

A Spinal Cord Injury Program in a Children's Hospital in Chicago that serves children from midwestern and south-central United States of America.

METHOD

Case reports and literature review.

RESULTS

Case reports are presented of four children or adolescents with SCI who exhibited self-injurious behavior. Two of the subjects had symptoms consistent with dysesthesia. The self-injurious behavior in these two subjects and a very young child responded to treatment with anticonvulsants. The self-injurious behavior in the fourth patient was probably the result of poor technique of using his mouth to move his hands, which responded to conservative management including education, occupational therapy and gloves.

CONCLUSION

Self-injurious behavior is a relatively unusual complication of pediatric onset SCI, and may be a manifestation of dysesthesia and be responsive to treatment with anticonvulsants.

Secondary conditions in children with disabilities: spina bifida as a case example

This paper examines the concept of secondary conditions and its application in studies of childhood disability focusing on children with spina bifida as a representative group. The "International Classification of Functioning, Disability and Health" (World Health Organization, Geneva, 2001) provides a classification of body function/structure, activities, participation and the environment to document dimensions of human functioning in context. The ICF is of value in the study of secondary conditions in two ways: as a conceptual framework for defining impairments, activity limitations and participation restrictions, and the mediating role of the environment in their expression; and as a taxonomy for coding these dimensions of disability. The ICF can yield a profile of a child's difficulties, and documentation of environmental barriers experienced by that child. Research studies with children and adolescents with spina bifida reveal that physical and mental impairments and limitations in performing activities and participating in communal life are experienced as secondary conditions. The significance of secondary conditions is that they are preventable. Identifying the mechanisms associated with their manifestation is thus an important priority for the development of effective prevention programs.

Self-injurious behavior in Rett syndrome: interactions between features of Rett syndrome and operant conditioning

Operant and biological theories of the cause of self-injurious behavior (SIB) in people with a mental handicap are often viewed as mutually exclusive. In this single case study, interactions between features of Rett syndrome and operant conditioning as determinants of SIB are examined. Functional analysis by analog methodology indicated different functions for two forms of SIB shown by the subject: automatic reinforcement by sensory stimulation and escape from social interactions. It is suggested that features of Rett syndrome established conditions under which operant conditioning of self-injurious responding was maximized. The implications of this interaction between features of syndromes and operant conditioning for the conceptualization of the cause of SIB are discussed and it is proposed that the notion of a unitary cause of SIB is inappropriate. It is more productive to consider operant conditioning as the process that maintains responding against a background of predisposing and mediating factors which may be biologically determined.

Self-biting with multiple finger amputations following spinal cord injury

We have observed mutilative self-biting leading to multiple finger amputations in two patients following C4 complete spinal cord injury (SCI). Both men were of normal intelligence without psychosis and each had a neurotic personality and history of fingernail biting. They related the self-biting to anxiety and depression. We believe these to be the first English language reports of multiple finger amputations due to self-biting following SCI.