Rehabilitation of Children With Spinal Dysraphism

Conventional physical therapy and physical therapy based on reflex stimulation showed similar results in children with myelomeningocele

We aimed to investigate whether infants with myelomeningocele would improve their motor ability and functional independence after ten sessions of physical therapy and compare the outcomes of conventional physical therapy (CPT) to a physical therapy program based on reflex stimulation (RPT). Twelve children were allocated to CPT (n = 6, age 18.3 months) or RPT (n = 6, age 18.2 months). The RPT involved proprioceptive neuromuscular facilitation. Children were assessed with the Gross Motor Function Measure and the Pediatric Evaluation of Disability Inventory before and after treatment. Mann-Whitney tests compared the improvement on the two scales of CPT versus RPT and the Wilcoxon test compared CPT to RPT (before vs. after treatment). Possible correlations between the two scales were tested with Spearman correlation coefficients. Both groups showed improvement on self-care and mobility domains of both scales. There were no differences between the groups, before, or after intervention. The CPT and RPT showed similar results after ten weeks of treatment.

A comparison of techniques for myelomeningocele defect closure in the neonatal period

PURPOSE

Numerous techniques have been described for repair of myelomeningoceles, but outcome data is scarce.

PATIENTS AND METHODS

A retrospective review was performed in 32 consecutive patients who underwent neonatal myelomeningocele repair and extra-dural closure to determine the influence of repair type on outcome. All procedures for myelomeningocele closure were classified into one of three groups, which included primary closure, myocutaneous flaps, and fasciocutaneous flaps.

RESULTS

Defect size ranged from 1 to 48 cm(2). Primary skin closure was performed in 3 patients, fasciocutaneous flaps in 13 patients, and myocutaneous flaps in 16 patients. The overall complication rate was 18%. No difference in the complication rates among the primary closure, myocutaneous, and fasciocutaneous flap groups was observed in our analysis. While not statistically significant, our data documents an association of fasciocutaneous flaps with postoperative complications that were not evident with primary skin closure or myocutaneous flaps (odds ratio 3.8; p = 0.15). The occurrence of one or more complications was associated with a longer hospital stay.

CONCLUSIONS

Myocutaneous flaps provide a secure repair and should be considered for smaller myelomeningocele defects in addition to the larger defects where they are more traditionally used. We propose a tissue-based classification of closure techniques strictly for multi-institution outcome comparison that may ultimately inform clinical decision-making.

Hospitalizations of adults with spina bifida and congenital spinal cord anomalies

OBJECTIVE

To examine hospital admission records from a large cohort of persons with spina bifida (SB) with a variety of insurers to provide descriptive detail about adult hospital use for persons with SB and associated disorders in terms of primary diagnosis for hospitalization, age, sex, payer source, lengths of stay, and total charges.

DESIGN

Retrospective secondary data analysis from the Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project for 2004 and 2005 of hospitalizations for adults with SB or associated spinal cord anomalies.

SETTING

Records from U.S. inpatient hospital admissions.

PARTICIPANTS

Persons with SB age 18 years and older.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Diagnoses associated with hospitalizations and death.

RESULTS

The most common primary diagnosis for hospitalization was urinary tract infection, followed by complications from devices/grafts/implants and skin wounds. Sepsis accounted for the most deaths. Approximately one third of hospitalizations were for primary diagnoses of potentially preventable conditions. Hospitalizations associated with a primary diagnosis of a potentially preventable condition occurred most often in those less than 51 years of age and in rural or urban nonteaching hospitals.

CONCLUSIONS

Reducing the number of secondary medical conditions with proactive and preventative approaches to health care could reduce the morbidity, mortality, and cost for health care for this group.

Tethered cord syndrome

Tethered cord syndrome is a clinical phenomenon resulting from anatomic restriction of the normal movement of the spinal cord or vascular compromise leading to hypoxia of its distal structures. Tethering can be acquired (secondary) or congenital (primary). This article presents the relevant embryology, primary and secondary causes of tethering, clinical presentations, the treatment of specific entities, indications and options for Tethered cord syndrome is a clinical phenomenon resulting from anatomic restriction of the normal movement of the spinal cord or vascular compromise leading to hypoxia of its distal structures. Causes of tethering can be acquired (secondary) or congenital (primary). This article presents the relevant embryology, primary and secondary causes of tethering, clinical presentations, the treatment of specific entities, indications and options for surgical treatment, and surgical complications.

Quality of Life and Continence in Patients with Spina Bifida

PURPOSE

Spina bifida (SB) is the most common congenital cause of incontinence in childhood. This study attempts to determine the relationships between urinary/faecal incontinence, methods of management, and Health Related Quality of Life (HRQoL) in people with SB.

PATIENTS AND METHOD

A total of 460 patients (300 adults and 160 adolescents) from six centres in France have taken part in this cross-sectional study. Clinical outcome measures included walking ability, urinary/faecal continence, and medical management. HRQoL was assessed using the SF36 in adults and the VSP in adolescents and their parents. Univariate and multivariate analysis was used to determine the relationships between clinical parameters and HRQoL.

RESULTS

HRQoL were significantly lower than in the general population. Adult women had significantly lower scores than men, and adolescent females had significantly lower scores for psychological well being. We did not found strong relationship between incontinence and HRQoL in this population. Moreover patients surgically managed for urinary/fecal incontinence did not show significantly higher scores of HRQoL.

CONCLUSION

Using generic HRQoL measures, urinary/faecal incontinence and their medical management may not play a determinant role in HRQoL of persons with SB. However many other factors affect HRQoL in these patients. A longitudinal study design is recommended to assess whether incontinence management is associated with improved HRQoL.