Spina Bifida

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IntroductionSpina Bifida means "split spine". It occurs when the spinal column does not close all the day during the development of the fetus.There are four types of Spina Bifida:Occult Spinal Dysraphism (OSD) - Indicated by a dimple in the child's back. Not all dimples are OSD so a doctor must run tests to confirm. OSD requires surgery at a young age to prevent further nerve and brain damage.Spina Bifida Occulta - Often called "hidden Spina Bifida". Often does not cause harm and has no visible symptoms. Does not require surgery.Meningocele - Part of the spinal cord comes through the spine like a sack. The sac is full of nerve fluid but there is usually no nerve damage. May cause minor disabilities. Surgery is needed.Myelomeningocele (Meningomyelocele), also called Spina Bifida Cystica - The most severe form of Spina Bifida. Occurs when both the spinal cord and the nerves protrude through the open part of the spine. Causes nerve damage and various disabilities. Many children born with this condition have too much fluid on their brains because it cannot drain properly through the spinal cord. The pressure and swelling caused by this can lead to brain damage. Surgery is required in the first few days after birth.(Spina Bifida Association, 2014)

CharacteristicsThe level and form of disability will depend on the type of Spina Bifida and where the hole is on the spine. See the diagram below for full details of how the various lesions impact daily functioning.Mobility issues range from minor to severe with many individuals needing orthopedic braces and other assistive devices for walking. Individuals with severe cases will be in a wheel chair full time.Individuals may struggle with bowel and/or bladder incontinence. This can sometimes be relieved through surgery. Individuals with SB often have average IQs and do well with reading, writing can be an issue if they have difficulties with motor skills and hand-eye coordination. Struggles with math are more common than struggles with reading and ADHD can also be a concurrent disability.See the attached date file in the upper right hand corner of this glog for detailed information about the common learning struggles people with SB may have.(Spina Bifida Association, 2014)

Causes* The exact cause is unknown. Experts believe that both genetics and environmental factors might interact to cause Spina Bifida. * The risk of a child developing Spina Bifida is greatly reduced when the mother maintains healthy levels of folate through diet and suppliments of folic acid.* It is recommended that women who are trying to get pregnant take 400 mcg of folic acid daily a month before and three months after conception. Women who have already had a pregnancy with Spina Bifida or have it themselves should take 4000 mcg of folic acid.(Spina Bifida Association, 2014)

Reference Sheet for Educators

Difficulties in the ClassroomPerceptual motor problemsOften, children with shunted hydrocephalus have poor eye-hand coordination and ineffective motor skills among children with Spina Bifida interfere with the ability to move, use tools, read and write. ComprehensionChildren with Spina Bifida sometimes have a hard time understanding concepts. AttentionChildren with Spina Bifida often have trouble paying attention at school where they may miss assignments, complete work slowly or overlook social cues. Hyperactivity/ImpulsivityWhile physical impairment may mask the restlessness, children with Spina Bifida often appear fidgety and impulsive. This behavior can get the children into trouble because they end up doing things quickly and carelessly. MemoryEven when children with Spina Bifida understand what they see or hear, they often have difficulty remembering. OrganizationChildren often have trouble keeping things organized and are likely to lose or misplace things. SequencingChildren and adolescents with Spina Bifida often have trouble keeping ideas or doing activities in their proper order. Sequencing problems become obvious when doing math, telling time and counting change. Decision Making/Problem SolvingPeople with Spina Bifida have trouble making decisions, which requires using what was learned in the past to solve a new problem now. (Spina Bifida Association, 2014)

Strategies for the ClassroomDepending on the type and severity of the disability the following accommodations must be considered:Building Accommodations* Ramps inside and outside of the school * An elevator in a multilevel building with free access for the student * Doorways wide enough to accommodate a student’s wheelchair * Accessible general areas (i.e.-gym, cafeteria, auditorium) * An accessible bathroom with grab bars * Classrooms with enough space to accommodate a student’s wheelchair (including turning space) * An accessible locker * Desks and tables high enough to accommodate a wheelchair in each of the student’s classrooms * A fire/emergency evacuation plan which should be shared with the local fire department * Provide a private location for catheterization and other necessary personal care * Temperature controlled environment * Temperature controlled transportation Scheduling accommodations* Allow students to leave classes early to travel to their next class, allowing them sufficient time and the ability to move through the halls when they are less crowded * Provide time in their schedule for catheterization Testing accommodations* Extra time on tests/assignments * One-on-one evaluation * Alternate response mode (i.e.-oral response, dictation of written answers) * Alternate presentation (i.e.-orally) * Give take-home tests * Reduce number of choices on multiple choice tests * Allow test to be taken over several sessions or several days * Use of a laptop * Use of calculator * Use of external prompts (i.e.-list of keyboard shortcuts)

Spina Bifida (SB)

ReferencesSpina Bifida Association. (2014). Health Information Sheets. Spina Bifida Association of America. Retrieved from: http://www.spinabifidaassociation.org/site/c.evKRI7OXIoJ8H/b.8029553/k.7027/Health_Information_Sheets.htmPorter, P., Obst, B., Zabel, A. (December, 2009). A Guide for School Personnel Working With Students With Spina Bifida. Maryland State Department of Education. Retrieved from: http://www.kennedykrieger.org/sites/kki2.com/files/guide_for_school_personnel_working_with_students_with_spina_bifida_1.pdf