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Malaysian children with spina bifida: relationship between functional outcome and level of lesion
1Department of Paediatrics, Universiti Kebangsaan Malaysia, Kuala Lumpur. onglc@mail.hukm.ukm.my
Insights
The level of spinal lesions in children with spina bifida correlates with mobility issues. However, predicting continence and school placement based on lesion level is challenging for long-term care planning.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Rehabilitation Medicine
Background:
- Spina bifida is a complex congenital condition affecting neural development.
- Understanding the impact of lesion level is crucial for predicting functional outcomes in affected children.
Purpose of the Study:
- To investigate the relationship between the spinal lesion level and various functional outcomes in children diagnosed with spina bifida.
- To assess how different lesion levels correlate with mobility, continence, and educational placement.
Main Methods:
- A prospective observational study involved 66 children with spina bifida attending a specialized clinic.
- Data collection included serial physical examinations and parent interviews to assess mobility, neurosensory deficits, continence, and school placement.
Main Results:
- Children with high-level lesions (thoracic/thoracolumbar) exhibited significantly more mobility challenges compared to those with intermediate (low lumbar) or low-level (sacral) lesions (p<0.001).
- While diaper use varied by lesion level (p=0.005), no significant differences in soiling or urinary incontinence were observed across groups.
- School placement, skin breakdown, epilepsy, and visual defects did not show significant differences based on lesion level.
Conclusions:
- The level of spinal lesion strongly correlates with mobility outcomes in children with spina bifida.
- Predicting functional outcomes such as continence and school placement based solely on lesion level is less reliable.
- These findings are vital for providing realistic counseling to families and planning long-term rehabilitation strategies.
Purpose:
To determine the relationship between spinal lesion level and functional outcome in children with spina bifida.
Methods:
Prospective observational study of 66 children who attended the Spina Bifida Clinic from 1994-1997. Data were obtained from serial physical examination and parent interview to determine mobility status, neurosensory deficits, continence and school placement.
Results:
Eighteen (27.3%) had high-level (thoracic and thoracolumbar), 27 (40.9%) intermediate (low lumbar) and 21 (31.8%) low-level (sacral) lesions. Children with high-level lesions experienced more mobility problems (independent ambulation, balance and use of appliances), than those with intermediate or low-level lesions (p<0.001). 58.8% of children with low-level lesions used diapers, compared with those with high (90%) or intermediate (100%) level lesions (p = 0.005), but there were no significant differences in the incidence of soiling or urinary incontinence among all three groups. There were no significant differences among the three groups in terms of school placement, skin breakdown, epilepsy or visual defect.
Conclusion:
Although there is good correlation between the level of the lesion and mobility in children with spina bifida, other measures of functional outcome like continence and school placement are more difficult to predict. These data are important for realistic counselling of families with newborns with spina and planning long term rehabilitation resources.
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