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Interdisciplinary treatment of spina bifida children
T Redaelli1, A Cassinis, F Cosignani
1Institute of Physical Medicine and Rehabilitation, Niguarda Ca' Granda Hospital, Milan, Italy.
Insights
This study on 60 children with spina bifida found that an interdisciplinary rehabilitation program significantly improved neuromotor, bladder, and psychosocial outcomes, fostering social integration. Early intervention is key for better ambulation and adaptation.
Area of Science:
- Pediatric Rehabilitation
- Spina Bifida Management
- Developmental Pediatrics
Background:
- Spina bifida presents complex challenges requiring comprehensive management.
- Effective rehabilitation is crucial for improving functional outcomes and social integration in affected children.
Purpose of the Study:
- To evaluate the outcomes of an interdisciplinary rehabilitation program for children with spina bifida.
- To assess the impact of the program on neuromotor, urological, and psychosocial aspects.
Main Methods:
- A cohort of 60 children with spina bifida treated between 1985 and 1990.
- Assessment of neuromotor function, bladder function (including urodynamics), and psychosocial adaptation.
- Longitudinal evaluation of rehabilitation program effectiveness.
Main Results:
- Approximately 89% of children achieved ambulation, with 90% achieving the standing position.
- Neuropathic bladder was common (hyperreflexic and areflexic types), with 40% utilizing intermittent catheterization.
- Good child adaptation (61%) and school enrollment (74%) were observed, though family issues (70%) and affect disturbances (33.3%) were noted.
Conclusions:
- An interdisciplinary approach in spina bifida rehabilitation significantly enhances functional abilities and social integration.
- Addressing both medical and psychosocial needs is vital for comprehensive care.
- Early and continuous rehabilitation efforts contribute to improved long-term outcomes for children with spina bifida.
Abstract:
In the Spina Bifida Centre, Niguarda Ca' Granda Hospital (Milan, Italy), from June 1985 to June 1990, 60 spina bifida children have been treated. The results of the rehabilitation programme (including orthopaedic, urological and psychosocial aspects) at the time of the survey were: (a) Neuromotor function: 72% of the patients achieved ambulation, 52% of these being less than 2 years of age, and 20% older than 2 years; 18% were too young for walking. Thus, considering the children's age, about 90% of the subjects achieved the standing position, and 89% achieved ambulation. (b) Bladder function: 83% of the children had a complete urological evaluation; 40% of those with a neuropathic bladder had a hyperreflex type, 54% areflexic, and 6% normoreflexic. Thirty-two percent of the patients had signs of 'high pressure' bladder function. Urinary continence was: 36% > or = 2 hours, 20% < 2 hours, 44% not detectable (age < 2 years). Forty percent of the subjects used intermittent catheterisation. (c) Psychosocial aspect: child adaptation to the disease and to the rehabilitation programme was good in 61% of the patients; family problems were identified in 70% of the patients; enrollment in preschool and school programmes was normal (or with specialist teaching) in about 74%; 33.3% of the subjects had disturbance of affect. The results clearly showed that the interdisciplinary approach favoured the social integration of these children.