A Review of the Literature
December 3, 2012
This work is a student’s compilation of research and information regarding spina bifida. Educational components include a description of spina bifida, its forms, etiology, prevalence and incidence. This work also outlines its signs, symptoms, and diagnostic requirements. In addition, information includes: complications, risk factors, progression, prognosis, and treatment. Furthermore, this review addresses occupational therapy related interventions, multi-disciplinary approaches, and psychosocial issues relevant to the condition. Spina bifida is a complicated condition, however with the proper treatment patients can be expected to enjoy respectable quality of life.
Description of Spina Bifida Mark Foster MD, defines spina bifida as a gestational abnormality wherein fetal neural tube development deviates from the norm. The fetal neural tube is that part of the fetal organism that develops into the brain and spinal cord. In spina bifida, also known as myelodysplasia, the neural tube and posterior aspect of the bony vertebral arch fails to close leading to varying degrees of deformity and disability. In her book entitled a Quick Reference to Occupational Therapy, Kathlyn Reed discusses the four most common types of spina bifida disorders. They are differentiated by degree of meninge and spinal cord protrusion. The four manifestations are occulta, meningocele, myelomeningocele and anencephaly. Among these, myelomeningocele and anencephaly are reported most often and considered most severe.
Thomas Farley, a research and statistics manager at the Arkansas Spinal Cord Commission (ASCC) indicates that the specific causality for spina bifida is not fully understood. Researchers involved with ASCC suspect multiple causes of spina bifida. Factors may include: genetics, malnutrition and environmental factors. Research further indicates that insufficient intake of a common B vitamin, folic acid, during pregnancy is most likely to cause spina bifida and other neural tube defects. (3)
Incidence and Prevalence
Centers of Disease Control and Prevention (CDC)’s data and statistic inform “each year about 1,500 babies are born with spina bifida”. At the same time, “the prevalence rate of spina bifida declined 31% from the pre-fortification of folic acid(1995-1996) rate of 5.04 per 10,000 babies to the post-fortification of folic (1998-2006) rate of 3.49 per 10,000 babies”. It means that every year there will be less 1,000 babies born without having any Neural Tube Defect condition after the fortification of folic acid began. (4)
Signs and Symptoms According to WebMD there are no signs and symptoms that can be seen by the external eyesight of one who is carrying a baby with spina bifida. This condition can only be detected through a prenatal blood test, or other technologies such as ultrasound, MRI, or CT-scan. However the severity of the spina bifida condition itself, will define the signs and symptoms for the baby or child born with spina bifida.
For babies with spina bifida occulata which is the mildest form of the spina bifida, the signs might only show the hairy patch or a dimple like a birthmark over the neural tube defect as the condition is a closed neural tube malformation. For the severe form of spina bifida (meningocele), there might be signs of a fluid-filled swollen bump on the baby’s spine. In a similar vein, for the most severe form of spina bifida ( myelomeningocele), the nerves and the tissues might be exposed on the baby’s back as it is the open neural tube malformation. For this condition, there is possibility that the brain and upper spinal cord are not in a normal formation. In addition, it is possible that babies with this condition will suffer from hydrocephalus, a swollen brain condition caused by the