A qualitative analysis of patient and caregiver experiences with myelomeningocele through online discussion boards.

PURPOSE: Patients and caregivers impacted by myelomeningocele (MMC) use online discussion board forums to create community and share information and concerns about this complex medical condition. We aim to identify the primary concerns expressed on these forums with the goal of understanding gaps in care that may merit investment of resources to improve care received by this population. METHODS: Anonymous posts from online MMC discussion boards were compiled using internet search engines. Posts were then analyzed using an adaptation of the Grounded Theory Method, a three-step system involving open, axial, and selective coding of the data by two independent researchers to identify common themes. RESULTS: Analysis of 400 posts written primarily by parents (n = 342, 85.5%) and patients (n = 45, 11.25%) yielded three overarching themes: questions surrounding quality of life, a lack of support for mothers of children with MMC, and confusion with a complex healthcare system. Many posts revealed concerns about management and well-being with MMC, including posts discussing symptoms and related conditions (n = 299, 75.75%), treatments (n = 259, 65.75%), and emotional aspects of MMC (n = 146, 36.5%). Additionally, families, especially mothers, felt a lack of support in their roles as caregivers. Finally, in 118 posts (29.5%), patients and families expressed frustration with navigating a complex healthcare system and finding specialists whose opinions they trusted. CONCLUSIONS: MMC is a complex medical condition that impacts patients and families in unique ways. Analysis of online discussion board posts identified key themes to be addressed in order to improve the healthcare experiences of those impacted by MMC.

The experience of parents with children with myelomeningocele who underwent prenatal surgery.

BACKGROUND: Prenatal surgery for myelomeningocele (MMC) has been demonstrated to have benefits over postnatal surgery. Nevertheless, prenatal surgery requires a significant emotional, physical, and financial commitment from the entire family. METHODS: Mixed methods study of parents' perceptions regarding provider communication, treatment choices, and the family impact of having a child with MMC. RESULTS: Parents of children with MMC (n= 109) completed questionnaires. Parents were well informed and reported gathering information about prenatal surgery from a wide range of sources. After a fetal diagnosis of MMC, most learned about their options from their obstetrician, although one-third were not told about the option of prenatal surgery. About one-fourth of these parents felt pressure to undergo one particular option. Half of parents said that having a child with MMC has had a positive impact on them and their family, while the other half indicated that having a child with MMC has had both positive and negative impacts. The most commonly noted positive impacts were changes in parental attitudes, as well as having new opportunities and relationships. The most frequently reported negative impacts concerned relational and financial strain. The vast majority of parents indicated that they would still undergo prenatal surgery if they could travel back in time with their present knowledge. CONCLUSIONS: A better understanding of the parental experiences and perspectives following prenatal surgery will play an important role in providing overall support for parents and family members.

Trends in incidence and long-term outcomes of myelomeningocele in British Columbia.

PURPOSE: Myelomeningocele is typically a disabling condition that results in neurologic, orthopedic, and urologic morbidity. The aim of this study was to examine the trends over time in both incidence and outcomes of myelomeningocele (MMC) in British Columbia (BC). METHODS: A retrospective chart review was performed of all children with MMC followed in the British Columbia Children's Hospital (BCCH) Spinal Cord Clinic between 1971 and 2016. The incidence of new MMC cases and the long-term outcomes of MMC were compared between two 10-year cohorts. The first cohort comprised children born with MMC between 1971 and 1981, and the second cohort comprised children born with MMC between 1996 and 2006. RESULTS: A total of 309 children with MMC were followed in the BCCH Spinal Cord Clinic between 1971 and 2016. There were 101 and 46 children with MMC in the two-time cohorts, respectively. Between the earlier and later cohorts, there was a significant difference in the following: MMC incidence [2.5/10,000 births vs 1.1/10,000 births, respectively (p = 0.0002)], mortality [18 vs 0% (p = 0.0009)], and the proportion of cases repaired in under 48 h [56 vs 98% (p < 0.0001)]. For surviving children, the proportion of children attending special classes was significantly different between the earlier and later cohorts [16 vs 46%, respectively (p = 0.0002)], whereas all other outcome measures, including the proportion with hydrocephalus, kyphoscoliosis, Chiari II surgery, bowel and bladder continence, recreation participation, obesity, and ambulation, were not significantly different. CONCLUSIONS: In BC, the incidence of new cases of MMC has decreased between 1971 and 2016, while the probability of survival for these patients has increased. Despite earlier and more universal post-natal repair, long-term outcomes have not improved significantly over time. Future research should focus on developing ways of reducing disability and improving quality of life for MMC patients and their families.

Independence in self-care activities in children with myelomeningocele: exploring factors based on the International Classification of Function model.

PURPOSE: To investigate the relationship between disease factors, body functions and structures, activities, personal and environmental factors with independence in self-care activities in children with myelomeningocele (MMC), utilizing the International Classification of Function model. METHOD: 113 children with MMC, aged 3-18 years were assessed during an annual MMC-clinic visit. Data on the personal and environmental factors, disease factors, hand function, mobility, visual perception, cognition, and communication were assessed in relation to the Pediatric Evaluation of Disability Inventory (PEDI) self-care domain. RESULTS: The mean PEDI caregiver assistance score was 22.1 (ranged between <10 and 62) well below the norms. The most significant determinant of dependence in self-care activities was the presence of hydrocephalus, a child with hydrocephalus scored a mean of 9.2 points less on the PEDI caregiver scale (p = 0.02). By using a linear regression, the most significant factors associated with the PEDI scores among children with hydrocephalus were the age of the child, function of the non-dominant hand, ambulation, and cognitive function. CONCLUSION: In children with MMC the presence of hydrocephalus appears to be more significantly associated with functional independence than the neurological level. The International Classification of Function model provides an in-depth multidisciplinary model that facilitates in investigating independence in self-care activities in children with MMC. It is important to take personal factors and various functional impairments into account when working with these children to promote independence. Implications for Rehabilitation When working with children with myelomeningocele on independence in daily living activities, it is necessary that health professionals demonstrate a holistic view of the child and his/her disability. Health professionals should take into account information on all factors of the International Classification of Function, in order to help the children, achieve maximal independence. It is important for health professionals to consider presence or lack of hydrocephalus when working with children with myelomeningocele to achieve functional gains. Improving upper extremity function and cognitive ability in children with myelomeningocele may help promote independence in activities of daily living. It is necessary for health professionals to continue to work with children with myelomeningocele on maximizing independence as they get older, for it is possible for them to achieve independence at a later age. While this study did not explore participation, this is an essential part of the International Classification of Function and is generally related to function. Participation allows a child to be involved in life situations, contributes to life satisfaction and prepares children for critical adult roles. It is therefore important to assess and monitor this measure. Further studies should examine associations between independence in self-care activities and participation.

Medical and socioeconomic predictors of quality of life in myelomeningocele patients with shunted hydrocephalus.

INTRODUCTION: Children with myelomeningocele (MMC) often develop hydrocephalus, and the combination of these conditions can lead to psychosocial, cognitive, and physical health issues that decrease their health-related quality of life (HRQOL). The goal of the present study was to understand the QOL in patients with MMC and shunted hydrocephalus. METHODS: Data from the Toronto Hydrocephalus QOL Database was acquired between 2004 and 2009 using parent-completed questionnaires and, when appropriate, child-completed questionnaires: Hydrocephalus Outcome Questionnaire (HOQ) and the Health Utilities Index. We identified several medical and socioeconomic factors potentially relevant to the outcome measure (e.g., level of myelomeningocele, length of stay in hospital, and shunt-related hospital admissions; family functioning, income, parental education, employment status, etc.). Linear regression models were used to examine associations between potential predictor variables and HRQOL, with P < 0.05 in the multivariate model suggesting significance. RESULTS: The analysis consisted of 131 patients (mean age = 12.6, SD = 3.7). The mean HUI score was 0.51, and the mean HOQ overall health score was 0.67. There was a significant association between lower age and higher HOQ social-emotional health (P = 0.03) and HUI scores (P = 0.03), lower anatomical level of myelomeningocele and higher HUI scores (P = 0.01), better family functioning and higher HOQ overall health scores (P = 0.004), and higher family income and higher HOQ overall health, physical health, and HUI scores (P = 0.001, P = 0.003, and P = 0.02, respectively). CONCLUSION: Myelomeningocele patients with shunted hydrocephalus can have a poor health-related quality of life. Our results indicate a strong association of income and family functioning on quality of life, along with younger age and lower level of myelomeningocele.

Health self-management, transition readiness and adaptive behavior in persons with cerebral palsy or myelomeningocele.

PURPOSE/OBJECTIVE: This study was conducted to examine the associations between generic and condition-specific health self-management and levels of adaptive behavior in 2 groups of transition-age youth with congenital neurodevelopmental conditions. METHOD: The sample included 43 adolescents/young adults diagnosed with cerebral palsy (CP) and 36 with spina bifida/myelomeningocele (SBM), ages 13-29, mean age 18.96 (4.77), 51.9% female. Health self-management was assessed with the Transition Readiness Assessment Questionnaire (TRAQ) completed by the child, and the Kennedy Krieger Independence Scales-Spina Bifida (KKIS-SB) completed by the parent/guardian. The Adaptive Behavior Assessment System (ABAS-II) completed by the parent/guardian was used to assess levels of adaptive behavior. RESULTS: There were significant group differences in condition-specific health self-management, including lower KKIS-SB Initiation of Routines and KKIS-SB Prospective Memory scores in the group with SBM. Those differences were no longer significant when scoring was modified to account for item applicability. Group differences in generic health self-management and adaptive behavior were not significant. There were significant differences in the correlations between health self-management instruments and ABAS-II composite scores. CONCLUSIONS: For youth with congenital neurodevelopmental conditions who are in the transition to adulthood, there are important condition-specific self-management needs that are not captured by measuring generic transition readiness or adaptive behavior. Findings highlight the need for clinicians to assess health self-management needs from multiple perspectives, utilizing generic and condition-specific measures that can inform targeted interventions and supports for optimal independence. (PsycINFO Database Record

The relationship between motor function, cognition, independence and quality of life in myelomeningocele patients.

Motor function, cognition, functional independence and quality of life have been described in myelomeningocele patients, but no study has investigated their relationships. We aimed to investigate the relationships between motor function, cognition, functional independence, quality of life, age, and lesion level in myelomeningocele patients, and investigate the influence of hydrocephalus on these variables. We assessed 47 patients with the Gross Motor Function Measure (motor function), Raven's Colored Progressive Matrices (cognition), Pediatric Evaluation of Disability Inventory (functional independence) and the Autoquestionnaire Qualité de vie Enfant Imagé (quality of life). Spearman's correlation tests determined relationships between the variables. The Friedman ANOVAs determined the influence of hydrocephalus. Motor function was strongly related to mobility and lesion level, and moderately related to cognition, self-care and social function. Cognition and quality of life were moderately related to functional independence. Age correlated moderately with functional independence and quality of life. Hydrocephalus resulted in poorer motor/cognitive outcomes and lower functional independence.

The relationship between motor function, cognition, independence and quality of life in myelomeningocele patients / Relação entre função motora, cognição, independência funcional e qualidade de vida em pacientes com mielomeningocele

ABSTRACT Motor function, cognition, functional independence and quality of life have been described in myelomeningocele patients, but no study has investigated their relationships. We aimed to investigate the relationships between motor function, cognition, functional independence, quality of life, age, and lesion level in myelomeningocele patients, and investigate the influence of hydrocephalus on these variables. We assessed 47 patients with the Gross Motor Function Measure (motor function), Raven's Colored Progressive Matrices (cognition), Pediatric Evaluation of Disability Inventory (functional independence) and the Autoquestionnaire Qualité de vie Enfant Imagé (quality of life). Spearman's correlation tests determined relationships between the variables. The Friedman ANOVAs determined the influence of hydrocephalus. Motor function was strongly related to mobility and lesion level, and moderately related to cognition, self-care and social function. Cognition and quality of life were moderately related to functional independence. Age correlated moderately with functional independence and quality of life. Hydrocephalus resulted in poorer motor/cognitive outcomes and lower functional independence.

RESUMO Função motora, cognição, independência funcional e qualidade de vida foram descritos em pacientes com mielomeningocele (MMC), mas sua correlação não foi investigada. Esse estudo investigou correlações entre função motora, cognição, independência funcional, qualidade de vida, idade, nível de lesão em pacientes com MMC e a influência da hidrocefalia nessas variáveis. Quarenta e sete pacientes foram avaliados com a Medida de Função Motora Grossa, Matrizes Progressivas de Raven, Inventário de Avaliação Pediátrica de Incapacidade e Autoquestionnaire Qualité de vie Enfant Imagé. Testes de Spearman investigaram as correlações. ANOVAS de Friedman investigaram a influência da hidrocefalia. A função motora correlacionou-se fortemente com mobilidade e nível de lesão e moderadamente com cognição, auto-cuidado e função social. Cognição e qualidade de vida correlacionaram-se moderadamante com independência funcional. Idade correlacionou moderadamente com independência funcional e qualidade de vida. Hidrocefalia associou-se a piores desfechos motores/cognitivos e menor independência funcional.

Mastery motivation and executive functions as predictors of adaptive behavior in adolescents and young adults with cerebral palsy or myelomeningocele.

PURPOSE/OBJECTIVE: To examine mastery motivation and executive functions or behaviors as predictors of adaptive behavior in adolescents and young adults with congenital neurodevelopmental conditions. METHOD: Participants were 2 groups of adolescents and young adults, ages 13-29, including 43 with cerebral palsy and 36 with myelomeningocele living with a parent or caregiver. Participants completed measures of mastery motivation, executive functions or behaviors, and a measure of adaptive behavior. RESULTS: Group differences in mastery motivation, executive functions and executive behaviors, and adaptive behavior profiles were not significant. Mastery motivation, executive functions, and executive behaviors explained a significant portion of variance in adaptive behavior. CONCLUSIONS: Findings highlight the importance of assessing and addressing motivational and executive needs in developing interventions to promote independence. Findings also suggest the need for more comprehensive assessment of adaptive behaviors that include the ability to self-direct others in the completion of tasks necessary for successful daily functioning. (PsycINFO Database Record

Health-related quality of life in non-paraplegic (ambulatory) children with myelomeningocele.

PURPOSE: Evaluation of the effects of ventriculoperitoenal shunt and incontinence presence on health-related quality of life of ambulatory myelomeningocele patients. METHODS: The study group included 35 myelomeningocele patients, between 5 and 18 years old (mean age = 9.6), who were neonatally operated. All patients were ambulatory. The Child Edition of the Child Health and Illness Profile (CHIP-CE) used to evaluate the patient group. Seventeen patients were using clean intermittent catheterization and nine patients had ventriculoperitoneal shunt. RESULTS: The CHIP-CE has five domains, and in satisfaction, resilience and achievement domains, significant lower scores were obtained from our study group. In terms of clean intermittent catheterization use, we got significantly lower scores on satisfaction, resilience and achievement domains (p < 0.05). According to the presence of ventriculoperitoneal shunt, we found lower scores in satisfaction, resilience, risk avoidance and achievement domains but the differences were not significant (p > 0.05). No significant difference was spotted according to gender and age. CONCLUSIONS: Continence problems have important effects on life quality of myelomeningocele patients. Incontinency should always be considered as a major variable in health-related quality of life evaluations.

Cognitive control and associated neural correlates in adults with spina bifida myelomeningocele.

OBJECTIVE: Accelerated aging can occur in adult survivors of neurodevelopmental disorders, but has been narrowly studied in spina bifida myelomeningocele (SBM). Since discrete aspects of cognitive control and related neural network macrostructure deteriorate in normal aging, the specificity and trajectory of cognition and neuropathology incurred across adulthood in SBM were examined. METHOD: Adults (N = 120) with and without SBM completed working memory span and manipulation tasks, and an inhibitory control task. A subset (n = 53) underwent structural MRI. Effects of group, age, and their interaction on performance and select gray matter volumes were examined. RESULTS: Adults with SBM had significantly poorer working memory accuracy and overall inhibitory control performance than typical peers. Age negatively predicted inhibitory control. Group × Age significantly interacted on span accuracy; advanced age related to diminished performance in typical adults, but not in adults with SBM. SBM related to disproportionately enlarged cortical and putamen and reduced hippocampus volumes. Group × Age significantly interacted on cortical, but not subcortical gray matter volumes. Dorsolateral prefrontal, hippocampus, and putamen volumes negatively correlated with cognitive performance. CONCLUSIONS: Supporting previous literature, current findings elucidated a profile of executive impairment in SBM that was maintained in a parallel maturational trajectory to typical aging. Accelerated aging in cognitive control or subcortical gray matter was not supported in SBM. However, reductions in anterior and posterior cortical regions were exacerbated in older adults with SBM compared with typical peers. Overall results supported persistent anomalous neurodevelopmental maturation across the life span in SBM that related to diminished cognitive control. (PsycINFO Database Record

Lateralidad, perfil cognitivo y rendimiento escolar en pacientes con mielomeningocele / Laterality, cognitive profile, and school performance in children with myelomeningocele

El mielomeningocele (MMC) es la forma más grave de los disrafismos de la columna vertebral. Afecta a 1/1200 recién nacidos vivos. Su etiología es multifactorial. El 80% cursa con hidrocefalia (HC) asociada a malformación de Arnold Chiari. El coeficiente intelectual (CI) oscila en un rango entre fronterizo y normal promedio. La tasa mundial de la población general de zurdos es del 10% pero se describe un aumento de su presentación en niños con MMC. Además se evidencian déficits visoespaciales, grafomotores, atencionales, memorísticos, dificultades en aritmética y en la comprensión de textos. Materiales y métodos: Este es un trabajo analítico, descriptivo, transversal. Se evaluaron 179 pacientes derivados del Consultorio Interdisciplinario de MMC; edad: entre 5 años, 0 meses y 15 años, 11 meses. No se emplearon controles sanos. Instrumentos administrados: Stanford Binet IV, Prolec ­ Prolec-Se, Wrat3, TMT A y B, d2, Stroop y pruebas de lateralidad de Zazzo. Objetivo: Describir la lateralidad, el perfil cognitivo y el rendimiento escolar en pacientes pediátricos con patología de mielomeningocele, analizando también las funciones ejecutivas, los procesos atencionales, memorísticos y la modalidad escolar en la cual se encuentran inmersos. Resultados: El 20% (35/179 pacientes) con edades que oscilan entre los 5 años, 0 meses y 15 años, 11 meses han presentado lateralidad zurda, y de ellos presentaban antecedentes familiares de zurdera 26%. Se observó lateralidad cruzada en 6% y eran ambidiestros 11%. El perfil cognitivo de la muestra completa (N: 179) fue homogéneo en todas las áreas (verbal, abstracto/visual y memoria de corto plazo), arrojando puntuaciones fronterizas. En pruebas atencionales el 100% obtuvo niveles descendidos. Todos reportaron dificultades en el rendimiento escolar. Sólo el 14% tuvo plan de integración y el 11% accedió a algún tipo de tratamiento. Conclusiones: Los niños con MMC evidencian déficits neuropsicológicos y alta tasa de zurdera, siendo probablemente los problemas de lateralidad una de las causas que ocasionarían el bajo rendimiento escolar y afectando el rendimiento académico (AU)

Myelomeningocele (MMC) is the most severe form of spinal dysraphism, affecting 1/1200 live newborns. Its etiology is multifactorial. Overall, 80% develops hydrocephalus (HC) associated with an Arnold Chiari malformation. The intelligence quotient (IQ) ranges from borderline to average. The worldwide incidence in the general population of left-handedness is 10%; however, an increase is found among children MMC. Additionally, visuospatial, graphomotor, attention, memory deficits as well as difficulties in arithmetic and text comprehension is found. Material and methods: A cross-sectional, analytical, descriptive study was conducted. Overall, 179 patients aged between 5 years 0 months and 15 years 11 months referred from the interdisciplinary MMC clinic were evaluated. No healthy control group was used. Instruments administrated: Stanford Binet IV, Prolec ­ Prolec-Se, Wrat3, TMT A and B, d2, Stroop and Zazzo's laterality test. Aim: To describe laterality, cognitive profile, and school performance in pediatric patients with MMC, analyzing executive functions, attention and memory, and the school system the children were attending. Results: 20% (35/179 patients) aged between 5 years, 0 months and 15 years, 11 months were left-handed, 26% of whom had a family history of left-handedness. Cross dominance was observed in 6% and ambidexterity in 11%. Overall, the cognitive profile of the sample (N: 179) was homogeneous in all areas (verbal, abstract/visual, and short-term memory), with borderline scores. In attention tasks, levels were low in 100%. All children had difficulties in school performance. Only 14% had an integration program and 11% received some type of treatment. Conclusions: Children with MMC show neuropsychological deficits and a high rate of left-handedness, the latter of which may be one of the causes of poor school performance and affecting academic achievements (AU)

Health-related quality of life in children with myelomeningocele: a systematic review of the literature.

Myelomeningocele (MMC) is the most complex congenital birth defect compatible with life. To provide the best health care for children with MMC, clinicians and researchers have to understand health and functional status of their patients as well as factors influencing their quality of life (QOL). The objective is to review studies that assess health-related quality of life (HRQOL) and determinants of HRQOL in children with MMC. The data sources include MEDLINE, along with reference lists of relevant reviews and included articles. Study eligibility criteria are quantitative studies that assess HRQOL using validated HRQOL instrument. Participants include children aged 0-18 years with diagnosis of MMC or spina bifida. Risk of bias was assessed using the Hayden system for non-randomized studies. Narrative synthesis and tables of results of HRQOL studies were conducted. Children with MMC have decreased HRQOL compared with normative population. Physical HRQOL is the most exposed aspect of QOL, while discrepancies in psychosocial domains vary by study. Many determinants of QOL have been found, and it is still not clear which determinant can be described as the strongest predictor. Psychosocial factors are the most consistent determinants of HRQOL.Heterogeneous study sample size, study designs, determinant and outcomes measures limited synthesis of findings. The HRQOL in children with MMC is complex and mediated by a number of associated medical problems, together with a variety of psychosocial and environmental factors. Future research is needed (a) on the relation between complex medical problems, functional independence, parent's and clinician's expectation and HRQOL in children and (b) to assess the differences in HRQOL by social environment and healthcare system.

Prospective and episodic memory in relation to hippocampal volume in adults with spina bifida myelomeningocele.

The present study examined prospective and episodic memory in relation to age, functional independence, and hippocampal volume in younger to middle-aged adults with spina bifida myelomeningocele (SBM) and typically developing (TD) adults. Prospective and episodic memory, as well as hippocampal volume, was reduced in adults with SBM relative to TD adults. Neither memory performance nor hippocampal volume showed greater decrements in older adults. Lower hippocampal volume was associated with reduced prospective memory in adults with SBM, and this relation was specific to the hippocampus and not to a contrast structure, the amygdala. Prospective memory mediated the relation between hippocampal volume and functional independence in adults with SBM. The results add to emerging evidence for reduced memory function in adults with SBM and provide quantitative evidence for compromised hippocampal macrostructure as a neural correlate of reduced memory in this population.

Depressive symptoms in parents of adolescents with myelomeningocele: the association of clinical, adolescent neuropsychological functioning, and family protective factors.

PURPOSE: The purpose of this study is to determine if neuropsychological functioning and family protective factors are related to depressive symptoms in parents of adolescents with myelomeningocele (MMC). METHODS: Fifty adolescents (28 females, 22 males; predominately Caucasian; ages 12-21 years, M=15.7, SD=2.4) and their parents from a large Midwestern MMC Program participated in a cross-sectional descriptive mixed-methods study. Participants completed measures of adolescent clinical status (WeeFIM®, Demographic and Clinical Information Form), neuropsychological (NP) functioning, family protective factors and parents' depressive symptoms. RESULTS: Parents' depressive symptoms correlated significantly with NP functioning in the domains of Mental Processing Speed, Psychomotor Speed, Executive Functioning, Fine Motor Skills, and Language, and with each self-reported family protective factor. Multiple regression analysis revealed independent main effects for the NP variable, Executive Functioning and the Family Protective Factors Composite (p< 0.05); there was no interaction (p> 0.10). CONCLUSION: Clinicians are especially encouraged to include assessment of parental depressive symptoms if the adolescent has executive functioning impairments or if the parents have few family protective factors.

[Aspects of sexuality in adolescents with spinal bifida]. / Aspekte der Sexualität bei Adoleszenten mit einer Spina bifida.

In the last few decades, the life expectancy of patients with meningomyelocele has increased through improved medical care. Problems associated with adulthood like sexuality, friendship, and fertility are now more important for these young persons. Physical and cognitive impairment can alter the complex process of sexual maturation, but nevertheless patients of today are well-informed and show a strong interest in sexual fulfillment.

Sexual function of young women with myelomeningocele.

OBJECTIVES: To assess the sexual function of young women with spina bifida and myelomeningocele and to determine the factors influencing their sexual function. METHODS: A postal cross-sectional study using a self-administered questionnaire was performed in 44 women, mean age 27.66 ± 5.89 years, with spina bifida and myelomeningocele. The questionnaire included the Brief Index of Sexual Functioning for Women and questions about voiding mode, urinary symptoms, socioeconomic status, education level, lifestyle, and partnership. In parallel, data were also collected from the paediatric surgery records of patients who returned the questionnaire. RESULTS: The response rate was 56.8% (25/44). All domains of female sexual function (thoughts/desires, arousal, frequency of sexual activity, receptivity/initiation, pleasure/orgasm, relationship satisfaction) were altered. Urinary incontinence was likely to be the main factor responsible for altered sexual function and was associated with lower thoughts/desires, arousal, and receptivity/initiation scores. Wearing pads also constituted a limitation to achieving intimacy. CONCLUSIONS: Young myelomeningocele women report poor sexual functioning. The presence of urinary incontinence is associated with lower thoughts/desire, arousal, and receptivity/initiation.

Health-related quality of life in children and adolescents with spinal dysraphism: results from a Taiwanese sample.

PURPOSE: This study was designed to investigate health-related quality of life (HRQL) in children and adolescents with spinal dysraphism and to determine the differences between the myelomeningocele (MMC) and lipomyelomeningocele (LMMC) groups. METHODS: Thirty-two patients (mean age, 13.2 years) with MMC and 28 patients (mean age, 11.3 years) with LMMC participated in this study. HRQL was measured using the Child Health Questionnaire-Parent Form 50 (CHQ-PF50). The CHQ-PF50 scores for the study participants were compared with those of a reference sample of healthy Taiwanese children. Outcomes for children with MMC were compared with those for children with LMMC. We also explored the relationships of the lesion level and associated medical problems with HRQL in these subjects. RESULTS: Patients with MMC had significantly lower scores on the physical and psychosocial aspects of CHQ-PF50 than did healthy children. Patients with LMMC had lower scores on some domains but had comparable psychosocial summary scores. Significant differences were noted between the MMC and LMMC groups for all subscales and both summary scores. Children with a higher lesion level had poor physical health (r = -0.52, P < 0.001) but not poor psychosocial health. The number of associated medical problems, indicating their severity, was related to both physical (r = -0.77, P < 0.001) and psychosocial health (r = -0.57, P < 0.001). CONCLUSIONS: Children and adolescents with MMC have reduced HRQL compared with those with LMMC. Children and adolescents with more associated medical problems have the greatest risk of diminished physical and psychosocial well-being.

Selective and sustained attention in children with spina bifida myelomeningocele.

Spina bifida myelomeningocele (SBM) is a neural tube defect that has been related to deficits in several cognitive domains including attention. Attention function in children with SBM has often been studied using tasks that are confounded by complex motor demands or tasks that do not clearly distinguish perceptual from response-related components of attention. We used a verbal-report paradigm based on the Theory of Visual Attention (Bundesen, 1990) and a new continuous performance test, the Dual Attention to Response Task (Dockree et al., 2006), for measuring parameters of selective and sustained attention in 6 children with SBM and 18 healthy control children. The two tasks had minimal motor demands, were functionally specific and were sensitive to minor deficits. As a group, the children with SBM were significantly less efficient at filtering out irrelevant stimuli. Moreover, they exhibited frequent failures of sustained attention and response control in terms of omission errors, premature responses, and prolonged inhibition responses. All 6 children with SBM showed deficits in one or more parameters of attention; for example, three patients had elevated visual perception thresholds, but large individual variation was evident in their performance patterns, which highlights the relevance of an effective case-based assessment method in this patient group. Overall, the study demonstrates the strengths of a new testing approach for evaluating attention function in children with SBM.

Neurosurgical input at pre-natal counselling for parents of babies with Spina bifida.

Prenatal counselling can be helpful to parents in making a decision with regard to continuation of the pregnancy or to help prepare for the birth and the future life of a child with Spina bifida. We aimed to assess the effectiveness of our specialist neuro counselling sessions and to highlight areas that could be improved upon. This was in the form of a questionnaire given to parents, who had been through the counselling and continued with their pregnancy. The areas highlighted for improvement were more explicit information about urinary catheterisation, the need for admission to the special care baby unit (SCBU) and the need for an information leaflet on Spina bifida.