Spina Bifida Clinic

Spina bifida is a complex condition that, from birth, presents challenges in multiple areas. Experts agree that multidisciplinary care is the gold standard of medical and rehabilitative care for individuals with spina bifida; unfortunately, the multidisciplinary team often does not address issues that fall outside the medical domain, such as school readiness, vocational training or participation in sports. We propose a new conceptual model for spina bifida services that integrates issues and perspectives from multiple arenas including medical, habilitative, and social domains. The Children's Hospital New Orleans model incorporates the latest WHO framework for conceptualizing function and disability, but also the dimensions of activity and participation.

Evaluation and treatment of spina bifida and secondary conditions (such as seizures, coordination problems, weakness, learning disabilities, bowel problems, bladder problems, chronic pressure wounds, and orthopedic problems) is achieved through a working partnership between interdisciplinary team members, including the patient and family. Treatment plans are coordinated with the family and the patient's pediatrician. Additionally, treatment plans include the school and community to optimize that re-integration piece.

Pediatric physiatrists (physical medicine and rehabilitation) specialize in the rehabilitation care and medical management of children with congenital spinal disorders like spina bifida. We understand how cognitive and physical disabilities affect growth and development and incorporate this knowledge to work with patients and their families to develop and direct individualized treatment programs. Main goals are to restore or improve function and maximize quality of life to facilitate school and community re-integration.

The Urology Department at Children’s Hospital New Orleans is excited to be a part of the multidisciplinary spina bifida clinic. Urologic care of children with spina bifida and related disorders is an area of interest for our group. The complex neural pathways that govern normal bladder function are affected to various degrees in children with spina bifida and the amount of bladder dysfunction will vary. The primary goal in caring for these patients is to ensure that bladder dysfunction does not cause damage to the kidneys. An annual kidney ultrasound is recommended to help detect any potentially negative changes in kidney health. Detailed assessment of bladder function is performed through specialized testing called urodynamics which is important to perform at regular intervals throughout childhood. Managing the bladder may require the use of intermittent bladder catheterization and/or bladder relaxing medications. As a child ages, social continence becomes of great importance and additional medical therapies and surgical procedures may be needed to achieve this goal. We use both conventional and emerging technologies such as robotic surgery to meet the needs of this special group of patients. Urologic health in individuals with spina bifida and related conditions is a lifetime commitment between patients, their families, and their physicians and we look forward to serving your needs.

Orthopedic abnormalities in individuals with spina bifida are caused by unbalanced muscle action around joints, paralysis, and decreased sensation in the lower extremities. These problems can be acute or chronic in nature. The main goal of orthopedic care of a patient with spina bifida is to correct deformities that may interfere with function. Functional goals may include ambulation using orthoses. Additionally, the orthopedic surgeon must monitor spinal balance and deformity. Because acute changes in orthopedic problems can be caused by acute neurologic events such as tethered cord syndrome, the orthopedic examination also assists in monitoring the neurologic status of the patient.

Pediatric neurosurgeons are fellowship trained subspecialists who treat surgical disorders of the brain, spine and peripheral nerves. Children’s Hospital New Orleans has more surgeons certified by the American Board of Pediatric Neurosurgeons than any other facility in Louisiana and also has the largest combined pediatric neurosurgical experience in the state. Each surgeon’s practice is dedicated solely to the care of children and is especially committed to treating patients with spina bifida. The neurosurgical operating rooms are equipped to provide advanced techniques such as neuroendoscopy, microneurosurgery and computerized frameless stereotactic image guidance.

The Neurosurgeon’s role may begin as early as the prenatal period and continues as the child grows. It includes the management of hydrocephalus, shunt malfunction, tethered cord, syringomyelia and Chiari malformations. During your visit to the multispecialty spina bifida clinic, you can expect a neurosurgeon to conduct a focused neurological evaluation on your child, address relevant concerns, order radiographic studies when indicated and review surgical options when necessary. Working closely with families and other specialties, a comprehensive team approach is emphasized in helping each child achieve and maintain their full potential.

Pediatric neuropsychologists specialize in understanding how the developing brain affects the cognitive, social, emotional, and behavioral functioning of children. Neuropsychological evaluations assess intellectual

abilities; academic skills; executive functions (organization, planning, flexibility, etc.); attention; memory; language; visual-spatial skills; motor coordination; and social, emotional, and behavioral functioning. Children and adolescents with spina bifida may exhibit weaknesses in mathematics, visual-motor coordination, attention, impulse control, and executive functions. If needed, our neuropsychologists will complete an evaluation and provide recommendations to optimize treatment and educational goals.

Physical Therapy is consulted for seating, mobility and chronic wound care when needed.
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