Spina bifida means cleft spine, which is an incomplete closure in the spinal column. There are three types of spina bifida (from mild to severe): 1) spina bifida occulta — an opening in one or more of the vertebrae (bones) of the spinal column without damage to the spinal cord; 2) meningocele — the meninges, or protective covering around the spinal cord, have pushed out through the opening in the vertebrae in a sac called the “meningocele,” but the spinal cord remains intact; and 3) myelomeningocele — not only are there openings in the vertebrae, but the spinal cord itself does not close. It usually protrudes from the back. The brain sends out messages for the muscles to move. However, in spina bifida, these messages reach a “dead end” at the level of the spinal defect. When no message gets through, there is total paralysis from the spinal level down. In some children, some messages are able to get through along the spine and there is only partial paralysis. If there is partial or complete paralysis of the trunk or legs, the child is paraplegic. If the arms are also involved and the spinal defect is higher in the spine, the child is a quadriplegic. Most children born with an open spine also develop hydrocephalus. Many people with spina bifida have some additional disabilities such as bladder and bowel dysfunction and leg paralysis. Another closely associated problem is Arnold-Chiari syndrome, in which part of the lower brain may protrude downward into the spinal canal.

Symptoms, treatment and transportation strategies

Symptoms or characteristics
Students with spina bifida have a defective closure of the spinal cord with protrusion of nerve fibers and other contents of the cord into an exterior sac. Symptoms are often associated with hydrocephaly and scoliosis and can include bladder and bowel dysfunction and leg paralysis. Spina bifida occulta children may be able to walk and have minimal bowel and bladder dysfunctions. Meningocele and myelomeningocele children lack bladder and bowel control, cannot walk and require the use of leg braces, crutches or canes. Some must use wheelchairs. With hydrocephalics, a shunt is required. Lower limb involvement, including ankle and feet deformities, is common. Urinary tract infections are also common.

Individualized Education Program (IEP) goals and objectives may include physical therapy, occupational therapy, programs designed for attendant mental retardation and shunt management by school nurse. Multiple surgeries may be required during childhood to maintain straight spine, legs, feet and joint mobility. Avoid contact with the spinal opening during lifting, transferring or other physical activities at school. Personal hygiene care is required by a personal attendant or the school nurse.

Transportation strategies
Provide door-to-door services. Avoid sudden stops, sharp turns and bumps on the route. Observe child carefully for signs of shunt displacement (vomiting, irritability, extreme headache) and immediately notify school nurse and/or parents. Bench seat padding may be necessary under physical therapist guidance to avoid bumping or chafing the spinal defect area. Lacking bowel and bladder control, the student may experience problems with personal hygiene and body odors that should be minimized on the bus. Feet may be displaced off the wheelchair foot rests and injured by other students in the aisle without the child knowing or feeling the injury.

Dr. Ray Turner is special-education coordinator at Northside Independent School District in San Antonio. He is the author of several special-needs transportation handbooks. For more information, visit his Website or e-mail him at drturner@earthlink.net