Students with special needs require special care by pupil transportation providers. There are certain things these providers should keep in mind when transporting students with spina bifida.

The U.S. Centers for Disease Control and Prevention reports that each year, approximately 1,400 babies born in the U.S. have spina bifida.

What is Spina Bifida?

It's important to understand what exactly spina bifida is. It means cleft spine, which is an incomplete closure in the spinal column. There are three types of spina bifida (from mild to severe):

• Spina bifida occulta — an opening in one or more of the vertebrae (bones) of the spinal column without damage to the spinal cord.

• 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 intac.

• 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 or Characteristics to Be Aware of

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.

Caring for Students with Spina Bifida

The purpose of an Individualized Education Program (IEP) is to lay out the instruction, supports, and services a student with disabilities.

IEP goals and objectives may include physical therapy, occupational therapy, programs designed for students with intellectual disabilities, and shunt management by a school nurse.

Teena Mitchell, special-needs transportation coordinator for Greenville (South Carolina) County Schools, recommends that pupil transportation departments be involved with the student's IEP team to discuss the student's needs with other team members, such as nursing services, physical therapists, and parents.

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 or when being transported to or from school. Personal hygiene care is required by a personal attendant or the school nurse.

Transportation Strategies for Bus Drivers

Here are a few things bus drivers should do when they are transporting students with spina bifida:

• Provide curb-to-curb services.

• Avoid sudden stops, sharp turns, and bumps on the route.

• Observe the child carefully for signs of shunt displacement (vomiting, irritability, extreme headache) and immediately notify school nurse and/or parents if these signs are observed.

Bench seat padding may be necessary under physical therapist guidance to avoid bumping or chafing the spinal defect area. Additionally, special seating that may help prevent injuries in case of an unavoidable sudden stop or accident may be used.

One thing to keep in mind is that because students with spina bifida may lack bowel and bladder control, he or she may experience problems with personal hygiene and body odors that should be minimized on the school bus.

Transportation personnel should look out for the student's feet, as they may be displaced off the wheelchair foot rests and injured by other students in the aisle without the child knowing or feeling the injury.

Bottom line, Mitchell recommends that transportation department staff collaborate to discuss and plan for challenges such as evacuation drills or actual emergencies.

At the time of the original print publication of this article in the December 2000 issue of School Bus Fleet Magazine, Dr. Ray Turner was a special education coordinator at Northside Independent School District in San Antonio. He has authored several special-needs transportation handbooks.