Hand function and intelligence were evaluated in 82 spina bifida cystica patients, aged 9 to 20 years. The patients required significantly more time to complete hand function tests and had significantly lower IQs than the test standardization populations. Inverse relationships were found between hand function times and IQ scores; patients with lower IQs (especially those with IQ scores less than 80) took significantly longer to complete the hand function tests. Patients with three or more shunt operations for correction of hydrocephalus required more time to complete the hand function tests and had lower IQs than patients with no shunt operations. Patients with higher level spinal cord deficits (particularly those with thoracic level lesions) required more time to complete the hand functions tests and had significantly lower IQ scores than patients with lower level lesions.