Rehabilitation and Medical Management of the Adult with Spina Bifida

Abstract

.As the life expectancy of individuals with spina bifida increases, a lifelong need for management of many health issues in a rehabilitation setting has emerged in recent years. Physiatrists, in consultation with a variety of adult specialists, are particularly well suited to manage the common musculoskeletal, skin, bowel, bladder, renal, neurological, and other issues that arise in the adult population. This article reviews the last 20 yrs of literature pertinent to the rehabilitative care of this population, summarizes current evidence-based practice, and identifies key areas in which scientific evidence is lacking and future research is needed.

Effectiveness of the Interdisciplinary Ambulatory Rehabilitation Program in Persons with Spina Bifida

“…Rehabilitative and supportive care needs are frequently experienced by pwSB many years after initial treatment [11,12]. In this study many participants reported ongoing transient and/or persistent physical and psychosocial morbidity such as bowel and/or urinary dysfunction and psychosocial issues, consistent with other reports [28,31,32].…”

“…Although several studies in the paediatric population demonstrate effectiveness of a coordinated ID approach to management, this does not extend to adults and there is lack of comprehensive ambulatory care models [11][12][13]. The aim of this study, therefore, was to assess the effectiveness of a structured ID rehabilitation intervention to improve disability and participation in an adult SB population in an Australian community cohort.…”

Complications following breast cancer therapy in the adult spina bifida population: A case report

“…Dicianno and colleagues demonstrated that a multidisciplinary dedicated spina bifida team provides optimal care for children. 10 However, far fewer comprehensive adult spina bifida clinics exist. 10 As spina bifida patients age, they present a variety of unique challenges.…”

“…10 However, far fewer comprehensive adult spina bifida clinics exist. 10 As spina bifida patients age, they present a variety of unique challenges. For instance, a recent systematic review found total continence in this population to be only 37.7%…”

“…11 Patients face not only medical issues, such as progressively worsening orthopedic deformities,or latemanifesting neurologic deficits, but also many psychosocial issues, including aging parents who can no longer be the primary caregivers, struggles with disease stigma, and developing independence. 10,12 From a urologic standpoint, Persun and colleagues recommend yearly renal ultrasound and serum creatinine to monitor for renal dysfunction secondary to elevated detrusor pressures, or decrease in functional bladder capacity. 13 Adult patients with spina bifida have a lifelong elevated risk of developing renal damage due to altered bladder behaviour.…”