国人腰骶椎隐裂发生率特点及相关因素

为了探讨腰骶椎隐裂发生率特点及相关因素,回顾分析了1082例螺旋CT检查信息,以12个月为间隔将18岁以下508例共分18小组,比较腰骶椎隐裂发生率有无统计学差异,找出差异的年龄段规律。并统计574例18岁以上隐裂发生率,结果显示0岁～8岁、8岁～14岁、14岁～18岁小组发生率分别为94．0％～97．2％、46．9％～52．4％、19．1％～20．8％,各年龄段内小组发生率无统计学差异,三大组总体发生率递减,有统计学差异,18岁以上为16．0％,由此我们可以把骨性椎弓发育分为三期：0岁～8岁为生理性未闭合期,8岁～14岁为闭合过渡期,14岁以上为闭合稳定期。     

Spatial knowledge of children with spina bifida in a virtual large-scale space

The spatial knowledge of 18 children with spina bifida and 18 healthy control children (matched according to sex, age, and verbal IQ) was investigated in a computer-simulated environment. All children had to learn a route through a virtual floor system containing 18 landmarks. Controlling for cognitive abilities, the results revealed that children with spina bifida showed impaired route knowledge but not an impaired landmark knowledge. Thus the results suggest that children with spina bifida are not impaired in all large-scale abilities similarly. The impairments of the children with spina bifida are more accentuated in more behaviour based measurements, which indicates a relation to the reduced mobility of the children with spina bifida.     

Impairment of a motor skill in children with spina bifida cystica and hydrocephalus: an exploratory study.

Twenty 7-10 year old children with spina bifida cystica and hydrocephalus and 20 normals matched for age, sex and IQ were compared on a 12-trial target task, first used by Connolly, Brown & Bassett (1968). Analysis of the results, in which particular attention was paid to statistical method and to ways of analysing individual differences, showed a significant impairment in dotting speed in the spina bifida group, although both groups improved with practice. In a second experiment immediately following the first, visual monitoring of this task was restricted. The spina bifida children were initially more affected than the controls but able to recover. The findings are discussed in relation to neurological abnormalities in the spina bifida group.     

Executive functioning and psychological adjustment in children and youth with spina bifida

Children and adolescents with spina bifida are at risk for poor neuropsychological functioning and psychological outcomes. The relationship between executive functioning and psychological adjustment is an area worthy of investigation in this population. The current study assessed executive functioning and psychological outcomes in a group of children and adolescents with spina bifida (SBM) (n = 51) and nondisabled controls (n = 45). A mediation model was hypothesized, such that Metacognition, as measured by the Behavior Rating Inventory of Executive Function (BRIEF), mediated the relationship between group status (spina bifida versus nondisabled controls) and psychological outcomes. Results indicated that metacognitive skills fully explained the relationship between group and internalizing and depressive symptoms as reported by mothers. In particular, specific components of the BRIEF Metacognition composite were most responsible for this relationship, including Initiate, Working Memory, and Plan/Organize. The study limitations include its cross-sectional nature that precludes drawing conclusions about causality. The results have implications for treatment interventions for children and adolescents with spina bifida and typically developing individuals.     

Children with spina bifida perceive visual illusions but not multistable figures

We compared 32 children with spina bifida and 32 age-matched controls on two classes of illusory perception, one involving visual illusions and the other, multistable figures. Children with spina bifida were as adept as age peers in the perception of visual illusions concerned with size, length, and area, but were impaired in the perception of multistable figures that involved figure-ground reversals, illusory contours, perspective reversing, and paradoxical figures. That children with spina bifida reliably perceive illusions that rely on inappropriate constancy scaling of size, length, and area suggests that their brain dysmorphologies do not prevent the acquisition of basic perceptual operations that enhance the local coherence of object perception. That they do not perceive multistable figures suggests that their visual perception impairments may involve not object processing so much as poor top-down control from higher association areas to representations in the visual cortex.     

Assessing the factorial invariance of Harter's self-concept measures: comparing preadolescents with and without spina bifida using child,parent, and teacher report

The purpose of this study was to determine whether the structure of children's self-concept, as rated by children themselves on the Self-Perception Profile for Children (SPPC; Harter, 1985), and the structure of children's competence, as rated by their parents on the Rating Scale of Child's Actual Behavior (PRS) and teachers on the Rating Scale of Child's Actual Behavior (TRS; Harter, 1985), are similar across samples of children with and without spina bifida (children were 8 and 9 years of age; n = 68 in each sample). Using confirmatory factor analyses, results revealed that a multidimensional model for the SPPC and the TRS fit the data well for both samples. On the other hand, the model for both mothers' and fathers' PRS ratings did not fit the data for the spina bifida sample. Further tests of factorial invariance conducted on the SPPC and TRS revealed that the spina bifida and able-bodied samples tended to have the same pattern and magnitude of factor loadings for both instruments. There was some invariance, however, in the amount of unique error variance accounted for across samples. These results bolster our confidence in using the SPPC and TRS to compare children with and without spina bifida.     

Visual but not spatial working memory deficit in children with spina bifida

Twenty children with spina bifida and twenty controls were assessed on a battery of visuospatial working memory tests. Children with spina bifida performed as well as the control group in the visuospatial test and in the forward and backward versions of the Corsi test, but were impaired in the 'House Visual Span.' This test, designed in our lab, provides specific information regarding visual ability to discriminate between pictorial targets and lures, and requires specific visual processing of stimuli. These results are discussed in terms of working memory models and are viewed as supporting the distinction between the visual and spatial components of working memory.     

Impact of Spina Bifida on Parental Caregivers: Findings from a Survey of Arkansas Families

The well-being of caregivers of children with spina bifida and other conditions is an important topic. We interviewed the primary caregivers of 98 children aged 0–17 years with spina bifida sampled from a population-based birth defects registry in Arkansas and the caregivers of 49 unaffected children. Measures of caregiver well-being were compared between the groups and by level of lesion (sacral, lower lumbar, and upper lumbar/thoracic). We performed linear and logistic regression analysis to test the associations controlling for other characteristics. Among caregivers of children with spina bifida, the average number of hours of sleep was significantly less than reported by other caregivers and was associated with lesion level among children less than 7 years of age. Significant associations, often varying by child age, were also found for the caregiver’s reports of lower Quality of Well-Being (QWB) score, often feeling blue, rarely feeling happy, fair or poor health, lack of leisure days, and not hosting friends, but no significant association was found with not visiting friends. The intensive long-term care required by children with spina bifida, particularly by those with higher lesions, can negatively impact caregiver health and well-being. Support for these caregivers is needed.     

Optimism,appraisals, and coping in the adjustment of mothers and their children with spina bifida

Families of children with physical disabilities show substantial differences in the levels of adjustment of both the children and their parents. These differences result, in part, from the complex interplay of family and child adaptation resources, such as coping and social support. In order to identify factors which may differentiate levels of adjustment among families with children with physical disabilities, this study examined relationships among optimism, primary and secondary appraisals of and coping with child-related stressors, maternal psychological adjustment, and child adjustment in 29 families with a child with spina bifida without mental retardation and 28 comparison families with a nondisabled child. For the spina bifida group, primary appraisals were related to the use of avoidant coping strategies, and these coping strategies were related to maternal psychological adjustment and child internalizing behavior problems. No significant differences between the groups in terms of the nature of the relationships or in the levels of the variables were found with the exception that mothers of children with spina bifida were less optimistic than comparison mothers. These data support the importance of coping in understanding the psychological adjustment of mothers faced with a chronic stressor in the family.     

Experiences of Prenatal Diagnosis of Spina Bifida or Hydrocephalus in Parents Who Decide to Continue with Their Pregnancy

The current study aimed to gain an understanding of the perspectives of those parents provided with a prenatal diagnosis of spina bifida or hydrocephalus and who decided to continue with their pregnancy. Qualitative interviews were conducted with 15 parents who learned of their unborn child’s spina bifida and/or hydrocephalus in the prenatal period. The interviewer asked parents about their experiences of receiving a prenatal diagnosis and their experience of coping throughout the remainder of the antenatal period. Parents’ reactions and experiences fell into five domains: response to diagnosis, experience of medical systems, information gathering, decision-making regarding continuation of the pregnancy following diagnosis and responses of significant others. Each of these domains is explicated. The findings derived from the current study have implications for professionals who provide support to parents during the prenatal period. Future research needs to further explore the common and unique issues for parents living in both urban and rural areas.     

The influence of juggling on mental rotation performance in children with spina bifida

This study examined the influence of juggling training on mental rotation ability in children with spina bifida. Children between the ages of 8 and 12 solved a chronometric mental rotation test. Half of the children received juggling training (EG) over an 8week time period; the other half did not receive training (CG). Afterwards, all participants completed the mental rotation test again. Children of the EG showed a significant decrease in reaction time and an increase in mental rotation speed compared to the control group. This indicates that juggling improves the rotation in the mental rotation process in children with spina bifida.     

Postural Stability in Children with High Sacral Level Spina Bifida: Deviations from a Control Group

Abstract

Objective: To assess static and dynamic postural stability changes in children with high sacral level spina bifida.

Methods: Thirty-five children with high sacral level spina bifida and 35 age-matched healthy controls were enrolled. Their lower extremity muscle strengths and static and dynamic postural stability parameters were measured with the use of a dynamometer and the NeuroCom Balance Master^® device, respectively. Functional gait and balance were evaluated using the five times sit-to-stand test (5STS) and the 6-minute walk test (6MWT). Spinal, hip, and ankle deformities of the patient group were measured by radiologic evaluation.

Results: In comparison with controls, patients were found to have lower ankle dorsiflexion and plantar-flexion strength, increased 5STS duration, and decreased 6MWT distance while both static and dynamic postural stability parameters were significantly different. Bilateral ankle muscle strengths were found to be negatively correlated with postural stability parameters. The presence of hydrocephalus or meningomyelocele in the patient group was found to have negative effects on static postural stability.

Conclusion: Static and dynamic postural stability is affected even in children with high sacral level spina bifida who are expected to have best condition in this patient population. The ankle muscle strength is the main factor influencing these changes.     

Reaching for Independence: Counseling Implications for Youth With Spina Bifida

Spina bifida, a congenital physical disability, is indirectly associated with difficulties in scholastic achievement, social development, and self‐determination. Environment can have an impact on psychosocial development and impede functioning academically, socially, and vocationally. Counselors must be aware of the societal atmosphere to identify potential difficulties and more efficiently meet the needs of children and adolescents with spina bifida.     

Specific language deficiencies in children with early onset hydrocephalus

Specific language abilities of children with early onset hydrocephalus were compared to nonhydrocephalic comparison groups. Ninety children, aged 5 to 7 years, composed six subject groups: three groups having a history of hydrocephalus due to spina bifida, prematurity-intraventricular hemorrhage, or aqueductal stenosis. and three comparison groups of children with spina bifida who had never been shunted, premature children with no hydrocephalus, and normal controls. Group performance scores were compared on measures of phonological awareness, semantics, fluency, and word retrieval. Children with hydrocephalus performed below their peers on all measures. These results indicate that early onset hydrocephalus has a substantial adverse impact on the development of a wide range of specific language abilities.     

Evidence for spatial navigational impairments in hydrocephalus patients without spina bifida

The cognitive sequelae of hydrocephalus have mostly been explored with standardised clinical tasks. The aim of the present research was determine whether impairments on these abstract tasks extend to everyday spatial and navigational behaviour. Patients with hydrocephalus, but without spina bifida, were compared to a control group on tests of searching behaviour, landmark memory, route learning, and path integration. Participants with hydrocephalus displayed reduced sensitivity to spatial cueing, less accurate route-learning, and significantly less accurate spatial updating. These data represent an important empirical demonstration of spatial navigational impairments due to hydrocephalus outside of the context of spina bifida. We discuss some of the cognitive, neural, and individual differences factors that might contribute to this particular pattern of impairments.     

Psychiatric Symptomatology and Family Functioning in Children and Adolescents with Spina Bifida

The purpose of this study was to (a) examine the occurrence of psychiatric symptomatology in children and adolescents with spina bifida, (b) investigate the relationship between psychiatric features and aspects of disability, and (c) explore the impact of spina bifida and psychiatric status on family functioning. Fifty-four children and adolescents ages 6 to 18 years (M = 12.94, SD = 3.59) were examined. Parents completed the Child Symptom Inventory (CSI) and the Family Assessment Device (FAD). Using the CSI, a psychiatric diagnostic screen, 43% of the sample obtained one, and 13% obtained two or more screening cutoff scores reflective of psychiatric diagnoses. The two most prevalent diagnostic categories were Attention-Deficit/Hyperactivity Disorder (33%) and Oppositional Defiant Disorder (13%). The sample as a whole exhibited elevated levels of clinical symptoms, with internalizing symptoms more prominent than externalizing symptoms. No differences in diagnostic categories or overall symptomatology were found based on age, gender, ambulation status, or lesion level. Overall symptom counts were positively correlated with scales on the FAD reflecting problematic family functioning (.42–.65). Results suggest that psychiatric symptomatology occurs at a high rate in children and youth with spina bifida. Although ADHD was the modal diagnostic category, the sample as a whole exhibited extensive psychiatric symptoms independent of specific diagnostic categories. Psychiatric symptoms were also associated with increased problematic functioning in families.     

Secondary conditions in children with disabilities: spina bifida as a case example

This paper examines the concept of secondary conditions and its application in studies of childhood disability focusing on children with spina bifida as a representative group. The "International Classification of Functioning, Disability and Health" (World Health Organization, Geneva, 2001) provides a classification of body function/structure, activities, participation and the environment to document dimensions of human functioning in context. The ICF is of value in the study of secondary conditions in two ways: as a conceptual framework for defining impairments, activity limitations and participation restrictions, and the mediating role of the environment in their expression; and as a taxonomy for coding these dimensions of disability. The ICF can yield a profile of a child's difficulties, and documentation of environmental barriers experienced by that child. Research studies with children and adolescents with spina bifida reveal that physical and mental impairments and limitations in performing activities and participating in communal life are experienced as secondary conditions. The significance of secondary conditions is that they are preventable. Identifying the mechanisms associated with their manifestation is thus an important priority for the development of effective prevention programs.     

Neuropsychological Findings in Congenital and Acquired Childhood Hydrocephalus

Hydrocephalus is an increase in cerebrospinal fluid volume that can be caused by a variety of etiologies. The most common connatal and acquired causes of hydrocephalus are spina bifida, aqueduct stenosis, and preterm low birthweight infants with ventricular hemorrhage. In general, the literature suggests mild neuropsychological deficits associated with hydrocephalus, which are predominant in visuospatial and motor functions, and other nonlanguage skills. Although the precise nature of the neuropsychological deficits in hydrocephalus are not completely known, several factors such as etiology, raised intracranial pressure, ventricular size, and changes in gray and white matter tissue composition as well as shunt treatment complications have been shown to influence cognition. In fact, the presence of complications and other brain abnormalities in addition to hydrocephalus such as infections, trauma, intraventricular hemorrhage, low birthweight, and asphyxia are important determinants of the ultimate cognitive status, placing the child at a high risk of cognitive impairment.     

Establishing use of crutches by a mentally retarded spina bifida child

A 5-yr-old mentally retarded spina bifida child was taught to walk with the aid of crutches. This behavior was developed through fading of physical prompting within a 10-step successive approximation sequence. Preliminary training to establish gait consisted of developing use of parallel bars through fading of physically modelled responses within a six-step successive approximation sequence. Use of parallel bars ceased during an extinction period and completely recovered upon being primed with one "free" reinforcement. Systematic use of natural reinforcers was employed as an aid in maintaining use of crutches.     

THE USE OF SELF-MODELING TO IMPROVE THE SWIMMING PERFORMANCE OF SPINA BIFIDA CHILDREN

The use of edited videotape replay (which showed only “positive” behaviors) to improve the water skills of three spina bifida children, aged 5 to 10 years was examined. A multiple baseline across subjects design was used, and behavioral changes were observed to occur in close association with intervention. One child was given successive reapplications of videotaped self-modeling with continuing improvements. It appears that a useful practical technique has been developed.