Long Term Effects of Chronic Illness

Question 1

What are the possible consequences of spina bifida?

Answer 1

• paralysis/loss of sensation and reflexes distal to abnormality
• severe = high risk of meningitis (if open lesion)
• hydrocephalus (due to interruption of CSF circulation)

Question 2

How is spina bifida and hydrocephalus treated?

Answer 2

• spina bifida: surgical closure of defect

- hydrocephalus: shunt to drain CSF

Question 3

What are the associated conditions with spina bifida?

Answer 3

• renal anomalies
• sphincter dysfunction
• intellectual impairments
• MSK (paralytic defortmities of the feet)

Question 4

What is the probability of walking ability as an adult with scoliosis?

Answer 4

• if thoracic/upper lumbar lesion: walking not possible

- lower lumbar/sacral: can walk but will need orthodontic splints to compensate

Question 5

Describe the features of an L4 lesion

Answer 5

• flexed knee gait: patient relies on quadriceps
• paralysed calf muscles (excessive ankle dorsiflexion)
• muscle fatigue
• knee pain

(problems increase with age as increase in height and weight but muscle strength stays the same causing muscle fatigue and pain to worsen)

Question 6

What are the consequences of L4 lesions in adults?

Answer 6

• charcot joints (loss of pain sensation and proprioception can cause joint destruction)
• urinary tract problems (incontinence, incomplete emptying, renal damage)
• faecal incontinence (paralysis of external anal sphincter)
• sexual dysfunction

Question 7

What are the possible challenges to living independently?

Answer 7

• learning/behavioural difficulties
• social continence not achieved
• cannot transfer independently
• ageing (increased need for support)