Clean Intermittent Catheterization
- Recommended when children with spina bifida have problems with bladder continence
- Insertion of a small plastic tube into the bladder, through the urethra, at intervals to drain the urine, so that the bladder is emptied completely, preventing reflux of urine into the kidneys, which may then cause damage and infection of the kidneys
- May be combined with bladder irrigation and/or instillation which involves washing the bladder with antiseptic or antibiotic solution
- Irrigation: solution flows through the catheter into the bladder and held for one minute, Instillation: solution is left in the bladder
- Usually done every 3 to 4 hours during the day, or 4 to 6 times during a 24 hour day, with no longer than 8 hours between catheterizations at night
- Parents usually do this for children aged 5 and under, and after that the child may be taught how to do CIC, if still required
http://www.healthcare.uiowa.edu/cdd/patients/cic.asp#whylearn
http://www.spinabifidaassociation.org/site/c.liKWL7PLLrF/b.2664425/apps/s/content.asp?ct=3822599
Friday, October 17, 2008
Gait and functional issues relating to spina bifida
People with Spina Bifida have different degrees of muscle paralysis, spine and limb difficulties and thus need specialised treatments that address any deformity that interferes with the patient’s function ie. Accessibility, gait and independence.
Generally, muscular imbalance is present, which results in joint contractures and developmental problems such as hip dislocation and spinal deformities.
Initially, a general orthopaedic evaluation is performed, to detect any early changes that may require intervention. A gait analysis which looks at the patient's muscle innervation, strength, joint range of movement and coordination is also used to evaluate patients functionally.
Independent ambulation generally is a function of having an intact quadriceps muscle with good-plus or excellent-plus strength levels. Patients who do not have adequate quadriceps function may require bilateral Lofstrand crutches or may be primarily restricted to a wheelchair.
Functional ambulation generally is described according to the following levels:
• Community ambulator - Indoors or outdoors, crutches with or without braces
• Household ambulator - Only indoors, crutches with or without braces
• Nonfunctional ambulator - Wheelchair, crutches, and braces, in therapy
• Nonambulator - Wheelchair bound
In addition, patients should be monitored for appropriate development and be provided with prolonged physical therapy, gym resources, and adaptive training while in school. Subsequent efforts are necessary to encourage, develop, and maintain independence.
The goal of bracing is to allow patients to function at the maximum level permitted by their neurologic lesion and intelligence. Bracing also ensures a normal developmental progression, its aim being to enable patients to ambulate and to participate in appropriate age-related activities. Finally, orthotics should aid in minimizing energy expenditure to maintain mobility levels.
As long as flexion contractures and skeletal deformities are not severe, patients with no lower-extremity reflexes may, with determination and strong upper extremities, become ambulatory using bilateral Lofstrand or forearm crutches.
Generally, muscular imbalance is present, which results in joint contractures and developmental problems such as hip dislocation and spinal deformities.
Initially, a general orthopaedic evaluation is performed, to detect any early changes that may require intervention. A gait analysis which looks at the patient's muscle innervation, strength, joint range of movement and coordination is also used to evaluate patients functionally.
Independent ambulation generally is a function of having an intact quadriceps muscle with good-plus or excellent-plus strength levels. Patients who do not have adequate quadriceps function may require bilateral Lofstrand crutches or may be primarily restricted to a wheelchair.
Functional ambulation generally is described according to the following levels:
• Community ambulator - Indoors or outdoors, crutches with or without braces
• Household ambulator - Only indoors, crutches with or without braces
• Nonfunctional ambulator - Wheelchair, crutches, and braces, in therapy
• Nonambulator - Wheelchair bound
In addition, patients should be monitored for appropriate development and be provided with prolonged physical therapy, gym resources, and adaptive training while in school. Subsequent efforts are necessary to encourage, develop, and maintain independence.
The goal of bracing is to allow patients to function at the maximum level permitted by their neurologic lesion and intelligence. Bracing also ensures a normal developmental progression, its aim being to enable patients to ambulate and to participate in appropriate age-related activities. Finally, orthotics should aid in minimizing energy expenditure to maintain mobility levels.
As long as flexion contractures and skeletal deformities are not severe, patients with no lower-extremity reflexes may, with determination and strong upper extremities, become ambulatory using bilateral Lofstrand or forearm crutches.
Thursday, October 16, 2008
Complications with Ventriculoperitoneal shunt
Complications for ventriculoperitoneal shunting include standard complications involved with surgery and anesthetic (respiratory failure, medication reactions, bleeding, infection, death).
The shunt may malfunction, resulting in under/over-draining of CSF from the ventricles.
Also the shunt may need to be replaced after the growth of a baby (body increases in size, shunt doesn’t).
The shunt can also disconnect or become blocked – CSF fluid will accumulate and symptoms will occur and necessitate immediate medical attention.
Other complications include fever, vomiting, irritability, redness and swelling over the sites of tubing, or decreased alertness and lethargy.
The shunt may malfunction, resulting in under/over-draining of CSF from the ventricles.
Also the shunt may need to be replaced after the growth of a baby (body increases in size, shunt doesn’t).
The shunt can also disconnect or become blocked – CSF fluid will accumulate and symptoms will occur and necessitate immediate medical attention.
Other complications include fever, vomiting, irritability, redness and swelling over the sites of tubing, or decreased alertness and lethargy.
PCL 13- Peer teasing
Psychological effects that may result from Peer teasing
· Reasons why the child is discriminated against
o Physical appearance
o Incompetency
· Psychological impact (situation tends to improve before preadolescence)
o Depression
o Anxiety
o Loneliness
o Negative self-perceptions and on others
o Aggression and delinquent behavior
· Counseling
o School programs to reduce harassment
o Teaching victimized children to focus on positive social encounters
Reference
http://www.news-medical.net/?id=13266
http://cat.inist.fr/?aModele=afficheN&cpsidt=18424075
http://www.medicalnewstoday.com/articles/30644.php
Biological and psychological factors of dealing with a disease in a Rural area
Biological
Access would be a factor in the care of Janet. As said in the PCL the only medical care available is that of a GP, a paediatrician requires a visit to a larger town. Due to this lack of specialist treatment, Janet could possibly not receive the ongoing treatment she requires. As found in a report by Strong et al, the number of specialists per capita decreases markedly in rural areas compared to metropolitan areas.
Psychological
Living in a rural town could influence Janet’s psychological needs. As it is a small town there is unlikely to be any other children or adults who have Spina Bifida, this could affect both Janet and her mother, as there could be a lack of support groups. Also mental health in rural areas can be sadly lacking, for adults let alone children. In a US survey, 65% of adults were provided with mental health care treatment, by their primary provider, so getting no specialised services. Often
Sarah
Refernces
Mental Healthcare in Rural Communities:
The Once and Future Role of Primary Care
www.arhen.org.au/docs/gphmhci-rsa-summary.pdf
Access would be a factor in the care of Janet. As said in the PCL the only medical care available is that of a GP, a paediatrician requires a visit to a larger town. Due to this lack of specialist treatment, Janet could possibly not receive the ongoing treatment she requires. As found in a report by Strong et al, the number of specialists per capita decreases markedly in rural areas compared to metropolitan areas.
Psychological
Living in a rural town could influence Janet’s psychological needs. As it is a small town there is unlikely to be any other children or adults who have Spina Bifida, this could affect both Janet and her mother, as there could be a lack of support groups. Also mental health in rural areas can be sadly lacking, for adults let alone children. In a US survey, 65% of adults were provided with mental health care treatment, by their primary provider, so getting no specialised services. Often
Sarah
Refernces
Mental Healthcare in Rural Communities:
The Once and Future Role of Primary Care
www.arhen.org.au/docs/gphmhci-rsa-summary.pdf
Osteomyelitis
Definition
Osteomyelitis is the medical term for an infection in a bone. Infections can reach a bone by traveling through your bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if trauma exposes your bone to germs. Bone infections commonly affect the long bones of your body, such as your leg bones and upper arm bone, as well as your spine and pelvis.
Osteomyelitis often occurs in children as an acute condition. In adults, osteomyelitis may occur as either the acute and chronic form.
Once considered incurable, osteomyelitis can be successfully treated today. Still, osteomyelitis is a serious condition, requiring aggressive treatment to prevent spread of your infection and to save the affected bone.
Symptoms
Signs and symptoms of osteomyelitis depend on whether the condition is acute, lasting several months or less, or chronic, lasting several months to years.
Signs and symptoms of acute osteomyelitis include:
-Fever that may be abrupt
-Irritability or lethargy in young children
-Pain in the area of the infection
-Swelling, warmth and redness over the area of the infection
Signs and symptoms of chronic osteomyelitis include:
-Warmth, swelling and redness over the area of the infection
-Pain or tenderness in the affected area
-Chronic fatigue
-Drainage from an open wound near the area of the infection
-Fever, sometimes
Sometimes osteomyelitis causes no signs and symptoms or has signs and symptoms that are difficult to distinguish from other problems. For instance, osteomyelitis of the hip, spine or pelvis may have few signs and symptoms. Osteomyelitis that occurs after a broken bone (fracture) or deep wound may cause pain and swelling that you may attribute to your injury, not an infection.
Tests and Diagnosis
Your doctor conducts a physical exam to better understand your signs and symptoms if he or she suspects you may have osteomyelitis. Your doctor may feel the area around the affected bone for any tenderness, swelling or warmth.
Your doctor may order a combination of tests and procedures to diagnose osteomyelitis and to determine what type of infection you have, including:
-Blood tests.
Blood tests may reveal elevated levels of white blood cells and other factors that may indicate that your body is fighting an infection. If your osteomyelitis was caused by an infection in the blood, tests may reveal what germs are to blame. No blood test exists that tells your doctor whether you do or do not have osteomyelitis. However, blood tests do give clues about your diagnosis, which your doctor uses to decide what further tests and procedures you may need.
-X-rays.
X-rays can reveal damage to your bone. However, damage may not be visible until osteomyelitis has been present for several weeks. More-detailed imaging tests may be necessary if your osteomyelitis has developed more recently.
-Other imaging procedures.
fI your doctor can't get a clear picture of the affected bone using X-ray, he or she may order other imaging procedures, such as computerized tomography (CT), magnetic resonance imaging (MRI) or a bone scan.
-Bone biopsy.
During a biopsy, a surgeon removes a small piece of your infected bone for analysis in a laboratory. The laboratory determines what type of bacteria or other pathogen is infecting your bone. Your doctor uses that information to determine your treatment. A biopsy can be performed as an open biopsy, meaning that it requires anesthesia and surgery to access the bone. In some situations, a surgeon inserts a long needle into your skin and your bone to take a biopsy (fine-needle aspiration). This procedure requires local anesthetics to numb the area where the needle is inserted.
Treatment
Doctors treat chronic osteomyelitis with surgery and antibiotics. In acute osteomyelitis in children or vertebral osteomyelitis, surgery isn't always necessary.
Doctors treat chronic osteomyelitis with surgery and antibiotics. In acute osteomyelitis in children or vertebral osteomyelitis, surgery isn't always necessary.
Surgery
What type of surgery you undergo for osteomyelitis depends on what bone is infected. Surgery may include one or more of the following procedures:
-Drain the infected area.
Opening up the area around your infected bone allows your surgeon to drain any pus or fluid that has accumulated in response to the infection.
-Remove diseased bone and tissue.
In a procedure called debridement, the surgeon removes as much of the diseased bone as possible, taking a small margin of healthy bone to ensure that all the infected areas have been removed. Surrounding tissue that shows signs of infection also may be removed.
-Restore blood flow to the bone.
Your surgeon may fill any empty space left by the debridement procedure with a piece of bone or other tissue, such as skin or muscle, from another part of your body. Sometimes temporary fillers are placed in the pocket until you're healthy enough to undergo a bone graft or tissue graft. The graft helps your body repair damaged blood vessels and form new bone.
-Remove any foreign objects.
In some cases, foreign objects, such as surgical plates or screws placed during a previous surgery, may need to be removed.
In order to stabilize the affected bone and the new graft, you may need to have metal plates, rods or screws inserted into the bone. This procedure is sometimes performed later. Your doctor may use other devices to stabilize your affected bone, such as external fixators.
People who can't tolerate surgery
Surgery as an osteomyelitis treatment isn't available to everyone. People who are very ill may not be able to endure the extensive surgery and recovery. In these cases, doctors may use antibiotics for longer periods of time, sometimes for years, in an attempt to suppress the infection, though cure generally isn't possible with this approach. If the infection persists, amputation of all or part of an infected arm or leg may be necessary.
Antibiotics
If your doctor suspects you have chronic osteomyelitis, he or she works to determine exactly what microorganism is causing the infection before prescribing antibiotics. Your doctor uses a bone biopsy or a piece of bone removed during surgical treatment to determine what's causing the infection.
Once the bacterium or fungus causing your infection has been identified and you've undergone surgery, if necessary, your doctor selects the antibiotic most likely to be effective in fighting your particular type of infection. Antibiotics are administered most often through a vein in your arm (intravenously) or, in some cases, they can be taken orally. You typically take antibiotics for four to six weeks, or even longer. In some cases, you may need to take antibiotics for the rest of your life.
Antibiotics carry a risk of side effects, including nausea, vomiting and diarrhea. Allergic reactions also can occur.
www.mayoclinic.com
Osteomyelitis is the medical term for an infection in a bone. Infections can reach a bone by traveling through your bloodstream or spreading from nearby tissue. Infections can also begin in the bone itself if trauma exposes your bone to germs. Bone infections commonly affect the long bones of your body, such as your leg bones and upper arm bone, as well as your spine and pelvis.
Osteomyelitis often occurs in children as an acute condition. In adults, osteomyelitis may occur as either the acute and chronic form.
Once considered incurable, osteomyelitis can be successfully treated today. Still, osteomyelitis is a serious condition, requiring aggressive treatment to prevent spread of your infection and to save the affected bone.
Symptoms
Signs and symptoms of osteomyelitis depend on whether the condition is acute, lasting several months or less, or chronic, lasting several months to years.
Signs and symptoms of acute osteomyelitis include:
-Fever that may be abrupt
-Irritability or lethargy in young children
-Pain in the area of the infection
-Swelling, warmth and redness over the area of the infection
Signs and symptoms of chronic osteomyelitis include:
-Warmth, swelling and redness over the area of the infection
-Pain or tenderness in the affected area
-Chronic fatigue
-Drainage from an open wound near the area of the infection
-Fever, sometimes
Sometimes osteomyelitis causes no signs and symptoms or has signs and symptoms that are difficult to distinguish from other problems. For instance, osteomyelitis of the hip, spine or pelvis may have few signs and symptoms. Osteomyelitis that occurs after a broken bone (fracture) or deep wound may cause pain and swelling that you may attribute to your injury, not an infection.
Tests and Diagnosis
Your doctor conducts a physical exam to better understand your signs and symptoms if he or she suspects you may have osteomyelitis. Your doctor may feel the area around the affected bone for any tenderness, swelling or warmth.
Your doctor may order a combination of tests and procedures to diagnose osteomyelitis and to determine what type of infection you have, including:
-Blood tests.
Blood tests may reveal elevated levels of white blood cells and other factors that may indicate that your body is fighting an infection. If your osteomyelitis was caused by an infection in the blood, tests may reveal what germs are to blame. No blood test exists that tells your doctor whether you do or do not have osteomyelitis. However, blood tests do give clues about your diagnosis, which your doctor uses to decide what further tests and procedures you may need.
-X-rays.
X-rays can reveal damage to your bone. However, damage may not be visible until osteomyelitis has been present for several weeks. More-detailed imaging tests may be necessary if your osteomyelitis has developed more recently.
-Other imaging procedures.
fI your doctor can't get a clear picture of the affected bone using X-ray, he or she may order other imaging procedures, such as computerized tomography (CT), magnetic resonance imaging (MRI) or a bone scan.
-Bone biopsy.
During a biopsy, a surgeon removes a small piece of your infected bone for analysis in a laboratory. The laboratory determines what type of bacteria or other pathogen is infecting your bone. Your doctor uses that information to determine your treatment. A biopsy can be performed as an open biopsy, meaning that it requires anesthesia and surgery to access the bone. In some situations, a surgeon inserts a long needle into your skin and your bone to take a biopsy (fine-needle aspiration). This procedure requires local anesthetics to numb the area where the needle is inserted.
Treatment
Doctors treat chronic osteomyelitis with surgery and antibiotics. In acute osteomyelitis in children or vertebral osteomyelitis, surgery isn't always necessary.
Doctors treat chronic osteomyelitis with surgery and antibiotics. In acute osteomyelitis in children or vertebral osteomyelitis, surgery isn't always necessary.
Surgery
What type of surgery you undergo for osteomyelitis depends on what bone is infected. Surgery may include one or more of the following procedures:
-Drain the infected area.
Opening up the area around your infected bone allows your surgeon to drain any pus or fluid that has accumulated in response to the infection.
-Remove diseased bone and tissue.
In a procedure called debridement, the surgeon removes as much of the diseased bone as possible, taking a small margin of healthy bone to ensure that all the infected areas have been removed. Surrounding tissue that shows signs of infection also may be removed.
-Restore blood flow to the bone.
Your surgeon may fill any empty space left by the debridement procedure with a piece of bone or other tissue, such as skin or muscle, from another part of your body. Sometimes temporary fillers are placed in the pocket until you're healthy enough to undergo a bone graft or tissue graft. The graft helps your body repair damaged blood vessels and form new bone.
-Remove any foreign objects.
In some cases, foreign objects, such as surgical plates or screws placed during a previous surgery, may need to be removed.
In order to stabilize the affected bone and the new graft, you may need to have metal plates, rods or screws inserted into the bone. This procedure is sometimes performed later. Your doctor may use other devices to stabilize your affected bone, such as external fixators.
People who can't tolerate surgery
Surgery as an osteomyelitis treatment isn't available to everyone. People who are very ill may not be able to endure the extensive surgery and recovery. In these cases, doctors may use antibiotics for longer periods of time, sometimes for years, in an attempt to suppress the infection, though cure generally isn't possible with this approach. If the infection persists, amputation of all or part of an infected arm or leg may be necessary.
Antibiotics
If your doctor suspects you have chronic osteomyelitis, he or she works to determine exactly what microorganism is causing the infection before prescribing antibiotics. Your doctor uses a bone biopsy or a piece of bone removed during surgical treatment to determine what's causing the infection.
Once the bacterium or fungus causing your infection has been identified and you've undergone surgery, if necessary, your doctor selects the antibiotic most likely to be effective in fighting your particular type of infection. Antibiotics are administered most often through a vein in your arm (intravenously) or, in some cases, they can be taken orally. You typically take antibiotics for four to six weeks, or even longer. In some cases, you may need to take antibiotics for the rest of your life.
Antibiotics carry a risk of side effects, including nausea, vomiting and diarrhea. Allergic reactions also can occur.
www.mayoclinic.com
Sexuality and spina bifida
Males can have normal sexual function, but may be affected to some degree. Erections are possible, but there is no ejaculation.
Females less affected.
May have problems with positioning during intercourse due to orthopaedic problems.
Most males and females are fertile.
It is common for people with spina bifida to have latex allergies.
For more information there is a very informative piece at:
http://www.spinabifida-incontinence.info/pdfs/Sex.pdf
Females less affected.
May have problems with positioning during intercourse due to orthopaedic problems.
Most males and females are fertile.
It is common for people with spina bifida to have latex allergies.
For more information there is a very informative piece at:
http://www.spinabifida-incontinence.info/pdfs/Sex.pdf
Effects of Lack of Innervation
Bladder Continence
Bladder and bowel function are controlled by sacral nerves:
Usual bladder emptying: when the bladder is full receptors sense this and signal it to the brain; when a person is ready to urinate motor nerves coordinate the contraction of the bladder with the relaxation of the sphincters.
Spina Bifida: a person with spina bifida will usually have nerve damage impairing the bladder and/or sphincters. There are three situations which may occur:
Bowel Continence:
Nerve damage generally affects three areas of the bowel:
· the external anal sphincter
=> limited control over when the bowel will empty
· the sensory mechanism which tells the brain that the rectum is full
=> not knowing when it is time to go to the toilet
· the muscles which move the faeces along the colon and out of the body
=> constipation
Skin Innervation:
Damaged and improperly developed nerves in people with spina bifida mean they may have little or no sensation in some areas of the skin, usually the areas corresponding with a loss of movement.
- Pressure sores: skin is pressed between bones and a hard surface, depriving the tissue of blood, oxygen and nutrients, leading cells to die. If there is a problem with the supply of blood to an area, the brain usually sends a message to the body to change position so that the cells will once again receive a proper blood supply. A person with spina bifida has areas of skin which do not have any feeling and often have partial or complete paralysis, and so does not receive these messages.
- Burns: sunburn, wheelchair left in sun, holding hot food on your lap etc. People with spina bifida have poor circulation so the skin is often not as strong, and will burn more easily than usual
- Scrapes: will take longer to heal due to poor circulation and poor nerve supply
Bladder surgery
Surgical Bladder Repair
Repairs for weakened or damaged bladders are the norm for most incontinence problems. Surgeries are available to remove blockages, raise fallen bladders, and even implant artificial sphincters.
Bladder Surgery
(a) Description
(b) Possible Complications
1. Retropubic Suspension
(a) This surgery is specifically for women. The bladder and urethra are raised in the pelvic area, bringing them back into the correct position. This prevents the bladder from pushing down onto the urethra.
(b) Urinary tract infections.Infections in the surgical area.Recurrence of incontinence
2. Sling Procedure
(a) Usually performed on women. Either a synthetic material or abdominal tissue is used to help compress the urethral sphincter.
I(b) nfections.Urine retention.Gradual deterioration of the sling.
3. Bladder Stone Removal
(a) A bladder stone can cause urinary tract infections and contribute to incontinence by blocking normal urine flow. More common in men than women, stones can usually be crushed by inserting a cystoscope into the bladder or broken up with ultrasonic waves.
(b) Long term treatment to prevent recurrence is usually required.Enlarged prostates prevent stones from being flushed out. Prostate treatment may also be required.
4. Artificial Urinary Sphincter
(a) An artificial sphincter replaces the faulty urinary sphincter. This is usually a last resort.
(b) Infections.Deterioration of surrounding tissues, requiring removal of the mechanism.
Depending on the procedure, surgery can be performed while the patient is under general, regional, or local anesthesia. Most patients are discharged home on the same day of surgery.
After surgery, they can expect to return to a normal level of activity after 6 weeks
Repairs for weakened or damaged bladders are the norm for most incontinence problems. Surgeries are available to remove blockages, raise fallen bladders, and even implant artificial sphincters.
Bladder Surgery
(a) Description
(b) Possible Complications
1. Retropubic Suspension
(a) This surgery is specifically for women. The bladder and urethra are raised in the pelvic area, bringing them back into the correct position. This prevents the bladder from pushing down onto the urethra.
(b) Urinary tract infections.Infections in the surgical area.Recurrence of incontinence
2. Sling Procedure
(a) Usually performed on women. Either a synthetic material or abdominal tissue is used to help compress the urethral sphincter.
I(b) nfections.Urine retention.Gradual deterioration of the sling.
3. Bladder Stone Removal
(a) A bladder stone can cause urinary tract infections and contribute to incontinence by blocking normal urine flow. More common in men than women, stones can usually be crushed by inserting a cystoscope into the bladder or broken up with ultrasonic waves.
(b) Long term treatment to prevent recurrence is usually required.Enlarged prostates prevent stones from being flushed out. Prostate treatment may also be required.
4. Artificial Urinary Sphincter
(a) An artificial sphincter replaces the faulty urinary sphincter. This is usually a last resort.
(b) Infections.Deterioration of surrounding tissues, requiring removal of the mechanism.
Depending on the procedure, surgery can be performed while the patient is under general, regional, or local anesthesia. Most patients are discharged home on the same day of surgery.
After surgery, they can expect to return to a normal level of activity after 6 weeks
Tuesday, October 14, 2008
Learning issues involved with hydrocephalus
Hydrocephalus- accumulation of cerebrospinal fluid (CSF) which is caused by an imbalance in the production and drainage of fluid within the brain. It can be caused by a Arnold Chiari malformation, which occurs due to an abnormal position of the lower brain. This abnormal position is believed to lead to learning difficulties.
Issues:
Issues:
- a slowing of mental capacity is seen as one of the first signs in children
- can be confused with dementia in adults/elderly
- 10% lower IQ than population on average
- These difficulties might be in one or more of the following areas:
- attention
- language
- memory and learning
- visuo-motor integration skills
- planning
- organisational skills
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