Research from the Medical Journals-2010

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Quality of life in obstructive hydrocephalus: endoscopic third ventriculostomy compared to cerebrospinal fluid shunt
This study suggests that there is no obvious difference in Quality of Life or intellectual outcomes after treatment with endoscopic third ventriculostomy and shunt.
Childs Nerv Syst DOI 10.1007/s00381-009-0983-7

Upper limb motor function in young adults with spina bifida and hydrocephalus
Young adults with SBH have significant limitations in upper limb function and are more disrupted by some challenges while performing upper limb motor tasks. Further, the upper limb motor deficits persist into adulthood and do not resolve with increasing age. Some motor functions could be performed when there were no distractions or dual task requirements, but deteriorate under the conditions of multitasking that mimic the real world instantiation of these skills.
Childs Nerv Syst DOI 10.1007/s00381-009-0948-x

Thinking styles and coping when caring for a child with severe spina bifida
This Spanish study was designed to identify the cognitive dimensions involved in coping and the psychological adjustment of parents of children with spina bifida. The results identify a range of behaviours in the cognitive domain characterised by a lower tendency to be internally focussed to process abstract and symbolic information (Intuiting Style); and to trust more their direct experience and observable phenomena. There was also a significantly lower tendency to use cognitive processes based on intellect, logic, and objectivity (Thought Guided). Lastly, Innovating, which involves creativity enhancing change and exploring new possibilities, was almost absent in these parents.

The thinking styles identified in this study may be good indicators of the way these parents respond to and cope with stressful situations; how effective those coping strategies are; and their effect on psychological adjustment. The study may facilitate the use of better intervention strategies for these parents and help to optimise their personal resources during counselling.
J Dev Phys Disabil 2009;21:169-183

Fetal myelomeningocele: natural history, pathophysiology, and in-utero intervention
Preliminary results suggest that fetal surgery results in reversal of hindbrain herniation (the Chiari II malformation), a decrease in shunt-dependent hydrocephalus, and possibly improvement in leg function, but these findings might be explained by selection bias and changing management indications. A randomised prospective trial (the MOMS trial) is currently being conducted by three centres in the USA, and is estimated to be completed in 2010. Further research is needed to better understand the pathophysiology of MMC, the ideal timing and technique of repair, and the long-term impact of in-utero intervention.
Sem Fetal Neonatal Med 2009 doi:10.1016/j.siny.2009.05.002

Quality of performance of everyday activities in children with spina bifida: a population-based study
Compared with age-normative values, 60% of the children with spina bifida were found to have motor ability measures below 2 SD and 48% process ability measures below 2 SD. Most of the children with spina bifida had difficulties performing well-known everyday activities in an effortless, efficient and independent way, relating to both motor and process skills. The motor skills hardest to accomplish involved motor planning and the process skills hardest to accomplish were adaptation of performance and initiations of new steps, thus actually getting the task done.
Acta Pediatr doi:10.1111/j.1651-2227-2009.0140.x

Quality of life in obstructive hydrocephalus: endoscopic third ventriculostomy compared to cerebrospinal fluid shunt
This study suggests that there is no obvious difference in Quality of Life or intellectual outcomes after treatment with endoscopic third ventriculostomy and shunt.
Childs Nerv Syst DOI 10.1007/s00381-009-0983-7

Mobility, assistive technology use, and social integration among adults with spina bifida
We found that individuals with spina bifida who used both manual and power wheelchairs do have lower daily home and community activity levels compared with ambulators, but that most individuals with spina bifida have low social integration and economic self-sufficiency scores, regardless of whether they can ambulate or use wheelchairs. A high prevalence of depression was also found.
Am J Phys Med Rehab 2009;88(7):533-41

Bone mineral density in children with myelomeningocele
The present study demonstrates that osteoporosis and osteopenia are a major complication in children with spina bifida. It establishes the significant relationship with low bone mineral density (BMD) in children who are wheelchair-dependent compared with ambulatory children. There was a strong trend toward lower BMD in children who have higher neurological levels. Children with a history of fractures did not appear to have reduced BMD.
Dev Med Child Neurol 2008;51:63-67

Factors associated with the psychological and behavioural adjustment of siblings of youths with spina bifida
This research utilised a social-ecological framework to enrich understanding of key areas to assess and support for siblings of youths with SB. These data identified attitude toward SB, satisfaction with family functioning, qualities of sibling interactions and experiences of peer support as particularly salient dimensions of sibling life to address in family-centred assessment and intervention processes. Minimising threats and bolstering protective influences on sibling adjustment are essential ingredients to advance a family-centred perspective in SB.
Fam Sys Health2009;27(1):1-15

The experience of finding an effective bowel management program for children with spina bifida; the parent’s perspective
It is clear that this component of SB is a major stressor for both child and his or her family. This long complicated journey was made problematic by health care professionals who were either unfamiliar or insensitive to the family’s need for bowel management counselling and information. Surgical options have brought joy for some families but frustrations for others.
J Ped Nurs 2009;24(4):280-291

Problematic aspects of fecal incontinence according to the experience of adults with spina bifida
Problematic aspects were related to participation in terms of time consumption, communication, social isolation, love and sexuality, and accessibility. Also, to a sense of helplessness in terms of panic and worry, to a sense of shame in terms of impurity, social acceptance and self-image, and to bowel function in terms of decisions about colostomy, voluntary constipation, and changing patterns.
J Rehab Med 2009;41:506-511

Neuropathology and structural changes in hydrocephalus
This article provides a review of the effects of hydrocephalus on brain development, structure and function. It notes that in most cases of hydrocephalus the changes that result from having large ventricles are independent from the cause of hydrocephalus and both impact on brain functioning. It further states that shunting may allow some changes, such as delayed myelination to recover. 
Dev Disabl Res Rev (2010);16:16-22

Transition to adult health care for adolescents with spina bifida: research issues
The dominant model of health care provision to children with SB since the 1960s, the subspecialty multidisciplinary clinic, has been highly successful. Despite the additional complexities associated with adults with SB compared to adults with other chronic conditions, models of health care for adults with SB has lagged behind service developments for adults with other chronic conditions. There is also a lack of evidence (about e.g. comorbidities) to inform clinical care standards.

The impact of some issues will lessen with age while others will increase (e.g. pain, impact of SB on intimacy and sexuality, obesity, cardiac disease, pregnancy, mental disorder and health risk behaviours including sexual abuse.)

A review of multidisciplinary clinics in Victoria showed major achievements as well as many gaps.
Dev Disabl Res Rev (2010);16:60-65

Effects of reading goals on reading comprehension, reading rate, and allocation of working memory in children and adolescents with spina bifida myelomeningocoele
This study found that children with SBM adjusted how they read a text in relation to the goal for reading it. When reading for fun or to find a specific piece of information, their reading was faster than when they read to answer comprehension questions or to generate a title for the story. This suggests that they might have better metacognitive abilities than would be expected from their deficits in comprehension.

In an apparent paradox, the consistently longer reading times for children with SBM did not translate into better comprehension.
JINS (2010) doi:10.1017/s1355617710000123

Factors influencing spinal canal stenosis in patients with long-term controlled hydrocephalus treated with cerebrospinal fluid shunt
Narrowing of the spinal canal (stenosis) can occur when a CSF shunt overdrains. This study found that 10 out of 33 patients had narrowed spinal canals and of these two presented with clinical symptoms. Slit ventricles also occurred in 11 patients, but was not associated with spinal canal stenosis in those who underwent  shunt insertion in infancy. None of the 11 had symptoms from slit ventricles..
Childs Nerv Syst (2010) doi:10.1017/s00381-010-1092-3

Optimizing health care for adults with spina bifida
The majority of individuals living SB are adults but less is known about this age group than children because most of the coordinated care and research remains within the paediatric specialties.

Adults with SB continue to have increased medical needs compared to the general population. Medical complications include typical SB concerns similar to paediatric patients but also conditions due to long-term aberrations of normal neurological, urological and musculoskeletal function. Research is needed to understand the late secondary conditions of SB and the longitudinal effects of childhood procedures, such as ventricular shunting, bladder augmentation, urinary diversion, tendon transfers and spinal rods.
Dev Disabl Res Rev (2010);16:76-81

Idiopathic normal pressure hydrocephalus: Thoughts on aetiology and pathophysiology
This article suggests that Normal Pressure Hydrocephalus is caused by repetitive disruption of the normal propagation of ventricular systole, due to chronic derangements of cerebral arterial hemodynamics. The author proposes a multi-step treatment be evaluated using computer modelling and animal experimentation.
Med Hypoth 2009 DOI.10.1016/j.mehy.2009.04.044

Prognosis of spina bifida in the era of prenatal diagnosis and termination of pregnancy
After fetal medicine assessment and patient choice with modern multi-disciplinary management, the prognosis of the selected spina bifida group whole a little better in terms of survival rates, remains relatively poor in terms of morbidity, and the rates of neuropathic bladder problems in these children remain a concern.
Fetal Diagn Ther 2009 DOI: 10.1159/000238116

TransMap From theory into practice: The underlying principles in supporting disabled young people in transition to adulthood
The 5 principles examined in this report are:
1. Comprehensive multi-agency engagement
2. The full participation of young people and their families
3. The provision of high quality information
4. Effective transition planning
5. An array of opportunities for living life

Managing non-compliance in the classroom: a review of empirically based interventions
Non-compliance in the classroom is a serious and time-consuming problem for teachers. This paper reviews empirical studies over the last 10 years that describe interventions delivered by classroom teachers to manage non-compliance within both regular and special education programs. Strategies such as behavioural momentum, effective commands or precision requests, positive reinforcement and group contingencies can be used effectively by teachers at little cost of time or money.
Spec Ed Perspect 2008;17(2):33-55

Transcallosal connectivity and cortical rhythms: findings in children with spina bifida
The findings of this study support the hypothesis of a decreased interhemispheric connectivity within the temporal and occipital lobes, diminishing the capacity of posterior regions to generate sustained rhythmic oscillations. Rhythmic cortical activity has been associated with a variety behavioural states (i.e. exploring, learning, sleeping) and it is well known that a synchronised oscillatory neuronal activity plays a crucial role in supporting higher function processes. 
NeuroReport 2009;20:1188-1192