## Post 3: Spina Bifida
* **Category:** Diagnoses & Clinical Alignments
* **Affiliated Image:** `images/spina_bifida_banner.png`
* **Excerpt:** Guidelines for supporting individuals with Spina Bifida in community settings, focusing on mobility accommodations and wheelchair accessibility mapping.
### 1. HHSC Regulatory Definition & Alignment
Spina Bifida is a congenital neural tube defect listed on the HHSC Related Conditions List. It occurs when the spine and spinal cord do not form properly during early fetal development, resulting in varying degrees of spinal cord damage, paralysis, and sensory loss below the level of the lesion.
### 2. Clinical Overview
Clinical features depend on the type (myelomeningocele being the most severe) and include:
* Partial or complete paralysis of the lower limbs.
* Loss of physical sensation in lower extremities (increased risk of skin pressure sores).
* Orthopedic complications (e.g., scoliosis, hip dislocations).
* Common neurodevelopmental associations, such as hydrocephalus (often requiring a shunt) and mild cognitive learning differences.
### 3. Typical Functional/Adaptive Challenges
ICAP adaptive domains affected:
* **Motor Skills:** Total reliance on mobility aids (wheelchairs, crutches, orthotics) and challenges navigating vertical changes (steps, high thresholds).
* **Community Living Skills:** Assessing public spaces for safety, utilizing public transit wheelchair lifts, and identifying accessible facilities.
### 4. Grace Steps Program Alignments (ICAP Goals)
* **Wheelchair Accessibility Exploration:** Auditing community spaces to map accessible paths, doorways, and ramps.
* **Adaptive Physical Exercise:** Supporting seated stretching, upper-body conditioning, and therapeutic outdoor recreation.
### 5. Facilitator Habilitation Action Guide
* **Skin Integrity Checks:** Encourage and prompt pressure-relief shifts every 15-20 minutes while seated in wheelchairs.
* **Temperature Monitoring:** Since lower-extremity sensation is reduced, verify that the individual is protected from hot surfaces (e.g., metal benches, hot pavement) and extreme cold.
* **Emergency Shunt Protocol:** Be trained on the signs of hydrocephalus shunt failure (e.g., headache, lethargy, nausea, irritability) and have direct contact info for the LAR and physician.
