The impacts of neural tube defects vary by type and location. Here is an overview:

• Spina bifida occulta

  • This is the least severe form of spina bifida. A few vertebrae are not completely closed. There may be a patch of hair or fatty mass at the base of the spine, but there may also be no visible indication of the defect.

  • With this type of neural tube defect, there is no paralysis or sensory loss. In fact, the individual may not be affected by this condition in his or her daily life.

• Meningocele

  • The meninges are the membranes that cover the spinal cord. WIth meningocele, the meninges balloons outward and protrudes from the spinal column. This creates a visible sac near the base of the spine. Because the spinal cord and spinal nerves are not affected by this protrusion, individuals with meningocele will not experience sensory loss or paralysis. However, they may still experience other associated conditions like hydrocephalus.

• Myelomeningocele

  • This is the most severe form of spina bifida. As with meningocele, a saclike protrusion will be visible. Unlike meningocele, however, the spinal cord itself is routed through the protrusion. This disruption of the spinal cord causes abnormal nerve function that leads to paralysis or loss of sensation.

  • Although the etiology of myelomeningocele is not perfectly clear, there appear to be both dietary and genetic factors.

    • "There is an increased probability of having a second child with a neural tube defect after having one child with this disorder, and this percentage increases if more than one child has a neural tube defect" (Heller et al., 2009).

    • Folic acid deficiency is a risk factor for spina bifida, which is partly why prenatal supplements and products like "enriched rice" contain folic acid.

Physically, students with myelomeningocele can experience paralysis, sensory loss, and bowel or bladder problems. Hydrocephalus also occurs in 80-90% of cases (Best et al., 2010)

• Paralysis

  • Depending on the location and severity of the defect, the student with myelomeningocele may not be able to move lower extremities. Although many will be able to walk, they may require mobility aids like braces, walkers, crutches, or wheelchairs. Those that do walk independently may be unsteady and tire easily.

• Sensory loss

  • Students with myelomeningocele may not be able to sense touch or pain below a certain point (again depending on the location and severity of the spinal defect).

• Bowel and bladder concerns

  • With the paralysis and sensory loss, many students with myelomeningocele will be unable to control their bladder and bowels. They may also be unable to identify when their bladder is full. This can cause bladder infections and kidney damage.

  • Many students with myelomeningocele will be catheterized and require a bowel routine. Students may have accidents at school, require regularly scheduled bathroom breaks, and need additional time or staff support for bowel and bladder routines.

• Hydrocephalus (commonly referred to as "water on the brain") is an extremely common condition for individuals with spina bifida. Essentially, this is when cerebrospinal fluid is unable to properly drain from the brain.

  • To help with the drainage, individuals often undergo surgery in which a shunt is inserted into the brain to help promote drainage.

  • Hydrocephalus can cause many educational implications (see below).

• Musculoskeletal abnormalities

  • Some individuals with myelomeningocele may end up with clubbed foot or other abnormalities with feet and ankles.

  • People with myelomeningocele are also at higher risk for scoliosis.

There are several treatments options available for individuals with myelomeningocele.

• Prenatal precautions like taking folic acid supplements may help reduce the chance of the baby having a neural tube defect.

• Surgery usually occurs within the first few days or hours of life for infants with spina bifida. In this surgery, the sac is removed and the spinal cord is tucked back into place. Although irreversible damage to the spinal cord has already occurred, this surgery helps prevent infection and further damage.

  • When discovered early enough, the surgery may happen in utero. Again, this does not reverse any damage that has already occurred. Sometimes the risks of this type of surgery outweigh the benefits.

• Some individuals with myelomeningocele may require tracheostomies (breathing) and/or gastronomy (feeding) tubes.

• As noted earlier, many will require a shunt due to hydrocephalus.

• Therapeutic and orthopedic treatments include stretching, gait training, braces, and splints.

• ADHD: Along with hydrocephalus comes a greatly increased risk of attention deficit disorders.

• Learning disabilities: Students with myelomeningocele may have difficulty with visual-spatial perception and memory, too.

• Time considerations: Students with spina bifida may need to perform care routines throughout the day that require additional time. They may also require more time for longer hallway transitions. See information about tangible barriers for scheduling concerns.

• Language: Pragmatic (social) language can be a communicative issue for students with myelomeningocele and hydrocephalus. Researches have noted that conversations can be very "chatty," but tend to be superficial and lack substantive meaning. Fittingly, Best et al. (2010) describe how "this behavior was originally called 'cocktail party syndrome.'"

• Social needs: A recent study by Edwards et al. (2019) suggests that students without special needs interact less with and harbor "negative attitudes" toward students with physical disabilities. See the mindset section of the barriers page for more information. Aside from the physical disability, the difficulties with pragmatic language can also cause social barriers for students with myelomeningocele. The bowel and bladder issues faced by many with myelomeningocele can also be an avenue for teasing or bullying by peers.

Many low-tech and high-tech AT considerations exist for students with spina bifida. Here are a few to consider:

• Organizational tools

  • Desk organizers

  • Visual or digital schedules

• Alternative computer access (if required)

• Mobility equipment (not directly addressed in the AT section)

• Toileting and personal care accommodations