Developmental Medicine & Child Neurology

Original Articles

Secondary impairments in young adults with spina bifida

Verhoef  a1 c1, HA Barf  a1, MWM Post  a2, FWA van Asbeck  a1, RHJM Gooskens  a3 and AJH Prevo  a4
a1 Rehabilitation Centre De Hoogstraat, Utrecht, the Netherlands.
a2 IRV, Institute for Rehabilitation Research, Hoensbroek, the Netherlands.
a3 Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Centre, Utrecht, the Netherlands.
a4 Department of Rehabilitation, Rudolf Magnus Institute of Neuroscience, University Medical Centre, Utrecht, the Netherlands.


The aim of this study was to examine the prevalence of secondary impairments in young adults with spina bifida and to relate the prevalence to the type of spina bifida and the level of lesion. This cross-sectional study is part of the ASPINE (Adolescents with Spina Bifida in the Netherlands) study. Data were collected on medical history, hydrocephalus (shunt: yes/no), neurological level of lesion (International Standards for Neurological and Functional Classification of Spinal Cord Injury), visual acuity (Landolt rings), spasticity (Modified Ashworth Scale), contractures (range of motion), scoliosis (deviation from perpendicular), ambulation (Hoffer criteria), pressure sores and blood pressure (physical examination), epilepsy, pain, incontinence and sexuality (questionnaire), and cognitive functioning (Raven Standard Progressive Matrices). In total, 179 patients with spina bifida participated (41% male, age range 16 to 25 years, mean 20 years 9 months, SD 2 years 11 months). These were 37 patients with spina bifida occulta, 119 patients with spina bifida aperta and hydrocephalus (AHC+) and 23 patients with spina bifida aperta without hydrocephalus (AHC). Of our patient group, 73 had a high-level lesion (L2 and above), 68 a mid-level lesion (L3 to L5), and 38 a low-level lesion (S1 and below). Both subdivisions were strongly related with patients with higher lesions more often having hydrocephalus. Most secondary impairments were found for patients with AHC+, and patients with AHC were mostly comparable to patients with spina bifida occulta. According to level of lesion, most medical problems were found in the high-level lesion group. However, all subgroups suffered from health problems.

(Accepted January 14 2004)

c1 Centre of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Centre De Hoogstraat, Rembrandtkade 10, 3583 TM Utrecht, the Netherlands. E-mail: