Parents' and pediatricians' views of individuals with meningomyelocele

Maternal-fetal surgery as part of pediatric palliative care

Maternal-fetal surgical interventions have become a more common part of prenatal care. This third option, beside termination or post-natal interventions, complicates prenatal decision-making: while interventions may be lifesaving, survivors may face a life with disability. Pediatric palliative care (PPC) is more than end of life or hospice care, it aims at helping patients with complex medical conditions live well. In this paper, we briefly discuss maternal-fetal surgery, challenges regarding counseling and benefit-risk evaluation, argue that PPC should be a routine part of prenatal consultation, discuss the pivotal role of the maternal-fetal surgeon in the PCC-team, and finally discuss some of the ethical considerations of maternal-fetal surgery. We illustrate this with a case example of an infant diagnosed with congenital diaphragmatic hernia (CDH).

Ethical challenges in the new world of maternal-fetal surgery

This article explores some of the complex ethical challenges that exist in the field of fetal diagnosis and treatment, especially surrounding maternal-fetal surgery. The rise of these new treatments force us to reconsider who or what is the fetus, what are our obligations to the fetus, and what are the limits to those obligations. In addition, we will consider provider and professional biases, disability issues, and how maternal-fetal surgery has, for a select group of women, changed the very experience of motherhood.

Children's longing for everydayness: life following traumatic brain injury in the USA

PRIMARY OBJECTIVE

Little is known about life after traumatic brain injury (TBI) from the child's perspective.

RESEARCH DESIGN

This descriptive phenomenological investigation explored themes of children's experiences following moderate-to-severe TBI.

METHODS AND PROCEDURES

INCLUSION CRITERIA

(1) 6-18 years of age at injury; (2) moderate-to-severe TBI; (3) ≤3 years since injury; and (4) English speaking and could participate in an interview. Children participated (n = 39) in two interviews at least 1 year apart. A preliminary model was developed and shared for participants' input.

MAIN OUTCOMES AND RESULTS

Six themes emerged: (1) it is like waking up in a bad dream; (2) I thought going home would get me back to my old life, but it did not; (3) everything is such hard work; (4) you feel like you will never be like the person you were before; (5) it is not all bad; and (6) some people get it, but many people do not.

CONCLUSIONS

Social support was important to how children adjusted to changes or losses. Most children did adjust to functional changes by second interviews. Children had a more difficult time adjusting to how others defined them and limited their possibilities for a meaningful life.

Gaps and opportunities: an agenda for further research, services, and program development in spina bifida

In this article an agenda is discussed for further research, services, and program development identified in the development of the Life Course Model Web site for individuals with spina bifida, their families and the health care providers who work with them. The gaps identified during development of the Life Course Model Web site revealed that there has been minimal progress made on the research agenda since the 2003 consensus document, "Evidence-Based Practice in Spina Bifida: Developing a Research Agenda" or the summary document from the First World Congress on Spina Bifida Research and Care gathering, "The Future is Now," in 2009. Gaps are delineated in the three main areas of the transition curriculum (self-management/health, personal and social relationships, and employment/income support), and recommendations for future research and program development are proposed.

Ashley X

The recent case of Ashley X has sparked much recent public debate and controversy, and raises critical questions for physiatrists and rehabilitation professionals. The case came to light when Gunther and Diekema published an article in the October 2006 issue of Archives of Pediatric and Adolescent Medicine describing a novel growth attenuation treatment for Ashley X, a 6-yr-old girl with developmental disabilities. Her parents also published a blog about Ashley, with detailed explanations for their rationale in choosing this treatment on behalf of Ashley which involved beliefs about her future and quality of life. Ashley's parents refer to the series of interventions as the Ashley Treatment in their blog, and this phrase has also been adopted by the popular press and others who have commented on the case. In this article we present an analysis of the Ashley X treatment and use a disability ethics approach to examine the perspectives of various stakeholders involved, including Ashley and other girls with extensive disabilities, parents, physicians, and bioethics committees. We conclude with critical questions for physiatrists and other disability specialists who are in a unique position to examine medical controversies involving people with disabilities.

Surgical treatment of myelomeningocele: year 2000 hospitalization, outcome, and cost analysis in the US

OBJECTIVE

To review cases of surgical repair for myelomeningocele (MMC) using a large inpatient database from the year 2000.

MATERIALS AND METHODS

The Nationwide Inpatient Sample (NIS) database with 7.45 million patient admissions for 2000 was retrospectively studied for the first 5 procedure diagnosis of MMC repair (ICD-9 CM procedure code 0352) and ages of less than 1 year. Eighty-eight patient stays were identified. Patient demographic data, length of stay, immediate disposition at the time of discharge, hospital information, and total cost for the hospitalization were determined.

CONCLUSION

Myelomeningocele repair is mostly performed in large teaching institutions in small numbers. The majority gets to go home at discharge. It is surprising to note that only 35% also required VP shunt placement during the same hospitalization.

Family functioning in children and adolescents with spina bifida: an evidence-based review of research and interventions

Research on the adjustment of families of children with spina bifida is reviewed, with a focus on delineating the impact of spina bifida on family functioning, the strengths and weaknesses of past research, and the needs for future evidence-based research on family interventions with this population. PsychINFO and MEDLINE literature searches were used to identify studies of family functioning and family-based interventions for children with spina bifida. Identified studies were empirically evaluated for the presence or absence of key methodological or analytic criteria. Thirty-two studies of family functioning were identified from 25 separate research groups; most studies displayed significant methodological limitations. No published studies of interventions to promote adaptive family functioning were identified. Methodologically sound, longitudinal, and theory-driven studies of family functioning are needed, as are randomized family-based intervention trials to promote adaptive functioning and better psychosocial outcomes in families of children with spina bifida. Specific recommendations for future work as well as clinical implications are noted.

The Experience of Parenting an Adolescent with Spina Bifida

Parents of adolescents with spina bifida (SB) face unique challenges of which they may not be aware. The purpose of this study was to heighten awareness of the challenge of parenting such adolescents. This enhanced understanding can help rehabilitation professionals optimize their interventions with families. In this qualitative study, which was part of a larger mixed-method descriptive investigation exploring adaptation by adolescents with SB, we used content analysis to evaluate 20 parent interviews for common domain, themes, and subthemes. The analysis yielded four major domains: (a) daily life experiences, (b) the dance of individuation, (c) reflections on parenting, and (d) practice suggestions for healthcare professionals. Overall, experiences of the parents were positive. Parents described meeting daily demands and balancing independence-dependence needs with the adolescent as major challenges. Rehabilitation professionals must provide guidance to foster autonomy, decision making, cognitive skill building, and coping skills to help parents and adolescents manage independence-dependence issues and multiple life demands.

Disability rights critique of prenatal genetic testing: reflections and recommendations

Using prenatal tests to prevent the birth of babies with disabilities seems to be self-evidently good to many people. Even if the testing will not help bring a healthy baby to term this time, it gives prospective parents a chance to try again to conceive. To others, however, prenatal testing looks rather different. If one thinks about the history of our society's treatment of people with disabilities, it is not hard to see why people identified with the disability rights movement might regard such testing as dangerous. For the members of this movement, living with disabling traits need not be detrimental to an individual's prospects of leading a worthwhile life, or to the families in which they grow up, or to society at large. Although the movement has no one position on prenatal diagnosis, many of its adherents believe that public support for prenatal diagnosis and abortion based on disability contravenes the movement's basic philosophy and goals.