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Secondary Medical Conditions Associated with Spina Bifida: Effects on Nerves and Function, Skin Problems -- SHNIC Educators Information

As mentioned, students with spina bifida usually have a loss of sensation below the level of the lesion. They do not have normal skin sensitivity to pain, touch or temperature. This puts them at risk for injury to their skin from sources such as hot bath water, heaters/radiators, and hot metal surfaces in the summer and prolonged exposure to cold in the winter. Warn students of any of these circumstances if they are encountered during the school day and remind them to protect their skin.

When sitting in a classroom chair or their wheelchair, pressure is placed on their skin by the chair surfaces and their bones. They do not feel uncomfortable and naturally shift positions in order to relieve the pressure. When this happens, the blood supply to that part of the skin is cut off and pressure ulcers or decubiti can develop. If these are left untreated, they can become infected and possibly affect the bone. It is necessary for students with spina bifida to shift their weight or change their position frequently (above every 20 minutes) in order to protect their skin. This is usually accomplished by having the student perform a "wheelchair push-up", which means pushing up on the arms of their wheelchair until their bottom clears the chair surface. Ideally, students should be independent with this and it should not disrupt their school day. However, younger students and students just beginning a skin care program may need some adult supervision or cueing initially. Students may also develop redness or sores from braces or shoes that don't fit well. If you notice any redness or swelling, report it to the school nurse.

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