The young adult with spina bifida.
The young adult with spina bifida.
复制标题
患有脊柱裂的年轻人。
作者：
B. Castree;J. Walker
Although the management of infants with congenital defects remains controversial,1 the adoption of a policy of selective surgery for the neonate with meningomyelocele has had the effect, predicted by Weatherall and White,2 of reducing the number of survivors with this condition and diminishing their degree of disability. The policy of careful selection for surgery practised in most centres followed an evaluation of the results of a period of more liberal intervention during the late 1950s and early 1960s when most infants were treated. Examination of the survivors of that period showed a group of children suffering from complex physical and intellectual handicaps,3 4 and complementary studies of their families measured the social and emotional costs of their care.5 6 Although in future the numbers of children and young adults heavily handicapped by the effects of spina bifida and meningomyelocele may be considerably reduced, it is important to remember that a cohort of those treated during the earlier years of active optimistic intervention remain and are in danger of being forgotten by all but those concerned in their day-to-day care. During their school years most children in this group benefited from a high standard of special education, often in newly built schools for the physically handicapped or in special units attached to normal schools. This care had been provided because the Department of Education, becoming aware of the optimism of the surgeons, had anticipated the increased survival of children with meningomyelocele and their ultimate arrival in School and had encouraged local education authorities to make special provision. In many areas the special school co-ordinated educational, social, and medical care and provided a high degree of physical and emotional security for both the child and the parents. As the children grew, became adolescent, and approached school-leaving age, it was increasingly apparent that security of this type would not continue and that many of the basic require? ments for an independent early adult life might be lacking. A leading article in the BMJ identified four hurdles awaiting each young adult with spina bifida. The first, on the assumption that the youngster would be capable of coping alone, was the withdrawal from the cosseting care of parents ; the second, the problem of finding suitable accommodation where he could live, if necessary in a wheelchair; the third, the problems of mobility; and the fourth, a job in a world where work even for the able bodied may be difficult to find. The ability of young adults with spina bifida to surmount these hurdles could be regarded as a measure of the adequacy of health and social services. In the Northern Region one exception to the generalisation that services for the young physically
