HAND FUNCTION IN SUBJECTS WITH SPINA-BIFIDA

The aim of our study was to assess the influence of the Arnold-Chiori malformation, cervical cord dysraphism and hydrocephalus on hand funct ion in subjects with meningomyelocele, but without many of the other c onfounding factors commonly found in this group e.g low IQ and cerebra l palsy, which in themselves cause poor hand function. Three groups of subjects who attended main stream schools underwent a basic neurologi cal examination of the upper limbs and a battery of hand function test s. Group 1 consisted of subjects with meningomyelocele and shunted hyd rocephalus (n = 21), Group 2 subjects had isolated shunted hydrocephal us (n = 13) and Group 3 were normal controls (n = 18). The results sho w that subjects with meningomyelocele had weaker power in the small mu scles of the hand as compared to the controls and those with isolated hydrocephalus (p = 0.01) and poorer fine motor control and co-ordinati on. The meningomyelocele group scored significantly poorer in all of t he tests as compared to the control group using the dominant hand (ove rall, p = 0.0003), and all of the tests but one using the non-dominant hand (overall, p = 0.0005). Our study has demonstrated that children with meningomyelocele have poorer hand function than healthy controls, which is due to causes other than hydrocephalus, poor IQ or cerebral hemisphere pathology. Instead, cerebellar and cervical cord abnormalit ies appear to be exerting a significant deleterious influence on the f unction of the upper limbs.