Presentations
- Congenital defects of spinal cord development
Conditions
- Associated central nervous system pathology, such as:
- Chiari malformation type II
- obstructive hydrocephalus
- Congenital spinal dysraphism conditions, such as:
- closed spinal bifida, including:
- lipomyelomeningocoele
- myelocoele
- spinal lipoma
- open spina bifida myelomeningocoele
- sacral agenesis
- spinal dysraphism associated with VACTERL sequence and other syndromic diagnoses
- tethered cord
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Anencephaly
- Encephalocoele
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Embryologic principles of spinal cord development
- Public health interventions, such as folate
- Risk factors for congenital spinal dysraphism
Clinical assessment tools
- Cognitive assessment
- Gait analysis:
- Manual muscle testing (MMT)
- Vision assessment
Investigations
- Biochemistry:
- Genetic investigations
- Medical imaging, such as:
- antenatal:
- kidney ultrasound
- micturating cystourethrogram (MCUG)
- MRI
- urodynamics
- Microbiology, such as urine microscopy and culture
- Respiratory function testing
- Sleep studies
Procedures
- Antenatal surgery
- Post natal surgery to close lesions and treat hydrocephalus
- Surgery for lower limbs and spine
- Surgical bladder and bowel management
Antenatal management
- Antenatal counselling
- Methods of prevention of neural tube defects, and antenatal care
- Understanding grief and loss
Management of the infant
- Bladder and kidney investigations and management:
- ladder catheterisation / alternative emptying
- imaging, including:
- urodynamics
- Bowel management
- Handling and equipment
- Hydrocephalus detection and management:
- cranial ultrasound / MRI
- head circumference measurement
- referral for treatment
- symptom identification
- Long-term clinical considerations:
- Complications of neurogenic bladder:
- management strategies to reduce risk
- routine investigations
- growth and nutrition monitoring and support
- hydrocephalus:
- cognitive assessment and support
- monitoring for progression or signs of shunt malfunction
- mood and behaviour assessment and support
- musculoskeletal complications:
- contracture prevention and management
- prevention and management of foot deformity
- spasticity management
- spinal deformity monitoring, prevention, and management
- progressive spinal cord pathology – cord tethering and syrinx:
- clinical monitoring
- referral for investigation and management
- Skin care:
- assessment and guidance regarding sensory deficits
- pressure injury:
- Orthopaedic management:
- hip ultrasound, and management of dysplasia
- management of congenital foot deformity
Supporting activity and participation
- Community support:
- home modifications and equipment
- mobility
- recreation and leisure
- relationships
- reproduction
- sexuality
- support for personal cares and transport
- therapy
- Educational support:
- personal care assistance
- physical access
- role and timing of neuropsychological assessments
- support and equipment to access the curriculum
- Family and whānau supports
- Funding supports
- Peer supports
- Vocational support
