LATEX ALLERGY
Latex allergy is commonly seen in children with myelodysplasia and is now being recognized in children with SCI. A report states the incidence of latex allergy in children with SCI is 6% to 18% (38).
Children and families should be educated about this potential problem and encouraged to avoid latex when possible. Latex allergy can lead to an anaphylactic reaction. Any child (and caregivers) with any type of latex allergy should be instructed on the use an EpiPen for emergency use.Spasticity
Approximately 50% of children with SCI have spasticity, which tends to be more common in those with incomplete lesions (39). Management of spasticity has the goals of promoting function and preventing contractures and pain because of the spasticity. Simple measures include ranging, positioning, and the use of orthoses. Some patients and families think that spasticity is reduced with a daily passive standing program. If spasticity still interferes with function, medications may be considered. See Table 11.6 for a summary of common antispasticity medications.
Local spasticity may be treated with splinting or casting or, if severe, with the use of intramuscular botulinum toxin. If spasticity continues to be severe and generalized after physical measures are employed and medications are maximized, surgical management of spasticity should be considered. Selective dorsal rhizotomy has been used in the United States since the mid-1980s. Although usually performed in children with spasticity of cerebral origin, the same technique may be used in children with SCI who are at least six months postinjury.
A newer surgical technique is the implantation of a subcutaneous pump for continuous administration of baclofen into the intrathecal space (40). Potential complications seen with intrathecal baclofen include infection, catheter disconnection or blockage, seroma around the pump, cerebrospinal fluid leak, seizures, failure to respond to increasing doses of baclofen, and pump failure. Some deaths have been reported after implantation of baclofen pump in children with SCI (41).
Psychosocial Issues
The primary psychosocial issue during rehabilitation is funding for care, equipment, therapies, and environmental modifications after discharge from inpatient rehabilitation. While parents are dealing with these issues, they must also adjust to the new needs of their child and assist their child in adjusting. The child must adjust to the new function of his or her body and learn to reenter home, community, and school. Recreation therapy can be of great help in assisting the child learn to move about in the community, both from the physical and the psychosocial perspective.