Which of the following is a secondary impairment of spina bifida?

• A. Hip flex contracture
• B. Paralysis below the lesion
• C. Loss of sensation
• D. Bowel/bladder dysfunction

Answer: (A)

Spina bifida can cause impairments in two ways: direct effects from the spinal lesion (primary impairments) and later problems that develop because of living with the condition (secondary impairments). Paralysis below the level of the lesion, loss of sensation, and bowel/bladder dysfunction are all direct results of the disrupted neural pathways and thus are primary impairments. A hip flex contracture, on the other hand, develops over time from the consequences of having a motor and sensory deficit—such as muscle imbalance, prolonged abnormal positioning, and limited movement—leading to shortened hip flexor tissues. That kind of deformity is a secondary impairment, arising after the primary deficits are present. To help prevent secondary contractures, ongoing stretching, range-of-motion exercises, and proper positioning or orthotics are important parts of care.