Secondary conditions in children with disabilities: spina bifida as a case example.

This paper examines the concept of secondary conditions and its application in studies of childhood disability focusing on children with spina bifida as a representative group. The "International Classification of Functioning, Disability and Health" (World Health Organization, Geneva, 2001) provides a classification of body function/structure, activities, participation and the environment to document dimensions of human functioning in context. The ICF is of value in the study of secondary conditions in two ways: as a conceptual framework for defining impairments, activity limitations and participation restrictions, and the mediating role of the environment in their expression; and as a taxonomy for coding these dimensions of disability. The ICF can yield a profile of a child's difficulties, and documentation of environmental barriers experienced by that child. Research studies with children and adolescents with spina bifida reveal that physical and mental impairments and limitations in performing activities and participating in communal life are experienced as secondary conditions. The significance of secondary conditions is that they are preventable. Identifying the mechanisms associated with their manifestation is thus an important priority for the development of effective prevention programs.