Students with spina bifida and hydrocephalus usually require the insertion of a “shunt” to drain excess fluid from the brain. The shunt was invented in 1956 by a mechanic who was desperate for a way to help his son, who was born with spina bifida and hydrocephalus. He was seeking to improve upon the metal plates that doctors had been using. Today, approximately 80% of students with spina bifida have hydrocephalus, a condition in which cerebral spinal fluid does not flow freely through the brain and builds up (Dias, 2008). This build-up causes intense pressure to the brain. Hydrocephalus is treated by means of the placement of a shunt, a long, thin tube that is placed inside the ventricles of the brain. Many students in general and special education classrooms have shunts, and teachers should know what to watch out for.
Types of Shunts
All shunts have three parts: 1) A ventricular catheter (the part that is placed in the ventricle), 2) a valve to control flow, and 3) tubing to carry the fluid away from the ventricles to other parts of the body.
A ventricular-peritoneal (VP) shunt is the most common type of shunt. This shunt carries fluid from the ventricles to the peritoneal cavity in the abdomen. Other types of shunts are:
- Ventriculo-Atrial (VA) Shunt: fluid is moved to a vein, usually in the neck or under the collarbone
- Ventriculo-Pleural Shunt: fluid is moved to the chest around the lungs
- Ventriculo-Gall Bladder Shunt: fluid is moved to the gall bladder
Find out what type of the shunt the student has, and ask the parents for any pertinent information about the shunt. Shunts often have to be revised through surgery, and it is helpful to know if the student has had any revisions and when those revisions took place.
What Are the Symptoms of Shunt Malfunction?
It is important for teachers to know the symptoms of possible shunt malfunction. In the school-aged child, the following symptoms can occur:
- Severe headache – “severe” is the keyword, as a headache from a shunt malfunction is extremely painful
- Nausea and vomiting
- Trouble focusing on schoolwork
- Lethargy – the student shows a marked change in energy and enthusiasm
- Vision problems – words seem to jump off the page
- Loss of balance
There are times when a shunt is malfunctioning, but there are no symptoms present. If shunt malfunction is suspected, it is important to notify the school nurse and parent right away. A malfunctioning shunt is a serious condition that can be life-threatening for the student. When symptoms are present, only a doctor can tell if the shunt is truly not working. Also, trust the parents’ instincts when it comes to shunts. They know their child, and they are usually able to tell if a trip to the neurologist is in order. Above all, don’t panic! It is important to be aware and knowledgeable about your student’s condition, and with a condition like shunt malfunction, it is permissable to err on the side of caution.
Are There Any Special Precautions for a Student with a Shunt?
The best precaution is to use common sense. Students with shunts should not play contact sports without a protective helmet, but most activities do not cause any problems. Watch for falls and head bumps, even slight ones, and follow up by observing the student and making a report to the school nurse and parents. If there is no school nurse, call the parents directly and let them know the student has fallen or hit his head. Many students like to bump other students on the head in fun and games (such as “cracking an egg” on the head with a fist), but it is important that this does not happen to the student with a shunt. Making the class aware of the shunt is a judgement call between the teacher and the parent; however, it should be noted that teachers cannot watch every student every second, and things are likely to happen. Teach the student to self-advocate. Older students can choose whether or not to tell about the shunt.
I Have a Student With a Shunt Who is Always Telling Me His Shunt is Malfunctioning. What Should I Do?
As terrible as it sounds, there are students who use their shunt as an excuse to get out of doing things. There are also students who panic when they have any type of headache. Unfortunately, this can lead to “The Boy Who Cried Wolf” syndrome. Teachers need to take students’ complaints about headaches seriously, but if it becomes a daily habit, it is time to get the school nurse and the parents involved to work out a plan. (Keep in mind, though, that daily headaches can actually be a sign of shunt malfunction.)
Document events leading up to the complaints, and see if a pattern emerges. Does it happen before every math test? Is there a certain day of the week that it seems to occur? Do the complaints occur during the same time every day or at different times? If the student is a teenaged girl, does it occur during her menstrual cycle? All of these need to be taken into consideration when working with a student who panics about shunt symptoms. They need reassurance, but it is also very important to make sure that it is behavioral, and not a true shunt malfunction. Special techniques involved in teaching a student with spina bifida can help greatly when dealing with behavioral issues involved with avoidance techniques and hypochondria.
A shunt is a lifesaving device for a student with spina bifida. Normally, it functions well and does it job. There are times, however, when it may malfunction, and having a knowledgeable teacher who knows what to watch for is imperative.