Age (in years, at the time of initial consult) |
Date of birth |
Sex |
Individual reporting concerns (communication status) |
Self, other, unknown, or not reported
|
Type of SB |
Myelomeningocele, meningocele, occulta, other (normal exam), or not reported
|
Neurological level |
Thoracic, high lumbar, low lumbar, sacral, unknown, or not reported
|
Ambulatory status (according to the Hoffer Classification of Ambulation for patients with spina bifida or other diagnoses ((49))) |
Community ambulator, household ambulator, or non-ambulator
|
Surgical history |
Epilepsy history |
Current medications and active non-medical treatment |
Physical exam results |
Hip flexion contracture, knee flexion contracture, plantar flexion contracture, or scoliosis
|
Presenting issues or concerns at initial consult |