Spina Bifida Family Support
"Families Helping Families"
Sports and Pediatric Cerebrospinal Fluid Shunts: Who Can Play?
Published by the Hydrocephalus Association July 2004
In 2002, after much deliberation and discussion, the Medical Advisory Board and the Board of Directors of the Hydrocephalus Association issued the following Consensus Statement on Physical Activities for Children with Hydrocephalus:
All children have a need and the right to be their own person as they mature and explore their world. A child with hydrocephalus is no different. It is essential that he or she be treated as any other child and afforded every opportunity to live as normal a life as possible. The shunt is a very durable device and should pose no special problems to normal physical activity or to childhood bumps and falls.
In general, the activities of children and adults with hydrocephalus should not be restricted. They should be encouraged to participate in regular activities including school and after school physical education programs and recreational sporting activities. While some neurosurgeons are reluctant to have their patients participate in contact sports, it should be emphasized that the specifics of each patient's situation are unique.
Consultation with the neurosurgeon is strongly recommended. Together, the neurosurgeon, the patient and the family should be the ultimate decision makers regarding specific activities for each individual with treated hydrocephalus.
We are pleased to report that Dr. Jeffrey P. Blount and his colleagues recently published an article on shunts and sports in Neurosurgery, Vol. 54, NO. 5 May 2004. The purpose of the study was to collect and review available data on the incidence of sport-related complications in children with cerebrospinal fluid (CSF) shunts. Dr. Blount and his colleagues reviewed medical and legal literature, which revealed no reports on sports, and they then conducted an Internet based survey of pediatric neurosurgeons collecting observed complications, recommendations for sports participating and shunt volume data.
The results: Ninety two providers (55% sample) responded. Seventy seven percent never observed a sport related complication in their practice. The remaining 23% witnessed an estimated total of 25-30 complications. Broken shunt catheters and shunt dysfunction were the most common complications observed. Only one acute intracranial hematoma was reported in the entire series. The incidence of sport related CSF complications in children seems to be significantly less than 1%. Ninety percent of pediatric neurosurgeons do not restrict their patient's participation in no contact sports. For contact sports, approximately one-third of neurosurgeons preclude all participation, whereas another third restrict specific sports. The final third of neurosurgeons surveyed do not restrict participation in contact sports for a child with CSF shunts.
The conclusion reached by the researchers in this article is that "sport related complications in children with CSF shunts are very uncommon".
Although the article does not prove that participation in sporting activities is safe, it established that the incidence of observed problems in shunted children attributable to sport participation seems very low. Given the paucity of other data, this seems to be the best currently available evidence.
The Hydrocephalus Association has recently established a comprehensive database on patients with hydrocephalus. The epidemiology of hydrocephalus has never been comprehensively studied; consequently, the exact number of shunted children who are physically capable of participating in organized sports is unknown. It is estimated that about 36,000 shunt-related procedures are performed in the United States, of which 18,000 are thought to be initial shunt placements.
Future adverse events for shunted patients participating in organized sports will be compiled as an adjunct to the database and reviewed by the Medical Advisory Board as to their appropriateness for inclusion. By prospectively collecting detailed information, future investigation may begin to address more precisely the incidence of sport related shunt problems and gain greater insight into the role of the cause of the hydrocephalus, the role of adolescent growth spurt, the importance of ventricular size and other important issues.
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