Chiari malformation occurs when there are rare structural abnormalities in the brain that are sometimes, but not always apparent at birth. Abnormalities occur when the back lower section of the skull that usually supports and protects a part of the brain called the cerebellum is smaller than usual. This can result in the cerebellum and brainstem protruding through the bottom of the skull into the spinal canal which interferes with the flow of cerebrospinal fluid to and from the brain. There are three types of Chiari malformation:
Type I
Type I Chiari malformations are often asymptomatic and usually only diagnosed following examination.
Type II or Arnold Chiari malformation
This type is commonly accompanied by a myelomeningocele—a form of spina bifida that occurs when the spinal canal and backbone do not close before birth, causing the spinal cord to protrude through an opening in the back. This can cause partial or complete paralysis below the spinal opening.
Type III
This type includes the above symptoms along with neurological defects and is the most serious form.
Other conditions associated with this Chiari malformation include curvature of the spine, hydrocephalus (swelling of the brain due to a build up of cerebrospinal fluid) and syringomyelia where cerebrospinal fluid enters the spinal canal.
Symptoms and characteristics:
Common symptoms and characteristics of Chiari malformation include:
- neck pain
- altered balance
- muscle weakness and possible numbness or paralysis
- dizziness and vomiting
- altered vision
- difficulty swallowing
- hearing loss, ringing or buzzing in the ears
- insomnia
- headache made worse by coughing or straining.
Hand coordination and fine motor skills may also be affected. Symptoms may change over time, depending on the build-up of cerebrospinal fluid and resulting pressure on the tissues and nerves.
Workplace adjustments and solutions:
If a person has the more serious form of Chiari malformation there are various factors that may assist them to manage their condition within the workplace. These include changes to work tasks and the environment, such as:
- ensuring wheelchair or walking aid accessibility to all areas of the workplace including kitchen and bathroom amenities, workspace and other doorways or emergency exits
- installation of ramps and automatic door openers for independent building access
- positioning of security pin pads for building access at a height that is accessible from a wheelchair
- set up of kitchen amenities at a height accessible from a wheelchair
- set up of office supplies, equipment and furniture which allows for independent access
- desk modifications to allow for wheelchair clearance and access to all items on the desk easily
- providing and adjusting a suitable ergonomic chair or stool to individual needs if not using a wheelchair for mobility
- if vision is altered, consideration be given to the use of adaptive technology or mobility training to assist with improving independence and productivity.
(National Institute of Neurological Disorders and Stroke 2007; American Syringomyelia Alliance Project Inc. 2008; National Organisation for Rare Disorders 2005; World Arnold Chiari Malformation Association 2007).
The Employment Assistance Fund provides financial assistance for work-related modifications, equipment and services to help people with disability to get employment and perform their work as independently and productively as possible. To determine eligibility, please refer to the full guidelines:
There are solutions and adjustments for the following job requirements related to Chiari malformation:
References:
American Syringomyelia Alliance Project Inc. 2008, What is Syringomyelia?, American Syringomyelia Alliance Project Inc., Texas, viewed 28 November 2008, http://www.asap.org/syringomyelia.html
National Institute of Neurological Disorders and Stroke 2007, NINDS Chiari Malformation Information Page, National Institutes of Health, Bethesda, viewed 6 March 2007, http://www.ninds.nih.gov/disorders/chiari/chiari.htm
National Organisation for Rare Disorders 2005, Arnold-Chiari Malformation, National Organisation for Rare Disorders, Danbury, viewed 6 March 2007, http://www.rarediseases.org/search/rdbdetail_abstract.html?disname=Arnold-Chiari%20Malformation
World Arnold Chiari Malformation Association 2007, Committed to the most accurate and current understanding of Chiari Malformations and treatments, World ACM Association, Pennsylvania , viewed 6 March 2007, http://www.wacma.com/