rehabРеабилитологияJournal of Medical Rehabilitation2949-58732949-5881IRBIS LLC10.17749/2949-5873/rehabil.2026.70rehab-150Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESКомплексная реабилитация детей с миелодисплазиями: систематический обзорComprehensive rehabilitation for children with myelodysplasia: a systematic reviewhttps://orcid.org/0000-0002-2536-296XКозловаИ. С.KozlovaI. S.

Козлова Ирина Сергеевна, к.м.н.

ул. Тенишевой, д. 9, Смоленск 214000

Irina S. Kozlova, PhD

9 Tenisheva Str., Smolensk 214000

e-vogue@bk.ruОбластное государственное бюджетное учреждение здравоохранения «Клиническая больница скорой медицинской помощи»РоссияClinical Hospital of Emergency Medical CareRussian Federation2026060720264123–31Copyright © Козлова И.С., 20262026Козлова И.С.Kozlova I.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rehabilitology.com/jour/article/view/150Актуальность

Актуальность. Миелодисплазия (лат. spina bifida) является одним из наиболее тяжелых врожденных пороков развития, приводящим к пожизненной инвалидизации и требующим мультидисциплинарного реабилитационного подхода. Отсутствие единых стандартов и ограниченность доказательной базы затрудняют формирование эффективных программ реабилитации.

Цель

Цель: систематизировать и проанализировать современные данные о методах комплексной реабилитации детей с миелодисплазией, оценить уровень доказательности и выделить ключевые направления вмешательств.

Материал и методы

Материал и методы. Проведен анализ 30 литературных источников, включая клинические рекомендации, руководства, систематические обзоры, рандомизированные контролируемые исследования (РКИ) и оригинальные статьи, опубликованные в базах данных PubMed/MEDLINE, Scopus, Web of Science, eLibrary и КиберЛенинка в период с 2011 по 2025 гг. Поиск и анализ данных осуществлялись в соответствии с рекомендациями PRISMA. Оценка качества исследований выполнялась с использованием шкал PEDro и GRADE.

Результаты

Результаты. Стандартом ведения пациентов является мультидисциплинарный подход с использованием Международной классификации функционирования. Выделены четыре ключевых направления реабилитации: 1) физическая терапия (тренировка на тредмиле, вибротерапия, этапное гипсование) с умеренным уровнем доказательности эффективности – новые проспективные исследования подтверждают положительное влияние вибрации всего тела на гемодинамику нижних конечностей и уменьшение контрактур; 2) нейроурологическая реабилитация – периодическая катетеризация (уровень А) и электростимуляция (метаанализ 4 РКИ, n=147) демонстрируют улучшение уродинамических параметров; 3) ортопедическая коррекция, основанная преимущественно на клиническом консенсусе; 4) развитие навыков самопомощи – выявлено отставание на 2–5 лет и доказана эффективность лагерных программ, а также показана перспективность мобильных приложений для поддержки этой сферы. К сожалению, количество РКИ высокого качества крайне ограниченно.

Заключение

Заключение. Комплексная реабилитация детей с миелодисплазией должна быть ранней, мультидисциплинарной и ориентированной на долгосрочное развитие функциональной независимости. Перспективными направлениями являются фетальная хирургия, фотобиомодуляция и поведенческие технологии, требующие дальнейшего изучения. Необходимы стандартизация протоколов вмешательств и создание национальных регистров для повышения качества доказательной базы.

Background

Background. Myelodysplasia, or spina bifida, is one of the most severe congenital malformations. Individuals with myelodysplasia experience lifelong disability; therefore, a multidisciplinary rehabilitation approach is required. However, developing effective rehabilitation programs remains challenging due to the lack of uniform standards and limited evidence base.

Objective

Objective: To systematically review current data on comprehensive rehabilitation methods for children with myelodysplasia, evaluate the level of evidence, and identify key areas of intervention.

Material and methods

Material and methods. A total of 30 literature sources were analyzed, including clinical guidelines, recommendations, systematic reviews, randomized controlled trials (RCTs), and original articles published in the PubMed/MEDLINE, Scopus, Web of Science, eLibrary, and CyberLeninka databases between 2011 and 2025. The literature search and data analysis were conducted in accordance with the PRISMA guidelines. Study quality was evaluated using the PEDro and GRADE scales.

Results

Results. A multidisciplinary approach based on the International Classification of Functioning provides the standard for patient care. Four key areas of rehabilitation have been identified: 1) physical therapy, including treadmill training, vibration therapy, and staged casting, has moderate evidence of effectiveness – new prospective studies confirm the positive effects of wholebody vibration on lower-limb hemodynamics and contracture reduction; 2) neurourological rehabilitation – intermittent catheterization (level A) and electrical stimulation improve urodynamic parameters, as demonstrated by a meta-analysis of 4 RCTs (n=147); 3) orthopedic correction based primarily on clinical consensus; 4) development of self-help skills – a 2–5-year developmental delay has been revealed, the effectiveness of camp-based interventions and the positive impact of mobile apps in this area have been demonstrated. Nevertheless, the number of high-quality RCTs is extremely limited.

Conclusion

Conclusion. Children with myelodysplasia should receive early, multidisciplinary rehabilitation focused on the long-term development of functional independence. Fetal surgery, photobiomodulation, and behavioral technologies are promising areas that require further study. To improve the quality of the evidence base, intervention protocols should be standardized in addition to establishing national registries.

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The authors declare that there are no conflicts of interest present.