Comprehensive rehabilitation for children with myelodysplasia: a systematic review

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: 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. 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. 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. 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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