Myelodysplasia--the musculoskeletal problem: habilitation from infancy to adulthood

The physical therapy and orthopedic management of patients with myelodysplasia from infancy to adulthood are reviewed. The overall goal for the child with myelodysplasia is functional independence. Physical therapy and orthopedic intervention enable the individual to achieve this goal. Associated problems, however, such as Arnold-Chiari malformation, hydrocephalus, and tethered spinal cord, influence functional expectations. Physical therapy management begins in the neonatal period and continues through adolescence. Treatment is modified at the various stages of development. Knowledge of current orthotic and adaptive equipment is necessary to achieve optimal locomotor function. Orthopedic management decisions are based on musculoskeletal and neurologic assessments, to which the physical therapist provides a significant contribution. Controversies exist over the orthopedic management of dislocated hips, scoliosis, and kyphosis.