Medical Rehabilitation of Children with CNS Tumors Developing State of Minimal Consciousness

Objective. To evaluate clinical characteristics and results of individualized medical rehabilitation in children with brain tumors, including those with tracheostomy and/or gastrostomy, upon recovery from a state of minimal consciousness.
Materials and methods. A prospective observational study included 309 patients aged 6 to 17 years who completed treatment for central nervous system (CNS) tumors during 2019–024 yy. at the «Russkoye Pole» medical rehabilitation research center of the Dmitry Rogachev National medical research center for pediatric hematology, oncology, and immunology, Russian Ministry of Health. All patients underwent a comprehensive assessment of treatment effects, including clinical and functional examination, testing of cognitive and emotional functions, and individualized medical rehabilitation. A subgroup of subjects in a state of minimal consciousness with tracheostomy and/or gastrostomy included 9 patients (2.9%). Rehabilitation goals were set based on the domains of the International Classification of Functioning, Disability and Health (ICF), according to an interdisciplinary approach.
Results. Severe neurological deficit as the sequelae of cancer treatment toxicity was documented in 90% of children with CNS tumors. However, all 309 patients achieved the goals of specialized medical programs within 14–21 days. Patients in a state of minimal consciousness most often had impaired breathing, swallowing, eating, communication, and emotional regulation, endangering with life-threatening complications. Adhering to the protocols adapted for management of such patients helped minimize the risk of life-threatening complications. No serious complications were recorded in any patient during the rehabilitation process.
Conclusion. Even in cases of severe functional impairment, including patients requiring tracheostomy and gastrostomy, an individualized medical rehabilitation approach allows for stabilization of patient's condition, upregulation of basic vital functions, and improvement quality of life of patients and their families. Restoring cognitive and sensorimotor functions in children in a state of minimal consciousness requires early initiation of rehabilitation measures by a multidisciplinary team, including a resuscitator, pediatrician, physical therapist, speech therapist, medical psychologist, etc.

1. Belkin A. A., Aleksandrova E. V., Akhutina T. V., Belkin V. A., Berdnikovich E. S., Bykova V. I., Varako N. A., et al. Chronic disorders of consciousness: guidelines of the all-Russian public organization «Federation of Anesthesiologists and Reanimatologists». Ann Crit Care = Vestnik Intensivnoy Terapii im AI Saltanova. 2023; (3): 7–42. (in Russ.). DOI: 10.21320/1818-474X-2023-3-7-42.

2. DeNunzio N. J., Yock T. I. Modern radiotherapy for pediatric brain tumors. Cancers (Basel). 2020; 12 (6): 1533. DOI: 10.3390/cancers12061533. PMID: 32545204.

3. Ruggi A., Melchionda F., Sardi I., Pavone R., Meneghello L., Kitanovski L., Zaletel L. Z., et al. Toxicity and clinical results after proton therapy for pediatric medulloblastoma: a multi-centric retrospective study. Cancers (Basel). 2022; 14 (11): 2747. DOI: 10.3390/cancers14112747. PMID: 35681727.

4. Aung W. T., Ong N. Y., Yeo S. Q.C., Juhari N. S.B., Kong G., Lim N. A., Amin Z., et al. Impact of pediatric tracheostomy on family caregivers‘ burden and quality of life: a systematic review and meta-analysis. Front Public Health. 2025; 12: 1485544. DOI: 10.3389/fpubh.2024.1485544. PMID: 39886387.

5. Willis L. D. Pediatric tracheostomy year in review. Respir Care. 2024; 69 (8): 1025–1032. DOI: 10.4187/respcare.11932. PMID: 38626953.

6. Semerci R., Pars H. Complications of pediatric enteral nutrition at home: a systematic review of quantitative research. Clin Sci Nutr. 2024; 6 (1): 27–42. DOI: 10.62210/ClinSciNutr.2024.80.

7. Pan J., Lucas B., Okcu M. F., Foster J., Pinto V., Chelius D. Jr., Roy K., et al. Indications and outcomes for tracheostomies in pediatric oncology patients — a single center study. Pediatr Blood Cancer. 2025; 72 (2): e31451. DOI: 10.1002/pbc.31451. PMID: 39616413.

8. Liu P., Teplitzky T. B., Kou Y. F., Johnson R. F., Chorney S. R. Longterm outcomes of tracheostomy-dependent children. Otolaryngol Head Neck Surg. 2023; 169 (6): 1639–1646. DOI: 10.1002/ohn.393. PMID: 37264977.

9. Kiryachkov Yu.Yu., Grechko A. V., Kolesov D. L., Loginov A. A., Petrova M. V., Rubanes M., Pryanikov I. V. Monitoring the effectiveness of intensive care and rehabilitation by evaluating the functional activity of the autonomic nervous system in patients with brain damage. General Reanimatology = Obshchaya Reanimatologiya. 2018; 14 (4): 21–34. (in Russ.& Eng.). DOI 10.15360/1813-9779-2018-4-21-34.

10. Mooney-Doyle K., Lindley L. C. Family and child characteristics associated with caregiver challenges for medically complex children. Fam Community Health. 2020; 43 (1): 74–81. DOI: 10.1097/FCH.0000000000000245. PMID: 31764308.

11. Gill-Thwaites H., Munday R. The Sensory Modality Assessment and Rehabilitation Technique (SMART): a valid and reliable assessment for vegetative state and minimally conscious state patients. Brain Inj. 2004; 18 (12): 1255–69. DOI: 10.1080/02699050410001719952. PMID: 15666569.

12. Acorda D. E., Brown J. N., Lambert E. M., Gibbs K. D. Psychosocial measures and outcomes among caregivers of children with tracheostomies: a systematic review. Otolaryngol Head Neck Surg. 2023; 168 (5): 979–987. DOI: 10.1002/ohn.202. PMID: 36939578.

13. Vo H. H., Mercer A. H., Jabre N. A., Henderson C. M., Boss R. D., Wilfond B. S. Parent perspectives on the child experience of pediatric home ventilation via tracheostomy. Hosp Pediatr. 2023; 13 (12): 1124–1133. DOI: 10.1542/hpeds.2023-007217. PMID: 37964652.

14. Kasatkin V. N., Chechelnytska S. M., Glebova E. V., Zhukovskaya E. V., Vashura A.Yu., Karelin A. F., Rumyantsev A. G. Principles and methods of rendering assistance in the second stage of rehabilitation to children who underwent oncological diseases. Physical and Rehabilitation Medicine, Medical Rehabilitation/Fizicheskaya i Reabilitatsionnaya Meditsina, Meditsinskaya Reabilitatsiya. 2019; 1 (2): 3 9. (in Russ). UDC 616.8