Intervenciones multidisciplinarias en la rehabilitación del traumatismo medular
DOI:
https://doi.org/10.32480/rscp.2026.e3104Palabras clave:
traumatismo molecular, lesión medular, adaptación, rehabilitación, electroestimulación, calidad de vida, recuperación funcionalResumen
El traumatismo de la médula espinal implica daños a la médula y sus estructuras, frecuentemente por impactos o caídas. Las lesiones se clasifican según su ubicación y tipo, y pueden provocar inflamación, muerte celular e isquemia, dificultando la recuperación. Los síntomas varían desde parálisis hasta problemas emocionales como ansiedad y depresión. La intervención terapéutica es crucial, comenzando con estabilización en el lugar del accidente y el uso de dispositivos para evitar daños adicionales. El manejo inicial incluye analgésicos y corticosteroides, y se realizan pruebas de imagen. La fisioterapia es fundamental en las fases aguda y crónica para mantener la función y la movilidad. Además, se debe abordar la calidad de vida, la adaptación social y las complicaciones médicas mediante un enfoque multidisciplinario. Las tecnologías asistidas y el apoyo psicológico son esenciales para la reintegración y autonomía del paciente, así como la adaptación del entorno. La prevención de complicaciones es clave para mejorar su bienestar.
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1. Karamian BA, Siegel N, Nourie B, Serruya MD, Heary RF, Harrop JS, et al. The role of electrical stimulation for rehabilitation and regeneration after spinal cord injury. Journal of Orthopaedics and Traumatology. 2022;23(1). Disponible en: https://doi.org/10.1186/s10195-021-00623-6
2. Yun K, Lim J, Kim O. Significance of physical factors on activities of daily living in patients with tetraplegia after spinal cord injury: a retrospective study. BMC Sports Science, Medicine and Rehabilitation. 2024;16(1). Disponible en: https://doi.org/10.1186/s13102-024-00928-z
3. Silva FVM, Silva ANJ, Castro DMP de, Ribeiro RP, Sales T de O, Nunes PP de B. Atuação fisioterapêutica e qualidade de vida de pacientes com Traumatismo Raquimedular: uma revisão integrativa. Rev Pesq Fisio. 2020;10(4):746-53. Disponible en: https://www5.bahiana.edu.br/index.php/fisioterapia/article/view/3300
4. Lu Y, Shang Z, Zhang W, Pang M, Hu X, Dai Y, et al. Global incidence and characteristics of spinal cord injury since 2000–2021: a systematic review and meta-analysis. BMC Medicine. 2024;22(1). Disponible en: https://doi.org/10.1186/s12916-024-03514-9
5. Jazayeri SB, Maroufi SF, Mohammadi E, Dabbagh Ohadi MA, Hagen EM, Chalangari M, Jazayeri SB, Safdarian M, Zadegan SA, Ghodsi Z, Rahimi-Movaghar V. Incidence of traumatic spinal cord injury worldwide: a systematic review, data integration, and update. World Neurosurg X. 2023; 18:100171. Disponible en: https://doi.org/10.1016/j.wnsx.2023.100171
6. Lili L, Sunnerhagen KS, Rekand T, Alt Murphy M. Independence and upper extremity functioning after spinal cord injury: a cross-sectional study. Sci Rep. 2023;13(1):3148. Disponible en: https://doi.org/10.1038/s41598-023-29986-y
7. Alizadeh A, Dyck SM, Karimi-Abdolrezaee S. Traumatic Spinal Cord Injury: An Overview of Pathophysiology, Models and Acute Injury Mechanisms. Frontiers in Neurology. 2019;10. Disponible en: https://doi.org/10.3389/fneur.2019.00282
8. Hachem LD, Fehlings MG. Pathophysiology of spinal cord injury. Neurosurg Clin N Am. 2021;32(3):305-313. Disponible: https://doi.org/10.1016/j.nec.2021.03.002
9. Ding W, Hu S, Wang P, Kang H, Peng R, Dong Y, Li F. Spinal cord injury: the global incidence, prevalence, and disability from the Global Burden of Disease Study 2019. Spine (Phila Pa 1976). 2022;47(21):1532–1540. Disponible en: https://doi.org/10.1097/BRS.0000000000004417
10. Lima R, Monteiro A, Salgado AJ, Monteiro S, Silva NA. Pathophysiology and therapeutic approaches for spinal cord injury. Int J Mol Sci. 2022;23(22):13833. Disponible en: https://doi.org/10.3390/ijms232213833
11. Margetis K, Das JM, Emmady PD. Spinal Cord Injuries. Nih.gov. StatPearls Publishing; 2025. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK560721/
12. Wilson KV, McDonnell JM, O’Malley S, Lynch D, Larouche J, Cunniffe GM, et al. Morbidity and mortality of traumatic cervical spinal cord injuries in a geriatric cohort. Irish Journal of Medical Science (1971 -). 2022;192(4):1719–25. Disponible en: https://doi.org/10.1007/s11845-022-03169-6
13. Peterson MD, Berri M, Lin P, Kamdar N, Rodríguez G, Mahmoudi E, et al. Cardiovascular and metabolic morbidity following spinal cord injury. The Spine Journal. 2021;21(9):1520–7. Disponible en: https://doi.org/10.1016/j.spinee.2021.05.014
14. Arriagada G, Macchiavello N. Traumatismo raquimedular (Trm). Revisión bibliográfica. Revista Médica Clínica Las Condes. 2020;31(5):423-9. Disponible en: https://doi.org/10.1016/j.rmclc.2020.11.001
15. Anjum A, Muhammad Da’in Yazid, Daud MF, Idris J, Min A, Naicker AS, et al. Spinal Cord Injury: Pathophysiology, Multimolecular Interactions, and Underlying Recovery Mechanisms. International Journal of Molecular Sciences. 2020;21(20):7533–3. Disponible en: https://doi.org/10.3390/ijms21207533
16. Hellenbrand DJ, Quinn CM, Piper ZJ, Morehouse CN, Fixel JA, Hanna AS. Inflammation after spinal cord injury: a review of the critical timeline of signaling cues and cellular infiltration. Journal of Neuroinflammation. 2021;18(1):284–4. Disponible en: https://doi.org/10.1186/s12974-021-02337-2
17. Reyes C, Mokalled MH. Astrocyte-neuron interactions in spinal cord injury. Adv Neurobiol. 2024; 39:213–231. Disponible en: https://doi.org/10.1007/978-3-031-64839-7_9
18. Michael FM, Patel SP, Rabchevsky AG. Intraspinal plasticity associated with the development of autonomic dysreflexia after complete spinal cord injury. Front Cell Neurosci. 2019; 13:505. Disponible en: https://doi.org/10.3389/fncel.2019.00505
19. Henke AM, Billington ZJ, Gater DR Jr. Autonomic Dysfunction and Management after Spinal Cord Injury: A Narrative Review. J Pers Med. 2022;12(7):1110. Disponible en: https://doi.org/10.3390/jpm12071110
20. Wulf MJ, Tom VJ. Consequences of spinal cord injury on the sympathetic nervous system. Front Cell Neurosci. 2023 Feb 28;17:999253. Disponible en: https://doi.org/10.3389/fncel.2023.999253
21. Budd MA, Gater DR, Channell I. Psychosocial Consequences of Spinal Cord Injury: A Narrative Review. Journal of Personalized Medicine. 2022;12(7):1178–8. Disponible en: https://doi.org/10.3390/jpm12071178
22. B. Perrouin-Verbe, Lefevre C, P. Kieny, Gross R, Reiss B, Fort ML. Spinal cord injury: A multisystem physiological impairment/dysfunction. Revue Neurologique. 2021; 177(5):594–605. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0035378721005087
23. Patsakos EM, Bayley MT, Kua A, Cheng C, Eng J, Ho C, Noonan VK, Querée M, Craven BC; Can-SCIP Guideline Expert Panel. Development of the Canadian Spinal Cord Injury Best Practice (Can-SCIP) Guideline: Methods and overview. J Spinal Cord Med. 2021;44(suppl 1):S52-S68. Disponible en: https://doi.org/10.1080/10790268.2021.1953312
24. Ribau A, Alves J, Rodrigues-Pinto R. Treatment of acute spinal cord injuries: a survey among Iberolatinoamerican spine surgeons — Part 1: use of high-dose corticosteroids. Rev Bras Ortop (Sao Paulo). 2022;58(2):331-336. Disponible en: https://doi.org/10.1055/s-0042-1749414
25. Wirz M, Mach O, Maier D, Benito-Penalva J, Taylor J, Esclarin A, Dietz V. Effectiveness of automated locomotor training in patients with acute incomplete spinal cord injury: a randomized, controlled, multicenter trial. J Neurotrauma. 2017;34(10):1891–1896. Disponible en: https://doi.org/10.1089/neu.2016.4643
26. Duan R, Qu M, Yuan Y, Lin M, Liu T, Huang W, et al. Clinical Benefit of Rehabilitation Training in Spinal Cord Injury. Spine. 2020;46(6):E398–410. Disponible en: https://doi.org/10.1097/BRS.0000000000003789
27. Álava Vásquez Zoila María, Rodríguez Felipe Diaslen, Ferrer Lozano Dunia Mercedes. Resiliencia en un grupo de discapacitados físicos motores. Rev Cubana Med Gen Integr. 2020; 36(4). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21252020000400006&lng=es
28. Bøgdal J, Schmidt AM, Nielsen KØ, Handberg C. An Integrated Multidisciplinary Rehabilitation Program Experienced by Patients with Chronic Low Back Pain. Clinical Medicine & Research. 2021;19(4):192–202. Disponible en: https://doi.org/10.3121/cmr.2021.1602
29.Budd MA, Gater DR Jr, Channell I. Psychosocial consequences of spinal cord injury: a narrative review. J Pers Med. 2022;12(7):1178. Disponible en: https://doi.org/10.3390/jpm12071178
30. Ponzano M, Buren R, Adams NT, Jun J, Jetha A, Mack DE, et al. Effect of Exercise on Mental Health and Health-related Quality of Life in Adults With Spinal Cord Injury: A Systematic Review and Meta-analysis. Archives of Physical Medicine and Rehabilitation. 2024;105(12):2350–61. Disponible en: https://doi.org/10.1016/j.apmr.2024.02.737
31. Gong W, Zhang T, Che M, Wang Y, He C, Liu L, et al. Recent advances in nanomaterials for the treatment of spinal cord injury. Materials Today Bio. 2022;18:100524–4. Disponible en: https://doi.org/10.1016/j.mtbio.2022.100524
32. De Miguel-Rubio A, Rascón-Maíz J, Alba-Rueda A, Rodrigues-de-Souza DP. Driving improvement in spinal cord injury patients using virtual reality. Systematic review. Revista de Neurología. 2022 ; 75(2). Disponible en: https://doi.org/10.33588/rn.7502.2022091
33. Manaila AI, Roman NA, Baseanu ICC, Minzatanu D, Tuchel VI, Basalic EB, et al. The Efficiency of Rehabilitation Therapy in Patients Diagnosed with Neurogenic Bladder: A Systematic Review. Medicina. 2024; 60(7):1152. Disponible en: https://doi.org/10.3390/medicina60071152
34. Yadav RL, Martin JC, Galea MP. Evaluation and management of autonomic functions in patients with spinal cord injury: A scoping review. Journal of Spinal Cord Medicine. 2025;1–61. Disponible en: https://doi.org/10.1080/10790268.2025.2485509
35. Maggio MG, Bonanno M, Manuli A, Calabrò RS. Improving Outcomes in People with Spinal Cord Injury: Encouraging Results from a Multidisciplinary Advanced Rehabilitation Pathway. Brain Sciences. 2024;14(2):140–0. Disponible en: https://doi.org/10.3390/brainsci14020140
36. Hu X, Xu W, Ren Y, Wang Z, He X, Huang R, et al. Spinal cord injury: molecular mechanisms and therapeutic interventions. Signal Transduction and Targeted Therapy. 2023;8(1). Disponible en: https://doi.org/10.1038/s41392-023-01477-6
37. Richardson EJ, McKinley EC, Richards JS. Perceived stress and pain interference in acute rehabilitation following spinal cord injury: Resilience as a moderator. Rehabil Psychol. 2024;69(2):85–93. Disponible en: https://doi.org/10.1037/rep0000532
38. Schönherr MC, Groothoff JW, Mulder GA, Eisma WH. Functional outcome of patients with spinal cord injury: rehabilitation outcome study. Clin Rehabil. 1999;13(6):457–463. Disponible en: https://doi.org/10.1191/026921599666105472
39. Hendershot KA, O’Phelan KH. Respiratory Complications and Weaning Considerations for Patients with Spinal Cord Injuries: A Narrative Review. Journal of Personalized Medicine. 2022;13(1):97. Disponible en: https://doi.org/10.3390/jpm13010097
40. Amidei CB, Salmaso L, Bellio S, Saia M. Epidemiology of traumatic spinal cord injury: a large population-based study. Spinal Cord. 2022;60(9):812–9. Disponible en: https://doi.org/10.1038/s41393-022-00795-w
41. Vierck C. Mechanisms of Below-Level Pain Following Spinal Cord Injury (SCI). J Pain. 2020 Mar-Apr;21(3-4):262-280. Disponible en: https://doi.org/10.1016/j.jpain.2019.08.007
42. Billington ZJ, Henke AM, Gater DR Jr. Spasticity management after spinal cord injury: The here and now. J Pers Med. 2022;12(5):808. Disponible en: https://doi.org/10.3390/jpm12050808
43. Altahla R, Alshorman J, Ali-Shah SZ, Nasb M, Tao X. Quality of life and subjective well-being comparison between traumatic, nontraumatic chronic spinal cord injury, and healthy individuals in China. Peer J. 2024;12: e18709. Disponible en: https://doi.org/10.7717/peerj.18709
44. Krassioukov A, Stillman M, Beck L, Longoni M, Castillo C, Hernández Jiménez I. Disfunciones autonómicas después de una lesión de la médula espinal: una descripción general para los médicos de atención primaria. Top Spinal Cord Inj Rehabil. 2020;26(2):123–7. Disponible en: https://asia-spinalinjury.org/wp-content/uploads/2020/07/Disfunciones-auton%C3%B3micas-despu%C3%A9s.pdf
45. Shackleton C, Samejima S, Miller T, Sachdeva R, Parr A, Samadani U, et al. Effect of epidural spinal cord stimulation on female sexual function after spinal cord injury. Frontiers in Neuroscience. 2023;17. Disponible en: https://doi.org/10.3389/fnins.2023.11557961
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