Revista Peruana de Medicina Integrativa

Diferencias en la escala de ASIA después de un tratamiento rehabilitador en pacientes con lesión medular incompleta traumática en el Instituto Nacional de Rehabilitación

Effect of a rehabilitation treatment on adults with incomplete spinal cord lesion in Instituto Nacional de Rehabilitación

Rosa Licetti Villena

Instituto Nacional de Rehabilitación “Dra. Adriana Rebaza Flores”. Lima-Perú.

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Resumen

Objetivo. Determinar si existe diferencias en la escala de ASIA en pacientes con lesión medular incompleta antes y después de un tratamiento rehabilitador en el Instituto Nacional de Rehabilitación entre los años 2002 a 2009. Materiales y métodos. Estudio retrospectivo correlacional. Se evaluaron diferencias en la escala de ASIA, índice motor y nivel motor antes y después de recibir un programamultidisciplinario de rehabilitación hospitalaria en pacientes con lesiones medulares incompletas (ASIA B, C o D) de tipo traumática. Se estudió si estas diferencias estuvieron asociadas a variables clínico-epidemiológicas (género, tono, etiología específica, tiempo de hospitalización o tiempo de enfermedad). Resultados. Se incluyeron 36 historias clínicas, donde se encontró variaciones de ASIA B inicial hacia ASIA C (34,8%), y ASIA D (4,3%); así como de ASIA C inicial hacia ASIA D (35,0%). Se encontraron diferencias significativas entre el tiempo de hospitalización mayor o igual a 5 meses (PR: 4,84; IC95% 1,25-18,56); el tiempo de enfermedad menor o igual a 6 meses (PR: 3,98; IC95% 1,11-17,87) y el cambio favorable de ASIA después del tratamiento. Se encontró disminución del nivel motor en 11 pacientes (13,1%); asimismo, la proporción del nivel motor disminuyo a niveles C5 (15,5%), C4 (14,3%) y C6 (10,7%). Conclusiones. Se encontraron diferencias significativas en la escala de ASIA en pacientes con lesiones medulares incompletas traumáticas después de haber completado un programa de rehabilitación en el Instituto Nacional de Rehabilitación entre los años 2002-2009; se hallaron mejores resultados en los pacientes con ASIA B y C inicial.

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Referencias

Witiw CD, Fehlings MG. Acute Spinal Cord Injury. J Spinal Disord Tech. 2015;28(6):202-210. doi:10.1097/BSD.0000000000000287

Henao-Lema CP, Pérez-Parra JE. Spinal Cord Injuries and Disabilities: A Review. Aquichán. 2010;10(2):157-172.

Devivo MJ. Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal Cord. 2012;50(5):365-372. doi:10.1038/sc.2011.178

Kang Y, Ding H, Zhou HX, et al. Epidemiology of worldwide spinal cord injury: a literature review. J Neurorestoratology. 2017;6:1-9.

Araujo R. Análisis Situacional del Instituto Nacional de Rehabilitación “Dra. Adriana Rebaza Flores”- 2004. 2006.

Wilson JR, Cho N, Fehlings MG. Acute Traumatic Spinal Cord Injury: Epidemiology, Evaluation, and Management. In: Spine Surgery Basics. Springer, Berlin, Heidelberg; 2014:399-409. doi:10.1007/978-3-642-34126-7_30

Lim PAC, Tow AM. Recovery and regeneration after spinal cord injury: a review and summary of recent literature. Ann Acad Med Singapore. 2007;36(1):49-57.

Marino RJ, Ditunno JF, Donovan WH, Maynard F. Neurologic recovery after traumatic spinal cord injury: data from the Model Spinal Cord Injury Systems. Arch Phys Med Rehabil. 1999;80(11):1391-1396.

Scivoletto G, Morganti B, Ditunno P, Ditunno JF, Molinari M. Effects on age on spinal cord lesion patients’ rehabil-itation. Spinal Cord. 2003;41(8):457-464. doi:10.1038/sj.sc.3101489

Sipski ML, Jackson AB, Gómez-Marín O, Estores I, Stein A. Effects of gender on neurologic and functional recovery after spinal cord injury. Arch Phys Med Rehabil. 2004;85(11):1826-1836.

Fisher CG, Noonan VK, Smith DE, et al. Motor recovery, functional status, and health-related quality of life in patients with complete spinal cord injuries. Spine. 2005;30(19):2200-2207.

Ditunno JF, Burns AS, Marino RJ. Neurological and functional capacity outcome measures: essential tospinal cord injury clinical trials. J Rehabil Res Dev. 2005;42(3 Suppl 1):35-41.

Instituto Nacional de Rehabilitación. Guía de Práctica Clínica Para Paciente Con Lesión Medular.; 2012:40.

Nas K, Yazmalar L, Şah V, Aydın A, Öneş K. Rehabilitation of spinal cord injuries. World J Orthop. 2015;6(1):8-16. doi:10.5312/wjo.v6.i1.8

American Spinal Injury Association. International Standards for Neurological Classifications of Spinal Cord Injury. Chicago: American Spinal Injury Association; 2000.

Marino RJ, Graves DE. Metric properties of the ASIA motor score: subscales improve correlation with functional activities. Arch Phys Med Rehabil. 2004;85(11):1804-1810.

Ansari NN, Naghdi S, Arab TK, Jalaie S. The interrater and intrarater reliability of the Modified Ashworth Scale in the assessment of muscle spasticity: limb and muscle group effect. NeuroRehabilitation. 2008;23(3):231-237.

Millet MF. Neurochirurgie dans le paraplegic spastiques. Resultats a moyen treme de la radicello-tomie posterieure selective. In: Actualites En Reedu-cation Fonctionnelle et Readaptation. Paris: Masson; 1981:76-85.

National Spinal Cord Injury Statistical Centre Birming-ham Alabama. Spinal Cord Injury Facts and Figures at a Glance. Alabama, USA; 2008.

Burney RE, Maio RF, Maynard F, Karunas R. In-cidence, Characteristics, and Outcome of Spinal Cord Injury at Trauma Centers in North America. Arch Surg. 1993;128(5):596-599. doi:10.1001/arch-surg.1993.01420170132021

Chen HY, Chen SS, Chiu WT, et al. A nationwide epidemiological study of spinal cord injury in geriatric patients in Taiwan. Neuroepidemiology. 1997;16(5):241-247. doi:10.1159/000109693

Chen CF, Lien IN. Spinal cord injuries in Taipei, Taiwan, 1978-1981. Paraplegia. 1985;23(6):364-370. doi:10.1038/sc.1985.58

Brasil AV, Coelho DG. The neurological outcome of acute spinal cord injury in a neurosurgical hospital of a developing country. Spinal Cord. 1998;36(5):353-356. doi:10.1038/sj.sc.3100630

Da Paz AC, Beraldo PS, Almeida MC, Neves EG, Alves CM, Khan P. Traumatic injury to the spinal cord. Prevalence in Brazilian hospitals. Paraplegia. 1992;30(9):636-640. doi:10.1038/sc.1992.126

Barbetta DC, Smanioto TR, Poletto MF, et al. Spinal cord injury epidemiological profile in the Sarah Network of Rehabilitation Hospitals-a Brazilian population sample. Spinal Cord Ser Cases. 2018;4:32. doi:10.1038/s41394-018-0049-8

Consortium for Spinal Cord Medicine. Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med. 2008;31(4):403-479.

Fawcett JW, Curt A, Steeves JD, et al. Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials. Spinal Cord. 2007;45(3):190-205. doi:10.1038/sj.sc.3102007

Spiess MR, Müller RM, Rupp R, Schuld C, EM-SCI Study Group, van Hedel HJA. Conversion in ASIA impairment scale during the first year after traumatic spinal cord injury. J Neurotrauma. 2009;26(11):2027-2036. doi:10.1089/neu.2008.0760

Sumida M, Fujimoto M, Tokuhiro A, Tominaga T, Magara A, Uchida R. Early rehabilitation effect for traumatic spinal cord injury. Arch Phys Med Rehabil. 2001;82(3):391-395. doi:10.1053/apmr.2001.19780

Failli V, Kopp MA, Gericke C, et al. Functional neurological recovery after spinal cord injury is impaired in patients with infections. Brain J Neurol. 2012;135(Pt 11):3238-3250. doi:10.1093/brain/aws267

Van Hedel HJA. Improvement in function after spinal cord injury: the black-box entitled rehabilitation. Swiss Med Wkly. 2012;142:w13673. doi:10.4414/smw.2012.13673

Teeter L, Gassaway J, Taylor S, et al. Relationship of physical therapy inpatient rehabilitation interven-tions and patient characteristics to outcomes follow-ing spinal cord injury: the SCIRehab project. J Spinal Cord Med. 2012;35(6):503-526. doi:10.1179/2045772312Y.0000000058

Wolfe DL, Hsieh JTC, Mehta S. Rehabilitation Practices and Associated Outcomes Following Spinal Cord Injury. 2010. https://scireproject.com/wp-content/uploads/20-Rehab-Practices-v4.pdf.

Fehlings MG, Tetreault LA, Aarabi B, et al. A Clinical Practice Guideline for the Management of Patients with Acute Spinal Cord Injury: Recommendations on the Type and Timing of Rehabilitation. Glob Spine J. 2017;7(3 Suppl):231S-238S. doi:10.1177/2192568217701910

Cotner BA, Ottomanelli L, Keleher V, Dirk L. Scoping review of resources for integrating evidence-based supported employment into spinal cord injury rehabilitation. Disabil Rehabil. February 2018:1-8. doi:10.1080/09638288.2018.1443161

Mingaila S, Krisciūnas A. Occupational therapy for patients with spinal cord injury in early rehabilitation. Med Kaunas Lith. 2005;41(10):852-856.