Revista Colombiana
de Medicina Física y Rehabilitación

Organo Oficial de la Asociación Colombiana de Medicina Física y Rehabilitación

ISSN Impreso: 0121-0041 - ISSN Electrónico: 2256-5655 - DOI: 10.28957/rcmfr

Trauma raquimedular y rehabilitación cardiopulmonar

Camilo Adolfo Leal Verdugo, Diego Mauricio Chaustre Ruiz

Resumen


Las personas con lesión medular presentan alteraciones cardiopulmonares y físicas más allá del compromiso motor secundario derivado de la lesión medular; ello genera desacondicionamiento, alteraciones de la dinámica respiratoria y del volumen sanguíneo circu- lante, y sedentarismo, lo cual aumenta el riesgo cardiovascular. El ejercicio es una herramienta demanejo de estas alteraciones con escasa difusión clínica. Se describe su importancia para el paciente lesionado medular, los mecanismos de evaluación funcional y la formulación del ejercicio. Los beneficios son la optimización del gasto cardiaco y el balance respiratorio muscular, así como la mejora en el desempeño de las actividades básicas cotidianas y su funcionalidad relacionada con dispositivos de marcha y movilidad. La valoración funcional tiene protocolos específicos dependientes del nivel de lesión, así como la prescripción del ejercicio. Los programas de rehabilitación cardiaca y pulmonar, así como la prescripción del ejercicio, deben ser considerados en los programas de rehabilitación y manejo del paciente con lesión medular.


Palabras clave


Trauma raquimedular, rehabilitación cardiaca, rehabilitación pulmonar, fisiología, pruebas funcionales, ejercicio.

Texto completo:

PDF

Referencias


Jacobs PL, Nash MS. Exercise recommendations for individuals with spinal cord injury. Sports Med. 2004;34(11):727–751. Disponible en: https://doi.org/10.2165/00007256-200434110-00003.

National Spinal Cord Injury Statistical Center [NSCISC]. Facts and Figures at a Glance - 2019 SCI Data Sheet. Birmingham, AL (EUA): University of Alabama at Birmingham; 2018. Disponible en: https: //www.nscisc.uab.edu/Public Facts%20and%20Figures%202019%20-%20Final.pdf.

Nash MS, Horton JA. Recreational and therapeutic exercise SCI. En: Kirshbaum S, Campagnolo DI, DeLisa JS, editors. Spinal cord medicine. Philadelphia: Lippincott, Williams and Wilkins; 2002. p. 331-337.

Haisma JA, Bussmann JB, Stam HJ, Sluis TA, Bergen MP, Dallmeijer AJ, et al. Changes in Physical Capacity During and After Inpatient Rehabilitation in Subjects With a Spinal Cord Injury. Arch Phys Med Rehabil. 2006;87(6): 741–748. Disponible en: https://doi.org/10.1016/j.apmr.2006.02.032.

Myers J, Lee M, Kiratli J. Cardiovascular disease in spinal cord injury: An overview of prevalence, risk, evaluation, and management. Am J Phys Med Rehabil. 2007; 86:142–152. Disponible en: https://doi.org/10.1097/PHM.0b013e31802f0247.

Hicks AL, Martin Ginis KA, Pelletier CA, Ditor DS, Foulon B, Wolfe DL. The effects of exercise training on physical capacity, strength, body composition and functional performance among adults with spinal cord injury: a systematic review. Spinal Cord, 2011;49(11):1103–1127. Disponi- ble en: https://doi.org/10.1038/sc.2011.62.

Van der Scheer JW, Martin Ginis KA, Ditor DS, Goosey-Tolfrey VL, Hicks AL, West CR, et al. Effects of exercise on fitness and health of adults with spinal cord injury: A systematic review. Neurology. 2017;89(7):736-745. Disponible en: https://doi.org/10.1212/WNL.0000000000004224.

King ML, Lichtman SW, Pellicone JT, Close RJ, Lisanti P. Exertional hypotension in spinal cord injury. Chest. 1994;106(4):1166-1171. Disponible en: http://doi.org/10.1378/chest.106.4.1166.

Cooper IV G, Tomanek RJ. Load regulation of the structure, composition, and function of mammalian myocardium. Circ Res. 1982;50(6)8: 788-798. Disponible en: https: //doi.org/10.1161/01.RES.50.6.788.

Nash MS, Bilsker S, Marcillo AE, Isaac SM, Bothelo LA, Klose KJ, et al. Reversal of adaptive left ventricular atrophy following electrically-timulated exercise training in human tetraplegics. Spinal Cord. 1991;29(9): 590-599. Disponible en: https://doi.org/10.1038/sc.1991.87.

Nash MS, Montalvo BM, Applegate B. Lower extremity blood and responses to occlusion ischemia differ in exercise trained and sedentary tetraplegic persons. Arch Phys Med Rehabil 1996;77:1260-1265. Disponible en: http://doi.org/10.1016/s0003-9993(96)90190-2.

Taylor PN, Ewins DJ, Fox B, Grundy D, Swain ID. Limb blood f low, cardiac output and quadriceps muscle bulk following spinal cord injury and the effect of training for the Odstock functional electrical stimulation standing system. Spinal Cord. 1993; 31: 303-310. Disponible en: https://doi.org/10.1038/sc.1993.54.

Hjeltnes N, Vokac Z. Circulatory strain in everyday life of paraplegics. Scand J Rehabil Med. 1979;11(2): 67-73. Disponible en: https://pubmed.ncbi.nlm.nih.gov/462147/.PMID: 462147.

Fu J, Wang H, Deng L, Li J. Exercise Training Promotes Functional Recovery after Spinal Cord Injury. Neural Plast. 2016;2016: 4039580. Disponible en: https://doi.org/10.1155/2016/4039580.

Brown R, DiMarco AF, Hoit JD, Garshick E. Respiratory dysfunction and management in spinal cord injur y. Respir Care. 2006;51(8):853-868;discussion 869-870. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2495152/. PMID: 16867197; PMCID: PMC2495152.

Schilero GJ, Bauman WA , Radulovic M. Traumatic Spinal Cord Injur y: Pulmonar y Physiologic Principles and Management. Clin Chest Med. 2018;39(2):411-425. Disponible en: https://doi.org/10.1016/j.ccm.2018.02.002.

Terson de Paleville DGL, McKay WB, Folz R J, Ovechkin AV. Respiratory motor control disrupted by spinal cord injury: mechanisms, evaluation, and restoration. Trans Stroke Res. 2011;2(4):463–473. Disponible en: https://doi.org/10.1007/s12975-011-0114-0.

Scanlon PD, Loring SH, Pichurko BM, McCool FD, Slutsky AS, Sarkarati M, et al. Respiratory Mechanics in Acute Quadriplegia: Lung and Chest Wall Compliance and Dimensional Changes during Respiratory Maneuvers. Am Rev Respir Dis. 1989;139(3), 615–620. Disponi- ble en: https://doi.org 10.1164/ajrccm/139.3.615.

Ditunno JF, Little, J. W., Tessler, A., & Burns, A. S. (2004). Spinal shock revisited: A four-phase model. Spinal Cord. 2004;42(7):383-395. Disponible en: https://doi.org/10.1038/sj.sc.3101603.

Oo T, Watt J, Soni B, Sett P. Delayed diaphragm recovery in 12 patients after high cervical spinal cord injury. A retrospective review of the diaphragm status of 107 patients ventilated after acute spinal cord injury. Spinal Cord. 1999;37(2):117-122. Disponible en: https://doi.org/10.1038/sj.sc.3100775.

Berlowitz DJ, Tamplin J. Respiratory muscle training for cervical spinal cord injury. Cochrane Database Syst Rev. 2013;23 July(7):CD008507. Disponible en: https://doi.org/10.1002/14651858.CD008507.pub2.

Van Houtte S, Vanlandewijck Y, Kiekens C, Spengler CM, Gosselink R. Patients with acute spinal cord injury benefit from normocapnic hyperpnoea training. J Rehabil Med. 2008;40(2):119-125. Disponible en: http://doi.org/10.2340/16501977-0140.

Zakrasek, E. C., Nielson, J. L., Kosarchuk, J. J., Crew, J. D., Ferguson, A. R., & McKenna, S. L. (2017). Pulmonary outcomes following specialized espiratory management for acute cervical spinal cord injury: A retrospective analysis. Spinal Cord. 2017;55(6):559-565. Disponible en: https://doi.org/10.1038/sc.2017.10.

Walker J, Cooney M, Norton S. Improved Pulmonary Function in Chronic Quadriplegics after Pulmonary Therapy and Arm Ergonometry. Spinal Cord. 1989;27:278-283. Disponible en: https://doi.org/10.1038/sc.1989.41.

Silva AC, Neder JA, Chiurciu MV, Pasqualin DC, da Silva RC, Fernandez AC, et al. Effect of aerobic training on ventilatory muscle endurance of spinal cord injured men. Spinal Cord. 1998;36(4):240-245. Disponible en: https://doi.org/10.1038/sj.sc.3100575.

Brown R, DiMarco AF, Hoit JD, Garshick E. Respirator y dysfunction and management in spinal cord injur y. Respir Care. 2006; 51(8):853-868;discussion 869-870. Disponible en: http://www.rcjournal.com/contents/08.06/08.06.0853.pdf. PMID: 16867197; PMCID: PMC2495152.

Franklin BA. Exercise testing, training and arm ergometry. Sports Med. 1985; 2:100-119. Dispo- nible en: https://doi.org/10.2165 00007256-198502020-00003.

Jacobs PL, Nash MS, Rusinowski JW. Circuit training provides cardiorespiratory and strength benefits in persons with paraplegia. Med Sci Sports Exerc. 2001;33(5):711-717. Disponible en: https://journals.lww.com/acsm-msse/Fulltext/2001/05000/Circuit_training_provides_cardiorespiratory_and.5.aspx. PMID: 11323537.

Janssen TW, Dallmeijer AJ, Veeger DJ, van der Woude LH. Normative values and determinants of physical capacity in individuals with spinal cord injury. J Rehabil Res Dev. 2002;39(1):29-39. Disponible en: https://www.rehab.research.va.gov/jour/02/39/1/Janssen.htm. PMID: 11930906.

Eerden S, Dekker R, Hettinga FJ. Maximal and submaximal aerobic tests for wheelchair- dependent persons with spinal cord injury: a systematic review to summarize and identify useful applications for clinical rehabilitation. Disabil Rehabil. 2018; 40(5):497-521. Disponible en: https://doi.org/10.1080/09638288.2017.1287623.

Sawka MN, Glaser RM, Laubach LL, Al-Samkari O, Suryaprasad AG. Wheelchair exercise per- formance of the young, middle-aged, and elderly. J Appl Physiol Respir Environ Exerc Physiol. 1981;50(4):824-828. Disponible en: https://doi.org/10.1152/jappl.1981.50.4.824.

Haisma JA, van der Woude LH, Stam HJ, Bergen MP, Sluis TA, Bussmann JB. Physical capacity in wheelchair-dependent persons with a spinal cord injury: a critical review of the literature. Spinal Cord. 2006;44(11):642-652. Disponible en: https://doi.org/10.1038/sj.sc.3101915.

Simmons OL, Kressler J, Nash MS. Reference fitness values in the untrained spinal cord injury population. Arch Phys Med Rehabil. 2014;95(12):2272-2278. Disponible en: https://doi.org/10.1016/j.apmr.2014.06.015.

Lundgaard E, Wouda MF, Strøm V. A comparative study of two protocols for treadmill walking exercise testing in ambulating subjects with incomplete spinal cord injur y. Spinal Cord. 2017;55(10):935-939. Disponible en: https://doi.org/10.1038/sc.2017.34.

Kim CM, Eng JJ, Whittaker MW. Level walking and ambulator y capacity in persons with incomplete spinal cord injury: relationship with muscle strength. Spinal Cord. 2004;42:156-162. Disponible en: https://dx.doi.org/10.1038%2Fsj.sc.3101569.

Leroux A, Fung J, Barbeau H. Adaptation of the walking pattern to uphill walking in normal and spinal-cord injured subjects. Exp Brain Res. 1999;126: 359. Disponible en: https://doi.org/10.1007/s002210050743.

Scivoletto G, Tamburella F, Laurenza L, Foti C, Ditunno JF, Molinari M. Validity and reliability of the 10-m walk test and the 6-min walk test in spinal cord injury patients. Spinal Cord. 2011;49(6):736-740. Disponible en: https://doi.org/10.1038/sc.2010.180.

Jackson AB, Carnel CT, Ditunno JF, Read MS, Boninger ML, Schmeler MR et al. Outcome measures for gait and ambulation in the spinal cord injury population. J Spinal Cord Med. 2008;31(5):487-499. Disponible en: https://doi.org/10.1080/10790268.2008.11753644.

Alexander MS, Anderson KD, Biering-Sorensen F, Blight AR, Brannon R, Bryce TN et al. Outcome measures in spinal cord injury: recent assessments and recommendations for future directions. Spinal Cord. 2009;47(8): 582–591. Disponible en: https://doi.org/10.1038/sc.2009.18.

Graham JE, Ostir GV, Fisher SR, Ottenbacher KJ. Assessing walkingspeed in clinical research: a systematic review. J Eval Clin Pract. 2008;14(4): 552-562. Disponible en: https://doi.org/10.1111/j.1365-2753.2007.00917.x.

Riebe D, Ehrman JK, Liguori G, Magal M, American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 10th edition. Philadelphia: Wolters Kluwer;2018 [citado 2020 enero 28].

Yim SY, Cho KJ, Park CI, Yoon TS, Han DY, Kim SK, et al. Effect of wheelchair ergometer training on spinal cord-injured paraplegics. Yonse Med J. 1993;34(3): 278-286. Disponible en: https://doi.org/10.3349ymj.1993.34.3.278.

Martin Ginis KA, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, et al. Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord. 2018;56(4):308-321. Disponible en: https://doi.org/10.1038/s41393-017-0017-3.

Figoni SF. Spinal cord injury. En: Durstine JL, editor. Exercise management for persons with chronic diseases and disabilities. Champaign (IL, EUA): Human Kinetics; 1997 [citado 2020 enero 26]. p. 175-179.45. Ginis KA, Hicks AL, Latimer AE, Warburton DE, Bourne C, Ditor DS, et al. The development of evidence-informed physical activity guidelines for adults with spinal cord injury. Spinal Cord. 2011;49(11):1088-1096. Disponible en: https://doi.org/10.1038/sc.2011.63.

Pelletier CA, Totosy de Zepetnek JO, MacDonald MJ, Hicks AL. A 16-week randomized controlled trial evaluating the physical activity guidelines for adults with spinal cord injury. Spinal Cord. 2015;53(5):363-367. Disponible en: https://doi.org/10.1038/sc.2014.167.

Gellman H, Sie I, Waters RL. Late complications of the weight-bearing upper extremity in the paraplegic patient. Clin Orthop Relat Res. 1988 agosto;(233): 132-135. Disponible en: https:// europepmc.org/article/med/3402118. PMID: 3402118.

Pentland WE, Twomey LT. Upper limb function in persons with long term paraplegia and implications for independence: part I. Paraplegia. 1994;32(4): 211-218. Disponible en: https:// doi.org/10.1038/sc.1994.40.

Curtis KA, Tyner TM, Zachary L, Lentell G, Brink D, Didyk T, et al. Effect of a standard exercise protocol on shoulder pain in long-term wheelchair. Spinal Cord. 1999;37(6): 421-429. Disponible en: https://doi.org/10.1038/sj.sc.3100860.

Bochkezanian V, Raymond J, de Oliveira CQ, Davis GM. Can combined aerobic and muscle strength training improve aerobic fitness, muscle strength, function and quality of life in people with spinal cord injury? A systematic review. Spinal Cord. 2015 Jun;53(6):418-31. Disponible en: https://doi.org/10.1038/sc.2015.48.

Gettman LR, Ayres JJ, Pollock ML, Jackson A. The effect of circuit weight training on strength, cardiorespiratory function, and body composition of adult men. Med Sci Sports. 1978;10(3):171-176. Disponible en: https://pubmed.ncbi.nlm.nih.gov/723506/. PMID: 723506.





© Rev Col Med Fis Reh 

DOI: 10.28957/rcmfr

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

La Asociación Colombiana de Medicina Física y Rehabilitación no es responsable de las opiniones aquí expresadas.

Reservados todos los derechos. El contenido de la presente publicación no puede ser reproducido, ni transmitido por ningún procedimiento electrónico, mecánico, incluyendo fotocopia, grabación magnética, ni registrado por ningún sistema de recuperación de información, en ninguna forma, ni por ningún medio, sin la previa autorización por escrito del titular de los derechos de explotación de la misma.

Cualquier forma de reproducción, distribución, comunicación pública o transformación de esta obra solo puede ser realizada con la autorización previa de la Asociación Colombiana de Medicina Física y Rehabilitación.

Información de contacto

Teléfono: (57-1) 6350840
Fax: (57-1) 6350841
Dirección: Calle 94 No. 15 - 32 Oficina 603
Bogotá - Colombia