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Neurorehabilitación intensiva o cómo recuperarse tras un ictus: "La edad no es un factor determinante para volver a hablar o caminar" Conoce la historia de Alicia, de 81 años, que se recuperó a la perfección de su ictus
En España, se produce un ictus cada seis minutos y es la primera causa de muerte en mujeres Hablamos con Cristina Vázquez, Cofundadora del Centro Europeo de Neurociencias (CEN), sobre una terapia pionera, la neurorehabilitación intensiva Te contamos la historia de Alicia, de 81 años, y su recuperación total tras un pronóstico muy negativo Cada año se producen unos 110.000 casos de ictus en nuestro país, uno cada seis minutos, y más de un tercio presentan secuelas graves, de acuerdo con la Sociedad Española de Neurología (SEN). Es la segunda causa de muerte en todo el mundo, la primera en mujeres , y, también, la primera causa de discapacidad, aproximadamente un 30% de los pacientes desarrollan dependencia funcional y, aunque sea desconocido, puede revertirse. Hablamos con Cristina Vázquez, Cofundadora del Centro Europeo de Neurociencias (CEN) para que nos explique una de las terapias más efectivas e innovadoras para la recuperación de estos enfermos, la neurorehabilitación intensiva.
¿Quiénes son las personas con mayor riesgo de ictus? Es una enfermedad bastante común en nuestro país , tanto en hombres como en mujeres, normalmente tiene una prevalencia alta en personas de edades más avanzadas porque suele estar relacionada con factores de estrés, hipertensión, diabetes, cardiopatías...
¿Cuáles son las secuelas más comunes? Depende mucho del tiempo que se tarde en tratar. Lo más importante es que si una persona tiene una sintomatología compatible se le traslade de inmediato al hospital . Si se atiende lo suficientemente rápido, el episodio puede revertirse casi por completo o dejar unas secuelas muy mínimas. Sin embargo, en cuestión de minutos, las secuelas que quedan son bastante graves. Lo más común es que produzca una hemiparesia , es decir, que se produzca una parálisis de uno de los lados del cuerpo , dependiendo de qué zona del cerebro esté afectada. Produce también cambios cognitivos, pérdida de memoria, trastornos en el lenguaje, en la deglución… Es una patología que puede generar muchas secuelas y en algunos pacientes son para toda la vida.
¿Esas secuelas se pueden tratar y mejorar? Claro. Cuando una persona tiene un ictus normalmente en poquitos días suele estar estabilizado y ya recibe el alta médica. Es súper importante que pasada esa primera semana, el paciente se empiece a tratar , porque durante los tres o seis primeros meses hay un periodo de recuperación espontánea en el que el propio cuerpo, el propio cerebro, está haciendo por recuperarse. Al igual que cuando nos hacemos una herida y la piel empieza a curar, en el cerebro pasa lo mismo. Entonces es ese primer periodo en el que hay que trabajar bien para que esas secuelas que puedan ir apareciendo sean mínimas y darle la oportunidad al cerebro de volver a recuperarse en la medida de las posibilidades de cada paciente , porque eso varía mucho según la lesión.
Y aquí es donde entra en juego la neurorehabilitación intensiva. ¿Qué es exactamente? Es un tratamiento que se lleva a cabo en centros especializados en patologías neurológicas , en los que se trabaja con el paciente, en lugar de tres horas a la semana con sesiones de 45 minutos – que es la rehabilitación normal que se ofrece a estos enfermos -, hasta seis horas diarias los primeros dos o tres meses para intentar recuperar al cuerpo lo antes y mejor posible.
¿Qué tipo de actividades o de ejercicios se realizan? Depende del paciente . Nosotros normalmente les hacemos una valoración especializada. A veces necesitan solo terapia física, a veces también necesitan neuropsicología y logopedia , porque como hemos hablado antes, las secuelas pueden ser muy variadas y abarcar muchas zonas diferentes del cerebro. Lo que se hace es combinar estas actividades y nosotros, además, también contamos con muchos dispositivos robóticos que nos facilitan que los pacientes que están todavía gravemente afectados o muy agudos puedan empezar a caminar, a ponerse de pie, a moverse. Y todo esto combinado con otro tipo de ejercicios o de terapia intensiva.
¿Una persona de edad avanzada, de 80 años puede recuperarse? Sí es posible. Uno de los casos más representativos que hemos tenido ha sido el de Alicia, de 81 años. Había sufrido un ictus y en el hospital le dieron por desahuciada y pidieron a sus familiares que adaptasen su casa porque no se iba a recuperar de las secuelas. Aquí entró en silla de ruedas y salió caminando y hablando a la perfección (para ver su historia completa dale al play al vídeo de arriba ).
Evidentemente hay que tener en cuenta cómo de severo ha sido el ictus y qué posibilidades vemos para recuperarse. La edad no tiene por qué ser, a priori, un factor que nos diagnostica que esa persona ya no va a volver, por ejemplo, a caminar o a hablar . Además, como comentaba antes, normalmente los ictus son más frecuentes en personas mayores porque están asociados a determinados síndromes envejecimiento y es un sector de la sociedad al que no podemos desahuciar porque cada vez vivimos más y necesitamos tener una mejor calidad de vida. No deberíamos dejarlos en una silla de ruedas para siempre.
¿Este tipo de terapias están cubiertas por la Seguridad Social? No, no están cubiertas. Todos los centros que nos dedicamos a este tipo de terapias en España somos privados . Hay algunos centros concertados de la Seguridad Social, son los llamados hospitales de media estancia a los que se traslada A pacientes agudos tras recibir el alta, pero, a pesar de eso, normalmente no hacen terapia intensiva, hacen a lo mejor tres horas de logopedia a la semana, una hora de fisioterapia al día, otra vez terapia ocupacional... Pero en realidad si lo juntas todo no es intensivo porque el paciente pasa muchas horas en ese centro, pero en realidad las horas de terapia suelen ser pocas.
En centros como el vuestro, ¿los pacientes son internos? No, nosotros somos un centro ambulatorio, los pacientes vienen aquí a pasar el día y cuentan con zonas especiales de descanso individual , porque algunos de ellos pasan muchas horas, se quedan a comer, pero no hacen noche.
En un día como hoy, ¿qué mensaje la podemos dar a las familias que se enfrentan a una situación así? Yo les diría que intenten informarse mucho de los medios que puedan tener cerca de donde ellos vivan y hablen con gente o familias que hayan vivido esta experiencia para ver un poco qué soluciones encontraron y dónde pueden ir.
Además, desde mi punto de vista, creo que los profesionales sanitarios, independientemente de que estés en el sector público o privado, deberían informar a las familias de todos los caminos que hay o de las alternativas que hay, porque nos encontramos que hay mucha gente que está muy desinformada y entonces creen que no hay posibilidades de recuperarse, o no conocen centros o profesionales que les puedan ayudar y, al final, tiran la toalla antes de tiempo.
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