A Comparative Study of Hydrotherapy and Robotic-Assisted Rehabilitation as Physiotherapeutic Interventions for Patients with Spinal Cord Injury.

Spinal cord injuries (SCIs) represent a complex clinical challenge, often leading to permanent disability, secondary complications, and a significant impact on quality of life. This study aimed to compare the effectiveness of hydrotherapy and robotic-assisted rehabilitation as physiotherapeutic interventions for functional recovery in patients with SCI. A narrative and bibliographic review was conducted through a systematic search in databases including PubMed, PEDro, Cochrane Library, and Google Scholar, covering literature published between 2013 and 2023. A total of 27 studies were analyzed (15 on hydrotherapy and 12 on robotic rehabilitation). Findings indicate that hydrotherapy enhances mobility by reducing spasticity, improving cardiovascular function, and enabling movement patterns facilitated by the physical properties of water. Conversely, robotic rehabilitation delivers repetitive, task-specific, and precise training, which promotes neuroplasticity and motor relearning. Comparative analysis highlighted that treatment choice should be based on patient profile and rehabilitation phase: robotic systems are particularly valuable during early stages, while hydrotherapy proves more beneficial during intermediate and advanced recovery phases. The evidence suggests that these modalities should not be seen as competing but rather complementary, each addressing distinct aspects of recovery. An integrated, individualized approach combining robotic rehabilitation with hydrotherapy appears to offer the greatest potential for enhancing functional outcomes, promoting patient independence, and improving quality of life for individuals with spinal cord injuries.