¿Qué hacemos cuando el brazo no se mueve? En este episodio hablamos de ese punto de partida que tanto intimida: el miembro superior completamente pléjico tras un ictus. A partir de la experiencia clínica y la neurofisiología más actual, exploramos cómo comenzar a activar un brazo desde cero. Abordamos estrategias basadas en evidencia como el trabajo en carga en cadena cinética cerrada, la electroestimulación funcional multicanal, el uso de herramientas como el PANAt Laptool, el entrenamiento bilateral y los paradigmas de uso forzado inspirados en Forced-Use Utley/Woll. También repasamos el papel del entrenamiento con soporte de peso, ese enfoque nacido de los laboratorios de Dewald y Ellis que ha cambiado la forma de entender la sinergia flexora.

Un episodio para fisioterapeutas y terapeutas ocupacionales que quieren comprender no solo qué hacer, sino por qué hacerlo.

Referencias del episodio:

1. Arya, K. N., & Pandian, S. (2014). Interlimb neural coupling: implications for poststroke hemiparesis. Annals of physical and rehabilitation medicine, 57(9-10), 696–713. https://doi.org/10.1016/j.rehab.2014.06.003 (https://pubmed.ncbi.nlm.nih.gov/25262645/).

2. Cauraugh, J. H., & Summers, J. J. (2005). Neural plasticity and bilateral movements: A rehabilitation approach for chronic stroke. Progress in neurobiology, 75(5), 309–320. https://doi.org/10.1016/j.pneurobio.2005.04.001 (https://pubmed.ncbi.nlm.nih.gov/15885874/).

3. Chen, S., Qiu, Y., Bassile, C. C., Lee, A., Chen, R., & Xu, D. (2022). Effectiveness and Success Factors of Bilateral Arm Training After Stroke: A Systematic Review and Meta-Analysis. Frontiers in aging neuroscience, 14, 875794. https://doi.org/10.3389/fnagi.2022.875794 (https://pubmed.ncbi.nlm.nih.gov/35547621/).

4. Ellis, M. D., Carmona, C., Drogos, J., & Dewald, J. P. A. (2018). Progressive Abduction Loading Therapy with Horizontal-Plane Viscous Resistance Targeting Weakness and Flexion Synergy to Treat Upper Limb Function in Chronic Hemiparetic Stroke: A Randomized Clinical Trial. Frontiers in neurology, 9, 71. https://doi.org/10.3389/fneur.2018.00071 (https://pubmed.ncbi.nlm.nih.gov/29515514/)

5. Jang, S. H., & Lee, S. J. (2019). Corticoreticular Tract in the Human Brain: A Mini Review. Frontiers in neurology, 10, 1188. https://doi.org/10.3389/fneur.2019.01188 (https://pubmed.ncbi.nlm.nih.gov/31803130/).

6. Khan, M. A., Fares, H., Ghayvat, H., Brunner, I. C., Puthusserypady, S., Razavi, B., Lansberg, M., Poon, A., & Meador, K. J. (2023). A systematic review on functional electrical stimulation based rehabilitation systems for upper limb post-stroke recovery. Frontiers in neurology, 14, 1272992. https://doi.org/10.3389/fneur.2023.1272992 (https://pubmed.ncbi.nlm.nih.gov/38145118/).

7. Langhorne, P., Wu, O., Rodgers, H., Ashburn, A., & Bernhardt, J. (2017). A Very Early Rehabilitation Trial after stroke (AVERT): a Phase III, multicentre, randomised controlled trial. Health technology assessment (Winchester, England), 21(54), 1–120. https://doi.org/10.3310/hta21540 (https://pubmed.ncbi.nlm.nih.gov/28967376/).

8. Michielsen, M., Cornelis, L., Cruycke, L., De Smedt, A., Fobelets, M., Putman, K., Vander Plaetse, M., Verheyden, G., & Meyer, S. (2025). Arm-hand BOOST (AHA-BOOST) therapy to improve recovery of the upper limb after stroke: rationale and description by means of the TIDieR checklist. Frontiers in neurology, 16, 1599762. https://doi.org/10.3389/fneur.2025.1599762 (https://pubmed.ncbi.nlm.nih.gov/41001199/).

9. Schick, T., Kolm, D., Leitner, A., Schober, S., Steinmetz, M., & Fheodoroff, K. (2022). Efficacy of Four-Channel Functional Electrical Stimulation on Moderate Arm Paresis in Subacute Stroke Patients-Results from a Randomized Controlled Trial. Healthcare (Basel, Switzerland), 10(4), 704. https://doi.org/10.3390/healthcare10040704 (https://pubmed.ncbi.nlm.nih.gov/35455881/).

10. Sukal, T. M., Ellis, M. D., & Dewald, J. P. (2007). Shoulder abduction-induced reductions in reaching work area following hemiparetic stroke: neuroscientific implications. Experimental brain research, 183(2), 215–223. https://doi.org/10.1007/s00221-007-1029-6 (https://pubmed.ncbi.nlm.nih.gov/17634933/)

11. Whitall, J., McCombe Waller, S., Silver, K. H., & Macko, R. F. (2000). Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke, 31(10), 2390–2395. https://doi.org/10.1161/01.str.31.10.2390 (https://pubmed.ncbi.nlm.nih.gov/11022069/).

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