Intervenciones para mejorar la función motora en el paciente con ictus

摘要

Many methods have been proposed to attempt to improve motor function in stroke. There is no doubt, at present, on the efficacy of Rehabilitation and we are obtaining increasing knowledge on which specific aspects are the most important (early treatment, interdisciplinary approach...). The reeducation programs can be classified into 3 large groups: I) compensation techniques; 2) facilitation techniques (they include the traditional therapies: Bobath, Brunnstrom, Proprioceptive Neuromuscular Facilitation) and 3) modern approaches among which task oriented motor re-education stands out. The discoveries on the plasticity of the adult brain and the possibility of influencing cerebral reorganization after stroke with specific rehabilitation techniques are opening new prospects. A brief description is given of four recent techniques that have attempted to take advantage of this potential and much more data has been accumulated on their efficacy in recent years than had been accumulated on the traditional treatments during almost 50 years: I) walking on treadmill, with partial suspension; 2) movement therapy induced by restricting the healthy side; 3) the muscular strengthening and physical rehabilitation programs and 4) the robot assisted sensory-motor stimulation. Finally, the scientific data on the possible role of some drugs (amphetamine, fluoxetine) on motor recovery and on the indications and utility of Biofeedback, Functional Electrical Stimulation and combination of both techniques are reviewed.