#88: Constraint-Induced Therapy en ictus. Historia, protocolos y evidencia

En este episodio viajamos desde los orígenes más controvertidos de la Neurociencia moderna hasta la consolidación del protocolo oficial de la Constraint-Induced Therapy (CIMT) en la Universidad de Alabama. Repasamos cómo surgió el concepto de learned non-use, cómo se formalizó la terapia, por qué el Paquete de Transferencia fue una revolución conductual, y qué nos dice la evidencia más robusta.

También exploramos la evolución del protocolo, desde las 6 horas diarias iniciales hasta el formato actual de 3.5h/día, y cómo el equipo brasileño de Sarah Dos Anjos logró expandir la CIMT al miembro inferior con resultados sorprendentes. Cerramos con una revisión profunda del papel del MAL, del protocolo KEYS y de la extended CIMT para manos severas.

Un episodio imprescindible para cualquier profesional que trate a personas con ictus o quiera comprender cómo una intervención conductual intensiva puede modificar el uso real del brazo afecto… y el cerebro.

Referencias del episodio:

1.     Corbetta, D., et al. (2015). Constraint-induced movement therapy for upper extremities in people with stroke. The Cochrane database of systematic reviews, 2015(10), CD004433. (https://pubmed.ncbi.nlm.nih.gov/26446....

2.     Dos Anjos, S. M., et al. (2020). Constraint-Induced Movement Therapy for Improving Motor Function of the Paretic Lower Extremity After Stroke. American journal of physical medicine & rehabilitation, 99(6), e75–e78. (https://pubmed.ncbi.nlm.nih.gov/31246....

3.     Dos Anjos, S., et al. (2020). Constraint-Induced Movement Therapy for Lower Extremity Function: Describing the LE-CIMT Protocol. Physical therapy, 100(4), 698–707. (https://pubmed.ncbi.nlm.nih.gov/31899....

4.     Dos Anjos, S., et al.(2025). Effects of a Distributed Form of Constraint-Induced Movement Therapy for Clinical Application: The Keys Treatment Protocol. Brain sciences, 15(1), 87. (https://pubmed.ncbi.nlm.nih.gov/39851....

5.     Gauthier, L. V., et al. (2008). Remodeling the brain: plastic structural brain changes produced by different motor therapies after stroke. Stroke, 39(5), 1520–1525. (https://pmc.ncbi.nlm.nih.gov/articles....

6.     Hakkennes, S., & Keating, J. L. (2005). Constraint-induced movement therapy following stroke: a systematic review of randomised controlled trials. The Australian journal of physiotherapy, 51(4), 221–231. (https://pubmed.ncbi.nlm.nih.gov/16321....

7.     Morris, D. M., et al. (2006). Constraint-induced movement therapy: characterizing the intervention protocol. Europa medicophysica, 42(3), 257–268 (https://pubmed.ncbi.nlm.nih.gov/17039....

8.     Richards, L., et al. (2006). Limited dose response to constraint-induced movement therapy in patients with chronic stroke. Clinical rehabilitation, 20(12), 1066–1074. (https://pubmed.ncbi.nlm.nih.gov/17148....

9.     Sterr, A., et al. (2002). Longer versus shorter daily constraint-induced movement therapy of chronic hemiparesis: an exploratory study. Archives of physical medicine and rehabilitation, 83(10), 1374–1377.(https://pubmed.ncbi.nlm.nih.gov/12370....

10.  Taub, E., et al. (1993). Technique to improve chronic motor deficit after stroke. Archives of physical medicine and rehabilitation, 74(4), 347–354 (https://pubmed.ncbi.nlm.nih.gov/84664....

11.  Taub, E., et al. (1999). Constraint-Induced Movement Therapy: a new family of techniques with broad application to physical rehabilitation--a clinical review. Journal of rehabilitation research and development, 36(3), 237–251 (https://pubmed.ncbi.nlm.nih.gov/10659....

12.  Taub, E., & Morris, D. M. (2001). Constraint-induced movement therapy to enhance recovery after stroke. Current atherosclerosis reports, 3(4), 279–286. (https://pubmed.ncbi.nlm.nih.gov/11389....

13.  Taub, E. et al. (2013). Method for enhancing real-world use of a more affected arm in chronic stroke: transfer package of constraint-induced movement therapy. Stroke, 44(5), 1383–1388. (https://pubmed.ncbi.nlm.nih.gov/23520....

14.  Uswatte, G., et al., (2006). Contribution of the shaping and restraint components of Constraint-Induced Movement therapy to treatment outcome. NeuroRehabilitation, 21(2), 147–156 (https://pubmed.ncbi.nlm.nih.gov/16917....

15.  Uswatte, G., et al. (2018). Rehabilitation of stroke patients with plegic hands: Randomized controlled trial of expanded Constraint-Induced Movement therapy. Restorative neurology and neuroscience, 36(2), 225–244. (https://pubmed.ncbi.nlm.nih.gov/29526....

16.  Wolf, S. L., et al. (1989). Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients. Experimental neurology, 104(2), 125–132. (https://pubmed.ncbi.nlm.nih.gov/27073....

17.  Wolf, S. L., et al. (2006). Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA, 296(17), 2095–2104.(https://pubmed.ncbi.nlm.nih.gov/17077....