Palabras clave
hemiparesia
neurorehabilitación
accidente cerebrovascular
marcha
Cómo citar
Resumen
Este estudio de caso describe la evaluación y tratamiento de una mujer de 60 años, ama de casa, quien sufrió un evento cerebrovascular isquémico en 2018, resultando en hemiparesia derecha y afasia. Se abordó su rehabilitación mediante el Concepto Bobath, con énfasis en el control postural, alineación, locomoción y movimiento selectivo, en un contexto de objetivos funcionales específicos y participación activa de la paciente. Después de 7 sesiones en 3 semanas, la paciente mostró mejoría funcional: pasó de 14 a 20 puntos en la Escala de Tinetti y disminuyó el tiempo del test Get Up and Go de 39 a 33 segundos.
Citas
Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, et al. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol[Internet]. 2021;20(10):795–820. doi: 10.1016/S1474-4422(21)00252-0
Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet [Internet]. 2011;377(9778):1693–1702. doi: 10.1016/S0140-6736(11)60325-5
Michielsen M, Vaughan-Graham J, Holland A, Magri A, Suzuki M. The Bobath concept – a model to illustrate clinical practice. Disabil Rehabil [Internet]. 2017; 41(17):2080-2092. doi:10.1080/09638288.2017.1417496.
Vaughan-Graham J, Cott C, Holland A, Michielsen M, Magri A, Suzuki M, et al. Developing a revised definition of the Bobath concept: Phase three. Physiother Res Int [Internet]. 2020;25(3):e1832. doi:10.1002/pri.1832.
Marques S, Vaughan-Graham J, Costa R, Figueiredo D. The Bobath concept (NDT) in adult neurorehabilitation: a scoping review of conceptual literature. Disabil Rehabil [Internet]. 2025;47(6):1379-1390. doi:10.1080/09638288.2024.2375054.
Cagna-Castillo D, Salcedo-Carrillo L, Carrillo-Larco R, Bernabé-Ortiz A. Prevalence and incidence of stroke in Latin America and the Caribbean: a systematic review and meta‑analysis. Sci Rep [Internet]. 2023;13(1):6809. doi: 10.1038/s41598-023-33182-3
Pabón‑Páramo C. Actualización en la prevalencia y carga de la enfermedad cerebrovascular en Costa Rica en el período comprendido entre 2009 y 2019. Rev Med Cos Cen [Internet]. 2020;86(630):6-15. Disponible en: https://www.medigraphic.com/pdfs/revmedcoscen/rmc-2020/rmc20630c.pdf
Longridge T, Mallinson A. A new perspective to interpret how the vestibular efferent system correlates the complexity of routine balance maintenance with management of emergency fall prevention strategies. Audiol Res [Internet]. 2024;14(3):518-544.
Duysens J, Clarac F, Cruse H. Load-regulating mechanisms in gait and posture: comparative aspects. Physiol Rev [Internet]. 2000;80(1):83133. doi: 10.1152/physrev.2000.80.1.83
Rossignol S, Dubuc R, Gossard JP. Dynamic sensorimotor interactions in locomotion. Physiol Rev [Internet]. 2006;86(1):89-154. doi: 10.1152/physrev.00028.2005
Allen JL, McKay JL, Sawers A, Hackney ME, Ting LH. Increased neuromuscular consistency in gait and balance after partnered, dance-based rehabilitation in Parkinson’s disease. J Neurophysiol [Internet]. 2017;118(1): 363-373. doi: 10.1152/jn.00813.2016
Bent LR, McFadyen BJ, Inglis JT. Visual-vestibular interactions in postural control during the execution of a dynamic task. Exp Brain Res [Internet]. 2002;146(4): 490-500. Doi: 10.1007/s00221-002-1204-8
Carvalho Z, Coelho J, Ramos R, De Oliveira D, Machado W, Maniva S, et al. Use of the Tinetti Index to assess fall risk in patients with sequelae of stroke. J Biomed Scienc Eng [Internet]. 2014;7:1088–1094. doi: 10.4236/jbise.2014.714106
Abdollahi M, Rashedi E, Jahangiri S, et al. Fall risk assessment in stroke survivors: a machine learning model using detailed motion data from common clinical tests and motor‑cognitive dual‑tasking. Sensors (Basel). 2024;24(3):812.
Trotman MM, Ha CH. The effects of plantar surface stimulation on neuromuscular responses during standing balance and gait. J Electromyogr Kinesiol. 2025;82:103007. doi:10.1016/j.jelekin.2024.103007
Gjelsvik B, Syre L. The Bobath Concept in Adult Neurology. Alemania: Thieme; 2016.
Ruget H, Blouin JS, Coyle T, Mouchnino L. Modulation of proprioceptive inflow when initiating a step influences postural adjustments. Exp Brain Res. 2010;201(3):409–418. doi:10.1007/s00221-009-2050-z
Yiou E, Caderby T, Delafontaine A, Forucade P, Honeine JL. Balance control during gait initiation: State-of-the-art and research perspectives. World J Orthop [Internet]. 2017;8(11):815-828. doi: 10.5312/wjo.v8.i11.815
Perry J, Burnfield JM. Gait analysis: normal and pathological function. 2a ed. Estados Unidos: SLACK Incorporated; 2010.
McKeon PO, Fourchet F. Freeing the foot: Integrating the foot core system into rehabilitation for lower extremity injuries. Clin Sports Med [Internet]. 2015;34(2):347–361. doi: 10.1016/j.csm.2014.12.002
Tseng SC, Stanhope SJ, Morton SM. Impaired reactive stepping adjustments in older adults. J Gerontol A Biol Sci Med Sci [Internet]. 2009;64A(11):807-815. doi: 10.1093/gerona/glp027
Sahrmann SA. Diagnosis and treatment of movement impairment syndromes.Estados Unidos: Elsevier Mosby; 2001.
Myers JB, Guskiewicz KM, Schneider RA, Prentice WE. Proprioception and neuromuscular control of the shoulder after muscle fatigue. J Athl Train. 1999 Oct;34(4):362–367.
Fraser JJ, Feger MA, Hertel J. Midfoot and forefoot involvement in lateral ankle sprains and chronic ankle instability. Part 1: Anatomy and biomechanics. Int J Sports Phys Ther. 2016 Dec;11(6):992-1005. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC5095951/
Kouzaki M, Masani K. Reduced postural sway during quiet standing by light touch is due to finger tactile feedback but not mechanical support. Exp Brain Res [Internet]. 2008;188(1):153–158. doi: 10.1007/s00221-008-1426-5
Knox MF, Chipchase LS, Schabrun SM, Marshall PW. Anticipatory and compensatory postural adjustments in people with low back pain: a protocol for a systematic review and meta-analysis. Syst Rev. 2016 Apr 16;5:62. doi:10.1186/s13643-016-0242-4. PMCID: PMC4833897. PMID: 27084681.
Thompson C, Bélanger M, Fung J. Effects of plantar cutaneo-muscular and tendon vibration on posture and balance during quiet and perturbed stance. Human Mov Sci [Internet]. 2011;30(2):153-171. doi: 10.1016/j.humov.2010.04.002
Kennedy PM, Inglis JT. Distribution and behaviour of glabrous cutaneous receptors in the human foot sole. J Physiol [Internet]. 2002;538:995–1002. doi: 10.1013/jphysiol.2001.013087
Lacquaniti F, Ivanenko YP, Zago M. Patterned control of human locomotion. J Physiol [Internet]. 2015;593(20):2189-2199. doi: 10.1113/jphysiol.2011.215137
Chiba R, Takakusaki K, Ota J, Yozu A, Haga N. Human upright posture control models based on multisensory inputs; in fast and slow dynamics. Neurosci Res [Internet]. 2016;104:96–104. doi: 10.1016/j.neures.2015.12.002
Song HS, Park SD, Kim JY. The effects of proprioceptive neuromuscular facilitation integration pattern exercise program on fall efficacy and gait ability in the elderly with experienced fall. J Exerc Rehabil [Internet]. 2014;10(4):236-240. doi: 10.12965/jer.140141
Santos MJ, Kanekar N, Aruin AS. The role of anticipatory postural adjustments in cocompensatory control of posture: 2. Biomechanical Analysis. J Electromyogr Kinesiol [Internet]. 2010;20(3):398-405. doi: 10.1016/j.jelekin.2010.01.002
Takakusaki K. Functional neuroanatomy for posture and gait control. J Mov Disord. 2017;10(1):1–17. doi: 10.14802/jmd.16062
Tinetti ME, Williams TF, Mayewski R. Fall risk index for elderly patients based on number of chronic disabilities. Am J Med [Internet]. 1986;80(3):429–434. doi: 10.1016/0002-9343(86)90717-5
Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc [Internet]. 1991;39(2):142–148. doi: 10.1111/j.1532-5415.1991.tb01616.x
Vaughan-Graham J, Cott C. Defining a Bobath clinical framework- A modified e- Delphi study . Physiother Theory Pract [Internet]. 2016;32(8):612-627. doi: 10.1080/09593985.2016.1228722
Bernhardt J, Hayward KS, Dancause N, Lannin NA, Ward NS, Nudo RJ, et al. A stroke recovery trial development framework: Consensus-based core recommendations from the second Stroke Recovery and Rehabilitation Roundtable. Int J Stroke. 2019;14(8):792-802. doi: 10.1177/1747493019879657.
Luft AR, Macko RF, Forrester LW, Villagra F, Ivey F, Sorkin JD, et al. Treadmill exercise activates subcortical neural networks and improves walking after stroke: a randomized controlled trial. Stroke [Internet]. 2008;39(12):3341–3350. doi: 10.1161/STROKEAHA.108.527531
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Derechos de autor 2025 Pablo Campos-Díaz