Hemispherics

By Hemispherics

Hemispherics, el podcast de Fisioterapia y Neurorrehabilitación, presentado por Javier Sánchez Aguilar. En este podcast podrán encontrar:

• Reseñas de libros de neurociencia, neurorrehabilitación, fi... more

· Science

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The podcast currently has 85 episodes available.

Hemispherics episodes:

September 06, 2025 #83: Mutismo acinético. Neurofisiopatología y neurorrehabilitación
En este episodio exploramos a fondo el mutismo acinético, una de las manifestaciones más desconcertantes tras un daño cerebral grave. Hablamos de su base neurofisiológica, su relación con el sistema dopaminérgico y los circuitos prefronto-subcorticales, y cómo se diferencia clínicamente de otros estados de conciencia alterada. Recorremos también las opciones terapéuticas más prometedoras, desde la estimulación multisensorial y la verticalización robótica hasta técnicas de neuromodulación como la estimulación cerebral profunda, la estimulación medular o la tDCS. Un episodio técnico, narrativo y lleno de preguntas clínicas clave, pensado para quienes trabajan día a día con pacientes que aún no responden... pero que podrían hacerlo.
Referencias del episodio:
1. Arnts, H., van Erp, W. S., Lavrijsen, J. C. M., van Gaal, S., Groenewegen, H. J., & van den Munckhof, P. (2020). On the pathophysiology and treatment of akinetic mutism. Neuroscience and biobehavioral reviews, 112, 270–278. https://doi.org/10.1016/j.neubiorev.2020.02.006 8 https://pubmed.ncbi.nlm.nih.gov/32044373/).
2. Arnts, H., Tewarie, P., van Erp, W. S., Overbeek, B. U., Stam, C. J., Lavrijsen, J. C. M., Booij, J., Vandertop, W. P., Schuurman, R., Hillebrand, A., & van den Munckhof, P. (2022). Clinical and neurophysiological effects of central thalamic deep brain stimulation in the minimally conscious state after severe brain injury. Scientific reports, 12(1), 12932. https://doi.org/10.1038/s41598-022-16470-2 (https://pubmed.ncbi.nlm.nih.gov/35902627/).
3. Arnts, H., Tewarie, P., van Erp, W., Schuurman, R., Boon, L. I., Pennartz, C. M. A., Stam, C. J., Hillebrand, A., & van den Munckhof, P. (2024). Deep brain stimulation of the central thalamus restores arousal and motivation in a zolpidem-responsive patient with akinetic mutism after severe brain injury. Scientific reports, 14(1), 2950. https://doi.org/10.1038/s41598-024-52267-1 (https://pubmed.ncbi.nlm.nih.gov/38316863/).
4. Bai, Y., Xia, X., Li, X., Wang, Y., Yang, Y., Liu, Y., Liang, Z., & He, J. (2017). Spinal cord stimulation modulates frontal delta and gamma in patients of minimally consciousness state. Neuroscience, 346, 247–254. https://doi.org/10.1016/j.neuroscience.2017.01.036 (https://pubmed.ncbi.nlm.nih.gov/28147246/).
5. Bai, Y., Xia, X., Liang, Z., Wang, Y., Yang, Y., He, J., & Li, X. (2017). Corrigendum: Frontal Connectivity in EEG Gamma (30-45 Hz) Respond to Spinal Cord Stimulation in Minimally Conscious State Patients. Frontiers in cellular neuroscience, 11, 251. https://doi.org/10.3389/fncel.2017.00251 (https://pubmed.ncbi.nlm.nih.gov/28828002/).
6. Bai, Y., Lin, Y., & Ziemann, U. (2021). Managing disorders of consciousness: the role of electroencephalography. Journal of neurology, 268(11), 4033–4065. https://doi.org/10.1007/s00415-020-10095-z (https://pubmed.ncbi.nlm.nih.gov/32915309/).
7. Cairns, H., Oldfield, R. C., Pennybacker, J. B., & Whitteridge, D. (1941). Akinetic mutism with an epidermoid cyst of the 3rd ventricle. Brain, 64(4), 273–290 (https://academic.oup.com/brain/article-abstract/64/4/273/332088?redirectedFrom=fulltext).
8. Chen, Q., Huang, W., Tang, J., Ye, G., Meng, H., Jiang, Q., Ge, L., Li, H., Liu, L., Jiang, Q., & Wang, D. (2025). Reviving consciousness: The impact of short-term spinal cord stimulation on patients with early-onset prolonged disorders of consciousness. Journal of Neurorestoratology, 13(1), 100143. https://doi.org/10.1016/j.jnrt.2024.100143 (https://www.sciencedirect.com/science/article/pii/S2324242624000500?via%3Dihub).
9. Clavo, B., Robaina, F., Montz, R., Carames, M. A., Otermin, E., & Carreras, J. L. (2008). Effect of cervical spinal cord stimulation on cerebral glucose metabolism. Neurological research, 30(6), 652–654. https://doi.org/10.1179/174313208X305373 (https://pubmed.ncbi.nlm.nih.gov/18513465/).
10. Corazzol, M., Lio, G., Lefevre, A., Deiana, G., Tell, L., André-Obadia, N., Bourdillon, P., Guenot, M., Desmurget, M., Luauté, J., & Sirigu, A. (2017). Restoring consciousness with vagus nerve stimulation. Current biology : CB, 27(18), R994–R996. https://doi.org/10.1016/j.cub.2017.07.060 (https://pubmed.ncbi.nlm.nih.gov/28950091/).
11. Della Pepa, G. M., Fukaya, C., La Rocca, G., Zhong, J., & Visocchi, M. (2013). Neuromodulation of vegetative state through spinal cord stimulation: where are we now and where are we going?. Stereotactic and functional neurosurgery, 91(5), 275–287. https://doi.org/10.1159/000348271 (https://pubmed.ncbi.nlm.nih.gov/23797266/).
12. De Luca, R., Bonanno, M., Vermiglio, G., Trombetta, G., Andidero, E., Caminiti, A., Pollicino, P., Rifici, C., & Calabrò, R. S. (2022). Robotic Verticalization plus Music Therapy in Chronic Disorders of Consciousness: Promising Results from a Pilot Study. Brain sciences, 12(8), 1045. https://doi.org/10.3390/brainsci12081045 (https://pubmed.ncbi.nlm.nih.gov/36009107/).
13. Dong, X., Tang, Y., Zhou, Y., & Feng, Z. (2023). Stimulation of vagus nerve for patients with disorders of consciousness: a systematic review. Frontiers in neuroscience, 17, 1257378. https://doi.org/10.3389/fnins.2023.1257378 (https://pubmed.ncbi.nlm.nih.gov/37781261/).
14. Fan, W., Fan, Y., Liao, Z., & Yin, Y. (2023). Effect of Transcranial Direct Current Stimulation on Patients With Disorders of Consciousness: A Systematic Review and Meta-analysis. American journal of physical medicine & rehabilitation, 102(12), 1102–1110. https://doi.org/10.1097/PHM.0000000000002290 (https://pubmed.ncbi.nlm.nih.gov/37205736/).
15. Frazzitta, G., Zivi, I., Valsecchi, R., Bonini, S., Maffia, S., Molatore, K., Sebastianelli, L., Zarucchi, A., Matteri, D., Ercoli, G., Maestri, R., & Saltuari, L. (2016). Effectiveness of a Very Early Stepping Verticalization Protocol in Severe Acquired Brain Injured Patients: A Randomized Pilot Study in ICU. PloS one, 11(7), e0158030. https://doi.org/10.1371/journal.pone.0158030 (https://pubmed.ncbi.nlm.nih.gov/27447483/).
16. Jang, S. H., & Byun, D. H. (2022). A Review of Studies on the Role of Diffusion Tensor Magnetic Resonance Imaging Tractography in the Evaluation of the Fronto-Subcortical Circuit in Patients with Akinetic Mutism. Medical science monitor : international medical journal of experimental and clinical research, 28, e936251. https://doi.org/10.12659/MSM.936251 (https://pubmed.ncbi.nlm.nih.gov/35181647/).
17. Lombardi, F., Taricco, M., De Tanti, A., Telaro, E., & Liberati, A. (2002). Sensory stimulation for brain injured individuals in coma or vegetative state. The Cochrane database of systematic reviews, 2002(2), CD001427. https://doi.org/10.1002/14651858.CD001427 (https://pmc.ncbi.nlm.nih.gov/articles/PMC7045727/).
18. Magee, W. L., & O'Kelly, J. (2015). Music therapy with disorders of consciousness: current evidence and emergent evidence-based practice. Annals of the New York Academy of Sciences, 1337, 256–262. https://doi.org/10.1111/nyas.12633 (https://pubmed.ncbi.nlm.nih.gov/25773642/).
19. Mateo-Sierra, O., Gutiérrez, F.A., Fernández-Carballal, C., Pinilla, D., Mosqueira, B., Iza, B., & Carrillo, R.. (2005). Mutismo acinético relacionado con hidrocefalia y cirugía cerebelosa tratado con bromocriptina y efedrina: revisión fisiopatológica. Neurocirugía, 16(2), 134-141. (https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-14732005000200005).
20. Noé, E., Ferri, J., Colomer, C., Moliner, B., O'Valle, M., Ugart, P., Rodriguez, C., & Llorens, R. (2020). Feasibility, safety and efficacy of transauricular vagus nerve stimulation in a cohort of patients with disorders of consciousness. Brain stimulation, 13(2), 427–429. https://doi.org/10.1016/j.brs.2019.12.005 (https://pubmed.ncbi.nlm.nih.gov/31866491/).
21. Norwood, M. F., Lakhani, A., Watling, D. P., Marsh, C. H., & Zeeman, H. (2023). Efficacy of Multimodal Sensory Therapy in Adult Acquired Brain Injury: A Systematic Review. Neuropsychology review, 33(4), 693–713. https://doi.org/10.1007/s11065-022-09560-5 (https://pubmed.ncbi.nlm.nih.gov/36056243/).
22. O'Neal, C. M., Schroeder, L. N., Wells, A. A., Chen, S., Stephens, T. M., Glenn, C. A., & Conner, A. K. (2021). Patient Outcomes in Disorders of Consciousness Following Transcranial Magnetic Stimulation: A Systematic Review and Meta-Analysis of Individual Patient Data. Frontiers in neurology, 12, 694970. https://doi.org/10.3389/fneur.2021.694970 (https://pubmed.ncbi.nlm.nih.gov/34475848/).
23. Schiff, N. D., Giacino, J. T., Kalmar, K., Victor, J. D., Baker, K., Gerber, M., Fritz, B., Eisenberg, B., Biondi, T., O'Connor, J., Kobylarz, E. J., Farris, S., Machado, A., McCagg, C., Plum, F., Fins, J. J., & Rezai, A. R. (2007). Behavioural improvements with thalamic stimulation after severe traumatic brain injury. Nature, 448(7153), 600–603. https://doi.org/10.1038/nature06041 (https://pubmed.ncbi.nlm.nih.gov/17671503/).
24. Schiff N. D. (2016). Central thalamic deep brain stimulation to support anterior forebrain mesocircuit function in the severely injured brain. Journal of neural transmission (Vienna, Austria : 1996), 123(7), 797–806. https://doi.org/10.1007/s00702-016-1547-0 (https://pubmed.ncbi.nlm.nih.gov/27113938/).
25. Schiff N. D. (2023). Mesocircuit mechanisms in the diagnosis and treatment of disorders of consciousness. Presse medicale (Paris, France : 1983), 52(2), 104161. https://doi.org/10.1016/j.lpm.2022.104161 (https://pubmed.ncbi.nlm.nih.gov/36563999/).
26. Shimojo, S., & Shams, L. (2001). Sensory modalities are not separate modalities: plasticity and interactions. Current opinion in neurobiology, 11(4), 505–509. https://doi.org/10.1016/s0959-4388(00)00241-5 (https://pubmed.ncbi.nlm.nih.gov/11502399/).
27. Stephens, T. M., Young, I. M., O'Neal, C. M., Dadario, N. B., Briggs, R. G., Teo, C., & Sughrue, M. E. (2021). Akinetic mutism reversed by inferior parietal lobule repetitive theta burst stimulation: Can we restore default mode network function for therapeutic benefit?. Brain and behavior, 11(8), e02180. https://doi.org/10.1002/brb3.2180 (https://pubmed.ncbi.nlm.nih.gov/34145791/).
28. Piedade, G. S., Assumpcao de Monaco, B., Guest, J. D., & Cordeiro, J. G. (2023). Review of spinal cord stimulation for disorders of consciousness. Current opinion in neurology, 36(6), 507–515. https://doi.org/10.1097/WCO.0000000000001222 (https://pubmed.ncbi.nlm.nih.gov/37889524/).
29. Rosenfelder, M. J., Helmschrott, V. C., Willacker, L., Einhäupl, B., Raiser, T. M., & Bender, A. (2023). Effect of robotic tilt table verticalization on recovery in patients with disorders of consciousness: a randomized controlled trial. Journal of neurology, 270(3), 1721–1734. https://doi.org/10.1007/s00415-022-11508-x (https://pubmed.ncbi.nlm.nih.gov/36536249/).
30. Thibaut, A., Bruno, M. A., Ledoux, D., Demertzi, A., & Laureys, S. (2014). tDCS in patients with disorders of consciousness: sham-controlled randomized double-blind study. Neurology, 82(13), 1112–1118. https://doi.org/10.1212/WNL.0000000000000260 (https://pubmed.ncbi.nlm.nih.gov/24574549/).
31. Visocchi, M., Della Pepa, G. M., Esposito, G., Tufo, T., Zhang, W., Li, S., & Zhong, J. (2011). Spinal cord stimulation and cerebral hemodynamics: updated mechanism and therapeutic implications. Stereotactic and functional neurosurgery, 89(5), 263–274. https://doi.org/10.1159/000329357 (https://pubmed.ncbi.nlm.nih.gov/21860253/).
32. Yang, Y., He, Q., Xia, X., Dang, Y., Chen, X., He, J., & Zhao, J. (2022). Long-term functional prognosis and related factors of spinal cord stimulation in patients with disorders of consciousness. CNS neuroscience & therapeutics, 28(8), 1249–1258. https://doi.org/10.1111/cns.13870 (https://pubmed.ncbi.nlm.nih.gov/35619213/).
33. Yang, Y., He, Q., Dang, Y., Xia, X., Xu, X., Chen, X., Zhao, J., & He, J. (2023). Long-term functional outcomes improved with deep brain stimulation in patients with disorders of consciousness. Stroke and vascular neurology, 8(5), 368–378. https://doi.org/10.1136/svn-2022-001998 (https://pubmed.ncbi.nlm.nih.gov/36882201/).
34. Yu, Y. T., Yang, Y., Wang, L. B., Fang, J. L., Chen, Y. Y., He, J. H., & Rong, P. J. (2017). Transcutaneous auricular vagus nerve stimulation in disorders of consciousness monitored by fMRI: The first case report. Brain stimulation, 10(2), 328–330. https://doi.org/10.1016/j.brs.2016.12.004 (https://pubmed.ncbi.nlm.nih.gov/28017322/).
35. Zhou, Y. F., Kang, J. W., Xiong, Q., Feng, Z., & Dong, X. Y. (2023). Transauricular vagus nerve stimulation for patients with disorders of consciousness: A randomized controlled clinical trial. Frontiers in neurology, 14, 1133893. https://doi.org/10.3389/fneur.2023.1133893 (https://pubmed.ncbi.nlm.nih.gov/36937511/).
36. Zhuang, Y., Yang, Y., Xu, L., Chen, X., Geng, X., Zhao, J., & He, J. (2022). Effects of short-term spinal cord stimulation on patients with prolonged disorder of consciousness: A pilot study. Frontiers in neurology, 13, 1026221. https://doi.org/10.3389/fneur.2022.1026221 (https://pubmed.ncbi.nlm.nih.gov/36313512/).
37. Zuo, J., Tao, Y., Liu, M., Feng, L., Yang, Y., & Liao, L. (2021). The effect of family-centered sensory and affective stimulation on comatose patients with traumatic brain injury: A systematic review and meta-analysis. International journal of nursing studies, 115, 103846. https://doi.org/10.1016/j.ijnurstu.2020.103846 (https://pubmed.ncbi.nlm.nih.gov/33485101/).
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1h 34min
August 09, 2025 #82: Los apellidos del cerebro y el mito del cerebro bayesiano
En este episodio exploramos las diversas formas en que se ha conceptualizado el funcionamiento del cerebro humano, guiados por las fascinantes metáforas divulgadas por el neuropsicólogo Javier Tirapu Ustárroz: el cerebro darwiniano (instinto y evolución), el skinneriano (aprendizaje por refuerzo), el popperiano (simulación mental y predicción), y el gregoriano (empatía y simulación social).
Profundizamos luego en la controvertida hipótesis del "cerebro bayesiano", según la cual nuestro cerebro actuaría como un científico estadístico que actualiza constantemente sus creencias sobre el mundo combinando experiencias previas y nueva información sensorial. Apoyándonos en el provocador artículo de Madhur Mangalam, "The Myth of the Bayesian Brain" (2025), examinamos en profundidad las fortalezas y las debilidades de este paradigma tan influyente.
Referencias del episodio:
1. Mangalam M. (2025). The myth of the Bayesian brain. European journal of applied physiology, 10.1007/s00421-025-05855-6. Advance online publication. https://doi.org/10.1007/s00421-025-05855-6 (https://pubmed.ncbi.nlm.nih.gov/40569419/).
2. Tirapu Ustárroz, J. (2008). ¿Para qué sirve el cerebro? Manual para principiantes. Editorial Alianza (https://www.calameo.com/books/00638959573c26c5b3fbc).
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28min
July 26, 2025 #81: Neurorrehabilitación somatosensorial en el ictus
En este episodio nos adentramos en una dimensión tan esencial como olvidada de la recuperación neurológica: la sensibilidad. Exploramos con profundidad la neurofisiología de los sistemas sensoriales, los tipos de sensibilidad, las vías implicadas y los déficits somatosensoriales que pueden aparecer tras un ictus. Hablamos de evaluación clínica y neurofisiológica, de escalas, de estereognosia, de patrones exploratorios, y de la implicación cortical tras una lesión. Abordamos también las principales intervenciones terapéuticas, desde la estimulación eléctrica sensitiva (SAES) hasta el entrenamiento activo sensitivo, repasando la evidencia más actual y las claves para una rehabilitación sensitiva eficaz.
Referencias del episodio:
1. Bastos, V. S., Faria, C. D. C. M., Faria-Fortini, I., & Scianni, A. A. (2025). Prevalence of sensory impairments and its contribution to functional disability in individuals with acute stroke: A cross-sectional study. Revue neurologique, 181(3), 210–216. https://doi.org/10.1016/j.neurol.2024.12.001 (https://pubmed.ncbi.nlm.nih.gov/39765442/).
2. Boccuni, L., Meyer, S., Kessner, S. S., De Bruyn, N., Essers, B., Cheng, B., Thomalla, G., Peeters, A., Sunaert, S., Duprez, T., Marinelli, L., Trompetto, C., Thijs, V., & Verheyden, G. (2018). Is There Full or Proportional Somatosensory Recovery in the Upper Limb After Stroke? Investigating Behavioral Outcome and Neural Correlates. Neurorehabilitation and neural repair, 32(8), 691–700. https://doi.org/10.1177/1545968318787060 (https://pubmed.ncbi.nlm.nih.gov/29991331/).
3. Carey, L. M., Matyas, T. A., & Oke, L. E. (1993). Sensory loss in stroke patients: effective training of tactile and proprioceptive discrimination. Archives of physical medicine and rehabilitation, 74(6), 602–611. https://doi.org/10.1016/0003-9993(93)90158-7 (https://pubmed.ncbi.nlm.nih.gov/8503750/).
4. Carey, L. M., Oke, L. E., & Matyas, T. A. (1996). Impaired limb position sense after stroke: a quantitative test for clinical use. Archives of physical medicine and rehabilitation, 77(12), 1271–1278. https://doi.org/10.1016/s0003-9993(96)90192-6 (https://pubmed.ncbi.nlm.nih.gov/8976311/).
5. Carey, L. M., & Matyas, T. A. (2005). Training of somatosensory discrimination after stroke: facilitation of stimulus generalization. American journal of physical medicine & rehabilitation, 84(6), 428–442. https://doi.org/10.1097/01.phm.0000159971.12096.7f (https://pubmed.ncbi.nlm.nih.gov/15905657/).
6. Carey, L., Macdonell, R., & Matyas, T. A. (2011). SENSe: Study of the Effectiveness of Neurorehabilitation on Sensation: a randomized controlled trial. Neurorehabilitation and neural repair, 25(4), 304–313. https://doi.org/10.1177/1545968310397705 (https://pubmed.ncbi.nlm.nih.gov/21350049/).
7. Carey, L. M., Abbott, D. F., Lamp, G., Puce, A., Seitz, R. J., & Donnan, G. A. (2016). Same Intervention-Different Reorganization: The Impact of Lesion Location on Training-Facilitated Somatosensory Recovery After Stroke. Neurorehabilitation and neural repair, 30(10), 988–1000. https://doi.org/10.1177/1545968316653836 (https://pubmed.ncbi.nlm.nih.gov/27325624/).
8. Carey, L. M., Matyas, T. A., & Baum, C. (2018). Effects of Somatosensory Impairment on Participation After Stroke. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 72(3), 7203205100p1–7203205100p10. https://doi.org/10.5014/ajot.2018.025114 (https://pubmed.ncbi.nlm.nih.gov/29689179/).
9. Chilvers, M., Low, T., Rajashekar, D., & Dukelow, S. (2024). White matter disconnection impacts proprioception post-stroke. PloS one, 19(9), e0310312. https://doi.org/10.1371/journal.pone.0310312 (https://pubmed.ncbi.nlm.nih.gov/39264972/).
10. Conforto, A. B., Dos Anjos, S. M., Bernardo, W. M., Silva, A. A. D., Conti, J., Machado, A. G., & Cohen, L. G. (2018). Repetitive Peripheral Sensory Stimulation and Upper Limb Performance in Stroke: A Systematic Review and Meta-analysis. Neurorehabilitation and neural repair, 32(10), 863–871. https://doi.org/10.1177/1545968318798943 (https://pmc.ncbi.nlm.nih.gov/articles/PMC6404964/#SM1).
11. Cuesta, C. (2016). El procesamiento de la información somatosensorial y la funcionalidad de la mano en pacientes con daño cerebral adquirido (https://burjcdigital.urjc.es/items/609ccf16-4688-0c23-e053-6f19a8c0ba23).
12. De Bruyn, N., Meyer, S., Kessner, S. S., Essers, B., Cheng, B., Thomalla, G., Peeters, A., Sunaert, S., Duprez, T., Thijs, V., Feys, H., Alaerts, K., & Verheyden, G. (2018). Functional network connectivity is altered in patients with upper limb somatosensory impairments in the acute phase post stroke: A cross-sectional study. PloS one, 13(10), e0205693. https://doi.org/10.1371/journal.pone.0205693 (https://pubmed.ncbi.nlm.nih.gov/30312350/).
13. De Bruyn, N., Saenen, L., Thijs, L., Van Gils, A., Ceulemans, E., Essers, B., Alaerts, K., & Verheyden, G. (2021). Brain connectivity alterations after additional sensorimotor or motor therapy for the upper limb in the early-phase post stroke: a randomized controlled trial. Brain communications, 3(2), fcab074. https://doi.org/10.1093/braincomms/fcab074 (https://pubmed.ncbi.nlm.nih.gov/33937771/).
14. Grant, V. M., Gibson, A., & Shields, N. (2018). Somatosensory stimulation to improve hand and upper limb function after stroke-a systematic review with meta-analyses. Topics in stroke rehabilitation, 25(2), 150–160. https://doi.org/10.1080/10749357.2017.1389054 (https://pubmed.ncbi.nlm.nih.gov/29050540/).
15. Kessner, S. S., Schlemm, E., Cheng, B., Bingel, U., Fiehler, J., Gerloff, C., & Thomalla, G. (2019). Somatosensory Deficits After Ischemic Stroke. Stroke, 50(5), 1116–1123. https://doi.org/10.1161/STROKEAHA.118.023750 (https://pubmed.ncbi.nlm.nih.gov/30943883/).
16. Ladera V, Perea MV. Agnosias auditivas, somáticas y táctiles. Rev Neuropsicol y Neurociencias. 2015;15(1):87–108 (http://revistaneurociencias.com/index.php/RNNN/article/view/82).
17. Laufer, Y., & Elboim-Gabyzon, M. (2011). Does sensory transcutaneous electrical stimulation enhance motor recovery following a stroke? A systematic review. Neurorehabilitation and neural repair, 25(9), 799–809. https://doi.org/10.1177/1545968310397205 (https://pubmed.ncbi.nlm.nih.gov/21746874/).
18. Lederman, S. J., & Klatzky, R. L. (1987). Hand movements: a window into haptic object recognition. Cognitive psychology, 19(3), 342–368. https://doi.org/10.1016/0010-0285(87)90008-9 (https://pubmed.ncbi.nlm.nih.gov/3608405/).
19. Meyer, S., De Bruyn, N., Lafosse, C., Van Dijk, M., Michielsen, M., Thijs, L., Truyens, V., Oostra, K., Krumlinde-Sundholm, L., Peeters, A., Thijs, V., Feys, H., & Verheyden, G. (2016). Somatosensory Impairments in the Upper Limb Poststroke: Distribution and Association With Motor Function and Visuospatial Neglect. Neurorehabilitation and neural repair, 30(8), 731–742. https://doi.org/10.1177/1545968315624779 (https://pubmed.ncbi.nlm.nih.gov/26719352/).
20. Miguel-Quesada, C., Zaforas, M., Herrera-Pérez, S., Lines, J., Fernández-López, E., Alonso-Calviño, E., Ardaya, M., Soria, F. N., Araque, A., Aguilar, J., & Rosa, J. M. (2023). Astrocytes adjust the dynamic range of cortical network activity to control modality-specific sensory information processing. Cell reports, 42(8), 112950. https://doi.org/10.1016/j.celrep.2023.112950 (https://pubmed.ncbi.nlm.nih.gov/37543946/).
21. Moore, R. T., Piitz, M. A., Singh, N., Dukelow, S. P., & Cluff, T. (2024). The independence of impairments in proprioception and visuomotor adaptation after stroke. Journal of neuroengineering and rehabilitation, 21(1), 81. https://doi.org/10.1186/s12984-024-01360-7 (https://pubmed.ncbi.nlm.nih.gov/38762552/).
22. Opsommer, E., Zwissig, C., Korogod, N., & Weiss, T. (2016). Effectiveness of temporary deafferentation of the arm on somatosensory and motor functions following stroke: a systematic review. JBI database of systematic reviews and implementation reports, 14(12), 226–257. https://doi.org/10.11124/JBISRIR-2016-003231 (https://pubmed.ncbi.nlm.nih.gov/28009677/).
23. Sharififar, S., Shuster, J. J., & Bishop, M. D. (2018). Adding electrical stimulation during standard rehabilitation after stroke to improve motor function. A systematic review and meta-analysis. Annals of physical and rehabilitation medicine, 61(5), 339–344. https://doi.org/10.1016/j.rehab.2018.06.005 (https://pubmed.ncbi.nlm.nih.gov/29958963/).
24. Stolk-Hornsveld, F., Crow, J. L., Hendriks, E. P., van der Baan, R., & Harmeling-van der Wel, B. C. (2006). The Erasmus MC modifications to the (revised) Nottingham Sensory Assessment: a reliable somatosensory assessment measure for patients with intracranial disorders. Clinical rehabilitation, 20(2), 160–172. https://doi.org/10.1191/0269215506cr932oa (https://pubmed.ncbi.nlm.nih.gov/16541937/).
25. Turville, M., Carey, L. M., Matyas, T. A., & Blennerhassett, J. (2017). Change in Functional Arm Use Is Associated With Somatosensory Skills After Sensory Retraining Poststroke. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 71(3), 7103190070p1–7103190070p9. https://doi.org/10.5014/ajot.2017.024950 (https://pubmed.ncbi.nlm.nih.gov/28422633/).
26. Turville, M. L., Cahill, L. S., Matyas, T. A., Blennerhassett, J. M., & Carey, L. M. (2019). The effectiveness of somatosensory retraining for improving sensory function in the arm following stroke: a systematic review. Clinical rehabilitation, 33(5), 834–846. https://doi.org/10.1177/0269215519829795 (https://pubmed.ncbi.nlm.nih.gov/30798643/).
27. Villar Ortega, E., Buetler, K. A., Aksöz, E. A., & Marchal-Crespo, L. (2024). Enhancing touch sensibility with sensory electrical stimulation and sensory retraining. Journal of neuroengineering and rehabilitation, 21(1), 79. https://doi.org/10.1186/s12984-024-01371-4 (https://pubmed.ncbi.nlm.nih.gov/38750521/).
28. Yilmazer, C., Boccuni, L., Thijs, L., & Verheyden, G. (2019). Effectiveness of somatosensory interventions on somatosensory, motor and functional outcomes in the upper limb post-stroke: A systematic review and meta-analysis. NeuroRehabilitation, 44(4), 459–477. https://doi.org/10.3233/NRE-192687 (https://pubmed.ncbi.nlm.nih.gov/31256086/).
29. Zamarro-Rodríguez, B. D., Gómez-Martínez, M., & Cuesta-García, C. (2021). Validation of Spanish Erasmus-Modified Nottingham Sensory Assessment Stereognosis Scale in Acquired Brain Damage. International journal of environmental research and public health, 18(23), 12564. https://doi.org/10.3390/ijerph182312564 (https://pubmed.ncbi.nlm.nih.gov/34886287/).
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1h 49min
May 24, 2025 #80: El tracto corticoespinal: All in
En este episodio, nos sumergimos en la vía motora más determinante del sistema nervioso humano: el tracto corticoespinal. A través de un recorrido detallado por su evolución, desarrollo, anatomía y función, analizamos por qué esta vía representa la gran apuesta evolutiva por la motricidad fina y por qué su lesión tiene consecuencias tan devastadoras. Hablamos de neurofisiología, de plasticidad, de evaluación con TMS y DTI, de terapias intensivas, neuromodulación, farmacología, robótica y de las posibilidades —y límites— reales de su regeneración tras un ictus. Si te interesa entender en profundidad cómo se ejecuta el movimiento voluntario y qué ocurre cuando esa vía falla, este episodio es para ti.
Referencias del episodio:
1. Alawieh, A., Tomlinson, S., Adkins, D., Kautz, S., & Feng, W. (2017). Preclinical and Clinical Evidence on Ipsilateral Corticospinal Projections: Implication for Motor Recovery. Translational stroke research, 8(6), 529–540. https://doi.org/10.1007/s12975-017-0551-5 (https://pubmed.ncbi.nlm.nih.gov/28691140/).
2. Cho, M. J., Yeo, S. S., Lee, S. J., & Jang, S. H. (2023). Correlation between spasticity and corticospinal/corticoreticular tract status in stroke patients after early stage. Medicine, 102(17), e33604. https://doi.org/10.1097/MD.0000000000033604 (https://pubmed.ncbi.nlm.nih.gov/37115067/).
3. Dalamagkas, K., Tsintou, M., Rathi, Y., O'Donnell, L. J., Pasternak, O., Gong, X., Zhu, A., Savadjiev, P., Papadimitriou, G. M., Kubicki, M., Yeterian, E. H., & Makris, N. (2020). Individual variations of the human corticospinal tract and its hand-related motor fibers using diffusion MRI tractography. Brain imaging and behavior, 14(3), 696–714. https://doi.org/10.1007/s11682-018-0006-y (https://pubmed.ncbi.nlm.nih.gov/30617788/).
4. Duque-Parra, Jorge Eduardo, Mendoza-Zuluaga, Julián, & Barco-Ríos, John. (2020). El Tracto Cortico Espinal: Perspectiva Histórica. International Journal of Morphology, 38(6), 1614-1617. https://dx.doi.org/10.4067/S0717-95022020000601614 (https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-95022020000601614).
5. Eyre, J. A., Miller, S., Clowry, G. J., Conway, E. A., & Watts, C. (2000). Functional corticospinal projections are established prenatally in the human foetus permitting involvement in the development of spinal motor centres. Brain : a journal of neurology, 123 ( Pt 1), 51–64. https://doi.org/10.1093/brain/123.1.51 (https://pubmed.ncbi.nlm.nih.gov/10611120/).
6. He, J., Zhang, F., Pan, Y., Feng, Y., Rushmore, J., Torio, E., Rathi, Y., Makris, N., Kikinis, R., Golby, A. J., & O'Donnell, L. J. (2023). Reconstructing the somatotopic organization of the corticospinal tract remains a challenge for modern tractography methods. Human brain mapping, 44(17), 6055–6073. https://doi.org/10.1002/hbm.26497 (https://pubmed.ncbi.nlm.nih.gov/37792280/).
7. Huang, L., Yi, L., Huang, H., Zhan, S., Chen, R., & Yue, Z. (2024). Corticospinal tract: a new hope for the treatment of post-stroke spasticity. Acta neurologica Belgica, 124(1), 25–36. https://doi.org/10.1007/s13760-023-02377-w (https://pubmed.ncbi.nlm.nih.gov/37704780/).
8. Kazim, S. F., Bowers, C. A., Cole, C. D., Varela, S., Karimov, Z., Martinez, E., Ogulnick, J. V., & Schmidt, M. H. (2021). Corticospinal Motor Circuit Plasticity After Spinal Cord Injury: Harnessing Neuroplasticity to Improve Functional Outcomes. Molecular neurobiology, 58(11), 5494–5516. https://doi.org/10.1007/s12035-021-02484-w (https://pubmed.ncbi.nlm.nih.gov/34341881/).
9. Kwon, Y. M., Kwon, H. G., Rose, J., & Son, S. M. (2016). The Change of Intra-cerebral CST Location during Childhood and Adolescence; Diffusion Tensor Tractography Study. Frontiers in human neuroscience, 10, 638. https://doi.org/10.3389/fnhum.2016.00638 (https://pubmed.ncbi.nlm.nih.gov/28066209/).
10. Lemon, R. N., Landau, W., Tutssel, D., & Lawrence, D. G. (2012). Lawrence and Kuypers (1968a, b) revisited: copies of the original filmed material from their classic papers in Brain. Brain : a journal of neurology, 135(Pt 7), 2290–2295. https://doi.org/10.1093/brain/aws037 (https://pubmed.ncbi.nlm.nih.gov/22374938/).
11. Li S. (2017). Spasticity, Motor Recovery, and Neural Plasticity after Stroke. Frontiers in neurology, 8, 120. https://doi.org/10.3389/fneur.2017.00120 (https://pubmed.ncbi.nlm.nih.gov/28421032/).
12. Liu, Z., Chopp, M., Ding, X., Cui, Y., & Li, Y. (2013). Axonal remodeling of the corticospinal tract in the spinal cord contributes to voluntary motor recovery after stroke in adult mice. Stroke, 44(7), 1951–1956. https://doi.org/10.1161/STROKEAHA.113.001162 (https://pubmed.ncbi.nlm.nih.gov/23696550/).
13. Liu, K., Lu, Y., Lee, J. K., Samara, R., Willenberg, R., Sears-Kraxberger, I., Tedeschi, A., Park, K. K., Jin, D., Cai, B., Xu, B., Connolly, L., Steward, O., Zheng, B., & He, Z. (2010). PTEN deletion enhances the regenerative ability of adult corticospinal neurons. Nature neuroscience, 13(9), 1075–1081. https://doi.org/10.1038/nn.2603 (https://pubmed.ncbi.nlm.nih.gov/20694004/).
14. Schieber M. H. (2007). Chapter 2 Comparative anatomy and physiology of the corticospinal system. Handbook of clinical neurology, 82, 15–37. https://doi.org/10.1016/S0072-9752(07)80005-4 (https://pubmed.ncbi.nlm.nih.gov/18808887/).
15. Stinear, C. M., Barber, P. A., Smale, P. R., Coxon, J. P., Fleming, M. K., & Byblow, W. D. (2007). Functional potential in chronic stroke patients depends on corticospinal tract integrity. Brain : a journal of neurology, 130(Pt 1), 170–180. https://doi.org/10.1093/brain/awl333 (https://pubmed.ncbi.nlm.nih.gov/17148468/).
16. Usuda, N., Sugawara, S. K., Fukuyama, H., Nakazawa, K., Amemiya, K., & Nishimura, Y. (2022). Quantitative comparison of corticospinal tracts arising from different cortical areas in humans. Neuroscience research, 183, 30–49. https://doi.org/10.1016/j.neures.2022.06.008 (https://pubmed.ncbi.nlm.nih.gov/35787428/).
17. Ward, N. S., Brander, F., & Kelly, K. (2019). Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme. Journal of neurology, neurosurgery, and psychiatry, 90(5), 498–506. https://doi.org/10.1136/jnnp-2018-319954 (https://pubmed.ncbi.nlm.nih.gov/30770457/).
18. Welniarz, Q., Dusart, I., & Roze, E. (2017). The corticospinal tract: Evolution, development, and human disorders. Developmental neurobiology, 77(7), 810–829. https://doi.org/10.1002/dneu.22455 (https://pubmed.ncbi.nlm.nih.gov/27706924/).
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1h 42min
May 10, 2025 #79: La denervación en la lesión medular y la estimulación eléctrica
En este episodio, profundizamos en uno de los fenómenos más devastadores pero menos comprendidos en neurorrehabilitación: la denervación muscular tras una lesión medular. A través de una revisión exhaustiva de la literatura científica y de la experiencia clínica, abordamos qué ocurre realmente con los músculos que han perdido su inervación, cómo se transforman con el tiempo y qué posibilidades tenemos para intervenir. Hablamos sobre neurofisiología, degeneración axonal, fases de la denervación, y cómo la estimulación eléctrica —especialmente con pulsos largos— puede modificar el curso degenerativo incluso años después de la lesión. Exploramos también el Proyecto RISE, los protocolos clínicos actuales y las implicaciones terapéuticas reales de aplicar electroestimulación en músculos completamente denervados. Si trabajas en neurorrehabilitación o te interesa la ciencia aplicada a la recuperación funcional, este episodio es para ti.
Referencias del episodio:
1. Alberty, M., Mayr, W., & Bersch, I. (2023). Electrical Stimulation for Preventing Skin Injuries in Denervated Gluteal Muscles-Promising Perspectives from a Case Series and Narrative Review. Diagnostics (Basel, Switzerland), 13(2), 219. https://doi.org/10.3390/diagnostics13020219 (https://pubmed.ncbi.nlm.nih.gov/36673029/).
2. Beauparlant, J., van den Brand, R., Barraud, Q., Friedli, L., Musienko, P., Dietz, V., & Courtine, G. (2013). Undirected compensatory plasticity contributes to neuronal dysfunction after severe spinal cord injury. Brain : a journal of neurology, 136(Pt 11), 3347–3361. https://doi.org/10.1093/brain/awt204 (https://pubmed.ncbi.nlm.nih.gov/24080153/).
3. Bersch, I., & Fridén, J. (2021). Electrical stimulation alters muscle morphological properties in denervated upper limb muscles. EBioMedicine, 74, 103737. https://doi.org/10.1016/j.ebiom.2021.103737 (https://pubmed.ncbi.nlm.nih.gov/34896792/).
4. Bersch, I., & Mayr, W. (2023). Electrical stimulation in lower motoneuron lesions, from scientific evidence to clinical practice: a successful transition. European journal of translational myology, 33(2), 11230. https://doi.org/10.4081/ejtm.2023.11230 (https://pmc.ncbi.nlm.nih.gov/articles/PMC10388603/).
5. Burnham, R., Martin, T., Stein, R., Bell, G., MacLean, I., & Steadward, R. (1997). Skeletal muscle fibre type transformation following spinal cord injury. Spinal cord, 35(2), 86–91. https://doi.org/10.1038/sj.sc.3100364 (Burnham, R., Martin, T., Stein, R., Bell, G., MacLean, I., & Steadward, R. (1997). Skeletal muscle fibre type transformation following spinal cord injury. Spinal cord, 35(2), 86–91. https://doi.org/10.1038/sj.sc.3100364).
6. Carlson B. M. (2014). The Biology of Long-Term Denervated Skeletal Muscle. European journal of translational myology, 24(1), 3293. https://doi.org/10.4081/ejtm.2014.3293 (https://pubmed.ncbi.nlm.nih.gov/26913125/).
7. Carraro, U., Boncompagni, S., Gobbo, V., Rossini, K., Zampieri, S., Mosole, S., Ravara, B., Nori, A., Stramare, R., Ambrosio, F., Piccione, F., Masiero, S., Vindigni, V., Gargiulo, P., Protasi, F., Kern, H., Pond, A., & Marcante, A. (2015). Persistent Muscle Fiber Regeneration in Long Term Denervation. Past, Present, Future. European journal of translational myology, 25(2), 4832. https://doi.org/10.4081/ejtm.2015.4832 (https://pubmed.ncbi.nlm.nih.gov/26913148/).
8. Chandrasekaran, S., Davis, J., Bersch, I., Goldberg, G., & Gorgey, A. S. (2020). Electrical stimulation and denervated muscles after spinal cord injury. Neural regeneration research, 15(8), 1397–1407. https://doi.org/10.4103/1673-5374.274326 (https://pubmed.ncbi.nlm.nih.gov/31997798/).
9. Ding, Y., Kastin, A. J., & Pan, W. (2005). Neural plasticity after spinal cord injury. Current pharmaceutical design, 11(11), 1441–1450. https://doi.org/10.2174/1381612053507855 (https://pmc.ncbi.nlm.nih.gov/articles/PMC3562709/).
10. Dolbow, D. R., Bersch, I., Gorgey, A. S., & Davis, G. M. (2024). The Clinical Management of Electrical Stimulation Therapies in the Rehabilitation of Individuals with Spinal Cord Injuries. Journal of clinical medicine, 13(10), 2995. https://doi.org/10.3390/jcm13102995 (https://pubmed.ncbi.nlm.nih.gov/38792536/).
11. Hofer, C., Mayr, W., Stöhr, H., Unger, E., & Kern, H. (2002). A stimulator for functional activation of denervated muscles. Artificial organs, 26(3), 276–279. https://doi.org/10.1046/j.1525-1594.2002.06951.x (https://pubmed.ncbi.nlm.nih.gov/11940032/).
12. Kern, H., Hofer, C., Mödlin, M., Forstner, C., Raschka-Högler, D., Mayr, W., & Stöhr, H. (2002). Denervated muscles in humans: limitations and problems of currently used functional electrical stimulation training protocols. Artificial organs, 26(3), 216–218. https://doi.org/10.1046/j.1525-1594.2002.06933.x (https://pubmed.ncbi.nlm.nih.gov/11940016/).
13. Kern, H., Salmons, S., Mayr, W., Rossini, K., & Carraro, U. (2005). Recovery of long-term denervated human muscles induced by electrical stimulation. Muscle & nerve, 31(1), 98–101. https://doi.org/10.1002/mus.20149 (https://pubmed.ncbi.nlm.nih.gov/15389722/).
14. Kern, H., Rossini, K., Carraro, U., Mayr, W., Vogelauer, M., Hoellwarth, U., & Hofer, C. (2005). Muscle biopsies show that FES of denervated muscles reverses human muscle degeneration from permanent spinal motoneuron lesion. Journal of rehabilitation research and development, 42(3 Suppl 1), 43–53. https://doi.org/10.1682/jrrd.2004.05.0061 (https://pubmed.ncbi.nlm.nih.gov/16195962/).
15. Kern, H., Carraro, U., Adami, N., Hofer, C., Loefler, S., Vogelauer, M., Mayr, W., Rupp, R., & Zampieri, S. (2010). One year of home-based daily FES in complete lower motor neuron paraplegia: recovery of tetanic contractility drives the structural improvements of denervated muscle. Neurological research, 32(1), 5–12. https://doi.org/10.1179/174313209X385644 (https://pubmed.ncbi.nlm.nih.gov/20092690/).
16. Kern, H., & Carraro, U. (2014). Home-Based Functional Electrical Stimulation for Long-Term Denervated Human Muscle: History, Basics, Results and Perspectives of the Vienna Rehabilitation Strategy. European journal of translational myology, 24(1), 3296. https://doi.org/10.4081/ejtm.2014.3296 (https://pmc.ncbi.nlm.nih.gov/articles/PMC4749003/).
17. Kern, H., Hofer, C., Loefler, S., Zampieri, S., Gargiulo, P., Baba, A., Marcante, A., Piccione, F., Pond, A., & Carraro, U. (2017). Atrophy, ultra-structural disorders, severe atrophy and degeneration of denervated human muscle in SCI and Aging. Implications for their recovery by Functional Electrical Stimulation, updated 2017. Neurological research, 39(7), 660–666. https://doi.org/10.1080/01616412.2017.1314906 (https://pubmed.ncbi.nlm.nih.gov/28403681/).
18. Kern, H., & Carraro, U. (2020). Home-Based Functional Electrical Stimulation of Human Permanent Denervated Muscles: A Narrative Review on Diagnostics, Managements, Results and Byproducts Revisited 2020. Diagnostics (Basel, Switzerland), 10(8), 529. https://doi.org/10.3390/diagnostics10080529 (https://pubmed.ncbi.nlm.nih.gov/32751308/).
19. Ko H. Y. (2018). Revisit Spinal Shock: Pattern of Reflex Evolution during Spinal Shock. Korean journal of neurotrauma, 14(2), 47–54. https://doi.org/10.13004/kjnt.2018.14.2.47 (https://pubmed.ncbi.nlm.nih.gov/30402418/).
20. Mittal, P., Gupta, R., Mittal, A., & Mittal, K. (2016). MRI findings in a case of spinal cord Wallerian degeneration following trauma. Neurosciences (Riyadh, Saudi Arabia), 21(4), 372–373. https://doi.org/10.17712/nsj.2016.4.20160278 (https://pmc.ncbi.nlm.nih.gov/articles/PMC5224438/).
21. Pang, Q. M., Chen, S. Y., Xu, Q. J., Fu, S. P., Yang, Y. C., Zou, W. H., Zhang, M., Liu, J., Wan, W. H., Peng, J. C., & Zhang, T. (2021). Neuroinflammation and Scarring After Spinal Cord Injury: Therapeutic Roles of MSCs on Inflammation and Glial Scar. Frontiers in immunology, 12, 751021. https://doi.org/10.3389/fimmu.2021.751021 (https://pubmed.ncbi.nlm.nih.gov/34925326/).
22. Schick, T. (Ed.). (2022). Functional electrical stimulation in neurorehabilitation: Synergy effects of technology and therapy. Springer. https://doi.org/10.1007/978-3-030-90123-3 (https://link.springer.com/book/10.1007/978-3-030-90123-3).
23. Swain, I., Burridge, J., & Street, T. (Eds.). (2024). Techniques and technologies in electrical stimulation for neuromuscular rehabilitation. The Institution of Engineering and Technology. https://shop.theiet.org/techniques-and-technologies-in-electrical-stimulation-for-neuromuscular-rehabilitation
24. van der Scheer, J. W., Goosey-Tolfrey, V. L., Valentino, S. E., Davis, G. M., & Ho, C. H. (2021). Functional electrical stimulation cycling exercise after spinal cord injury: a systematic review of health and fitness-related outcomes. Journal of neuroengineering and rehabilitation, 18(1), 99. https://doi.org/10.1186/s12984-021-00882-8 (https://pubmed.ncbi.nlm.nih.gov/34118958/).
25. Xu, X., Talifu, Z., Zhang, C. J., Gao, F., Ke, H., Pan, Y. Z., Gong, H., Du, H. Y., Yu, Y., Jing, Y. L., Du, L. J., Li, J. J., & Yang, D. G. (2023). Mechanism of skeletal muscle atrophy after spinal cord injury: A narrative review. Frontiers in nutrition, 10, 1099143. https://doi.org/10.3389/fnut.2023.1099143 (https://pubmed.ncbi.nlm.nih.gov/36937344/).
26. Anatomical Concepts: https://www.anatomicalconcepts.com/articles
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1h 26min
March 30, 2025 #78: Entrevista a Bernat de las Heras. Ejercicio físico y neuroplasticidad
En este episodio entrevistamos a Bernat de las Heras, investigador en neurorehabilitación y experto en neuroplasticidad post-ictus. Desde su formación inicial en Ciencias del Deporte hasta su doctorado en la Universidad McGill, Bernat ha explorado cómo el ejercicio cardiovascular —en especial el aeróbico y HIIT— puede modular la neuroplasticidad cerebral tras un ictus. Bernat nos explica los beneficios y limitaciones del entrenamiento interválico de alta intensidad, su percepción por parte de los pacientes, y cómo combinarlo de forma efectiva con otras estrategias terapéuticas. Hablamos también de aprendizaje y localización de la lesión. Una conversación profunda y práctica para entender los límites actuales de la evidencia, y al mismo tiempo, abrir nuevas vías para la rehabilitación neurológica individualizada.
Referencias del episodio:
1) Ploughman, M., Attwood, Z., White, N., Doré, J. J., & Corbett, D. (2007). Endurance exercise facilitates relearning of forelimb motor skill after focal ischemia. The European journal of neuroscience, 25(11), 3453–3460. https://doi.org/10.1111/j.1460-9568.2007.05591.x (https://pubmed.ncbi.nlm.nih.gov/17553014/).
2) Jeffers, M. S., & Corbett, D. (2018). Synergistic Effects of Enriched Environment and Task-Specific Reach Training on Poststroke Recovery of Motor Function. Stroke, 49(6), 1496–1503. https://doi.org/10.1161/STROKEAHA.118.020814 (https://pubmed.ncbi.nlm.nih.gov/29752347/).
3) De Las Heras, B., Rodrigues, L., Cristini, J., Moncion, K., Ploughman, M., Tang, A., Fung, J., & Roig, M. (2024). Measuring Neuroplasticity in Response to Cardiovascular Exercise in People With Stroke: A Critical Perspective. Neurorehabilitation and neural repair, 38(4), 303–321. https://doi.org/10.1177/15459683231223513 (https://pubmed.ncbi.nlm.nih.gov/38291890/).
4) Roig, M., & de Las Heras, B. (2018). Acute cardiovascular exercise does not enhance locomotor learning in people with stroke. The Journal of physiology, 596(10), 1785–1786. https://doi.org/10.1113/JP276172 (https://pubmed.ncbi.nlm.nih.gov/29603752/).
5) Rodrigues, L., Moncion, K., Eng, J. J., Noguchi, K. S., Wiley, E., de Las Heras, B., Sweet, S. N., Fung, J., MacKay-Lyons, M., Nelson, A. J., Medeiros, D., Crozier, J., Thiel, A., Tang, A., & Roig, M. (2022). Intensity matters: protocol for a randomized controlled trial exercise intervention for individuals with chronic stroke. Trials, 23(1), 442. https://doi.org/10.1186/s13063-022-06359-w (https://pubmed.ncbi.nlm.nih.gov/35610659/).
6) Cristini, J., Kraft, V. S., De Las Heras, B., Rodrigues, L., Parwanta, Z., Hermsdörfer, J., Steib, S., & Roig, M. (2023). Differential effects of acute cardiovascular exercise on explicit and implicit motor memory: The moderating effects of fitness level. Neurobiology of learning and memory, 205, 107846. https://doi.org/10.1016/j.nlm.2023.107846 (https://pubmed.ncbi.nlm.nih.gov/37865261/).
7) Moncion, K., Rodrigues, L., De Las Heras, B., Noguchi, K. S., Wiley, E., Eng, J. J., MacKay-Lyons, M., Sweet, S. N., Thiel, A., Fung, J., Stratford, P., Richardson, J. A., MacDonald, M. J., Roig, M., & Tang, A. (2024). Cardiorespiratory Fitness Benefits of High-Intensity Interval Training After Stroke: A Randomized Controlled Trial. Stroke, 55(9), 2202–2211. https://doi.org/10.1161/STROKEAHA.124.046564 (https://pubmed.ncbi.nlm.nih.gov/39113181/).
8) De las Heras, B., Rodrigues, L., Cristini, J., Moncion, K., Dancause, N., Thiel, A., Edwards, J. D., Eng, J. J., Tang, A., & Roig, M. (2024). Lesion location changes the association between brain excitability and motor skill acquisition post-stroke. medRxiv. https://doi.org/10.1101/2024.07.30.24311146 (https://www.medrxiv.org/content/10.1101/2024.07.30.24311146v1.article-info).
9) Rodrigues, L., Moncion, K., Angelopoulos, S. A., Heras, B. L., Sweet, S., Eng, J. J., Fung, J., MacKay-Lyons, M., Tang, A., & Roig, M. (2025). Psychosocial Responses to a Cardiovascular Exercise Randomized Controlled Trial: Does Intensity Matter for Individuals Post-stroke?. Archives of physical medicine and rehabilitation, S0003-9993(25)00498-8. Advance online publication. https://doi.org/10.1016/j.apmr.2025.01.468 (https://pubmed.ncbi.nlm.nih.gov/39894292/).
10) de Las Heras, B., Rodrigues, L., Cristini, J., Weiss, M., Prats-Puig, A., & Roig, M. (2022). Does the Brain-Derived Neurotrophic Factor Val66Met Polymorphism Modulate the Effects of Physical Activity and Exercise on Cognition?. The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry, 28(1), 69–86. https://doi.org/10.1177/1073858420975712 (https://pubmed.ncbi.nlm.nih.gov/33300425/).
11) MacKay-Lyons, M., Billinger, S. A., Eng, J. J., Dromerick, A., Giacomantonio, N., Hafer-Macko, C., Macko, R., Nguyen, E., Prior, P., Suskin, N., Tang, A., Thornton, M., & Unsworth, K. (2020). Aerobic Exercise Recommendations to Optimize Best Practices in Care After Stroke: AEROBICS 2019 Update. Physical therapy, 100(1), 149–156. https://doi.org/10.1093/ptj/pzz153 (https://pubmed.ncbi.nlm.nih.gov/31596465/).
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1h 42min
March 08, 2025 #77: Actualización en stiff-knee o rodilla rígida post-ictus
En este episodio, actualizamos la evidencia científica sobre la rodilla rígida post-ictus o stiff-knee, ampliando lo que ya sintetizamos hace varios años en el episodio #48. Indagamos en las sinergias musculares en el stiff-knee y en sus fenotipos, para poder realizar una valoración y tratamiento más específico e individualizado.
Referencias del episodio:
1. Brough, L. G., Kautz, S. A., & Neptune, R. R. (2022). Muscle contributions to pre-swing biomechanical tasks influence swing leg mechanics in individuals post-stroke during walking. Journal of neuroengineering and rehabilitation, 19(1), 55. https://doi.org/10.1186/s12984-022-01029-z (https://pubmed.ncbi.nlm.nih.gov/35659252/).
2. Chantraine, F., Schreiber, C., Pereira, J. A. C., Kaps, J., & Dierick, F. (2022). Classification of Stiff-Knee Gait Kinematic Severity after Stroke Using Retrospective k-Means Clustering Algorithm. Journal of clinical medicine, 11(21), 6270. https://doi.org/10.3390/jcm11216270 (https://pubmed.ncbi.nlm.nih.gov/36362499/)
3. Fujita, K., Tsushima, Y., Hayashi, K., Kawabata, K., Sato, M., & Kobayashi, Y. (2022). Differences in causes of stiff knee gait in knee extensor activity or ankle kinematics: A cross-sectional study. Gait & posture, 98, 187–194. https://doi.org/10.1016/j.gaitpost.2022.09.078 (https://pubmed.ncbi.nlm.nih.gov/36166956/).
4. Fujita, K., Tsushima, Y., Hayashi, K., Kawabata, K., Ogawa, T., Hori, H., & Kobayashi, Y. (2024). Altered muscle synergy structure in patients with poststroke stiff knee gait. Scientific reports, 14(1), 20295. https://doi.org/10.1038/s41598-024-71083-1 (https://pubmed.ncbi.nlm.nih.gov/39217201/).
5. Krajewski, K. T., Correa, J. S., Siu, R., Cunningham, D., & Sulzer, J. S. (2025). Mechanisms of Post-Stroke Stiff Knee Gait: A Narrative Review. American journal of physical medicine & rehabilitation, 10.1097/PHM.0000000000002678. Advance online publication. https://doi.org/10.1097/PHM.0000000000002678 (https://pubmed.ncbi.nlm.nih.gov/39815400/).
6. Lee, J., Lee, R. K., Seamon, B. A., Kautz, S. A., Neptune, R. R., & Sulzer, J. (2024). Between-limb difference in peak knee flexion angle can identify persons post-stroke with Stiff-Knee gait. Clinical biomechanics (Bristol, Avon), 120, 106351. https://doi.org/10.1016/j.clinbiomech.2024.106351 (https://pubmed.ncbi.nlm.nih.gov/39321614/).
7. Tenniglo, M. J. B., Nene, A. V., Rietman, J. S., Buurke, J. H., & Prinsen, E. C. (2023). The Effect of Botulinum Toxin Type A Injection in the Rectus Femoris in Stroke Patients Walking With a Stiff Knee Gait: A Randomized Controlled Trial. Neurorehabilitation and neural repair, 37(9), 640–651. https://doi.org/10.1177/15459683231189712 (https://pubmed.ncbi.nlm.nih.gov/37644725/).
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33min
February 07, 2025 #76: Aprendiendo Neurología con el MIR
En este episodio traigo un formato nuevo que creo que puede ser muy útil para aprender y repasar neurología de una forma más aplicada. He cogido preguntas del examen MIR del año 2025 relacionadas con neurología y, además de responderlas, las utilizo como excusa para profundizar en cada tema.
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1h 5min
January 25, 2025 #75: Desentrañando el sistema de neuronas espejo
En este episodio, exploramos a fondo el fascinante pero controvertido sistema de las neuronas espejo. Desentrañamos su descubrimiento, su neurofisiología, y el papel que desempeñan en procesos como la comprensión de acciones, la imitación, la empatía y el lenguaje. Además, abordamos las críticas más relevantes de autores como Hickok y Heyes, reflexionamos sobre su relevancia en la neurorrehabilitación y analizamos su conexión con otras redes cerebrales como el cerebelo. Un episodio esencial para entender el estado actual de la ciencia detrás de estas células y su impacto en la cognición y la clínica.
Referencias del episodio:
1. Antonioni, A., Raho, E. M., Straudi, S., Granieri, E., Koch, G., & Fadiga, L. (2024). The cerebellum and the Mirror Neuron System: A matter of inhibition? From neurophysiological evidence to neuromodulatory implications. A narrative review. Neuroscience and biobehavioral reviews, 164, 105830. https://doi.org/10.1016/j.neubiorev.2024.105830 (https://pubmed.ncbi.nlm.nih.gov/39069236/9.
2. Bonini, L., Rotunno, C., Arcuri, E., & Gallese, V. (2022). Mirror neurons 30 years later: implications and applications. Trends in cognitive sciences, 26(9), 767–781. https://doi.org/10.1016/j.tics.2022.06.003 (https://pubmed.ncbi.nlm.nih.gov/35803832/).
3. Borges, L. R., Fernandes, A. B., Oliveira Dos Passos, J., Rego, I. A. O., & Campos, T. F. (2022). Action observation for upper limb rehabilitation after stroke. The Cochrane database of systematic reviews, 8(8), CD011887. https://doi.org/10.1002/14651858.CD011887.pub3 (https://pubmed.ncbi.nlm.nih.gov/35930301/).
4. Catmur, C., Walsh, V., & Heyes, C. (2007). Sensorimotor learning configures the human mirror system. Current biology : CB, 17(17), 1527–1531. https://doi.org/10.1016/j.cub.2007.08.006 (https://pubmed.ncbi.nlm.nih.gov/17716898/)
5. Dinstein I. (2008). Human cortex: reflections of mirror neurons. Current biology : CB, 18(20), R956–R959. https://doi.org/10.1016/j.cub.2008.09.007 (https://pubmed.ncbi.nlm.nih.gov/18957251/).
6. Fadiga, L., Fogassi, L., Pavesi, G., & Rizzolatti, G. (1995). Motor facilitation during action observation: a magnetic stimulation study. Journal of neurophysiology, 73(6), 2608–2611. https://doi.org/10.1152/jn.1995.73.6.2608 (https://pubmed.ncbi.nlm.nih.gov/7666169/).
7. Gallese, V., Fadiga, L., Fogassi, L., & Rizzolatti, G. (1996). Action recognition in the premotor cortex. Brain : a journal of neurology, 119 ( Pt 2), 593–609. https://doi.org/10.1093/brain/119.2.593 (https://pubmed.ncbi.nlm.nih.gov/8800951/).
8. Gallese, V., Gernsbacher, M. A., Heyes, C., Hickok, G., & Iacoboni, M. (2011). Mirror Neuron Forum. Perspectives on psychological science : a journal of the Association for Psychological Science, 6(4), 369–407. https://doi.org/10.1177/1745691611413392 (https://pubmed.ncbi.nlm.nih.gov/25520744/).
9. Glenberg, A. M. (2015). Big Myth or Major Miss? [Review of The Myth of Mirror Neurons: The Real Neuroscience of Communication and Cognition, by Gregory Hickok]. The American Journal of Psychology, 128(4), 533–539. https://doi.org/10.5406/amerjpsyc.128.4.0533 (https://www.jstor.org/stable/10.5406/amerjpsyc.128.4.0533).
10. Heyes, C., & Catmur, C. (2022). What Happened to Mirror Neurons?. Perspectives on psychological science : a journal of the Association for Psychological Science, 17(1), 153–168. https://doi.org/10.1177/1745691621990638 (https://pmc.ncbi.nlm.nih.gov/articles/PMC8785302/).
11. Hickok G. (2009). Eight problems for the mirror neuron theory of action understanding in monkeys and humans. Journal of cognitive neuroscience, 21(7), 1229–1243. https://doi.org/10.1162/jocn.2009.21189 (https://pmc.ncbi.nlm.nih.gov/articles/PMC2773693/).
12. Hickok, G. (2014). The myth of mirror neurons: The real neuroscience of communication and cognition. W. W. Norton & Company (https://wwnorton.com/books/9780393089615).
13. La Touche, R. (2020). Métodos de representación del movimiento en rehabilitación. Construyendo un marco conceptual para la aplicación en clínica. Journal of MOVE and Therapeutic Science, 2(2), 152–159. https://doi.org/10.37382/jomts.v2i2.42 (https://publicaciones.lasallecampus.es/index.php/MOVE/article/view/42).
14. Lingnau, A., Gesierich, B., & Caramazza, A. (2009). Asymmetric fMRI adaptation reveals no evidence for mirror neurons in humans. Proceedings of the National Academy of Sciences of the United States of America, 106(24), 9925–9930. https://doi.org/10.1073/pnas.0902262106 (https://pmc.ncbi.nlm.nih.gov/articles/PMC2701024/).
15. Molenberghs, P., Cunnington, R., & Mattingley, J. B. (2012). Brain regions with mirror properties: a meta-analysis of 125 human fMRI studies. Neuroscience and biobehavioral reviews, 36(1), 341–349. https://doi.org/10.1016/j.neubiorev.2011.07.004 (https://pubmed.ncbi.nlm.nih.gov/21782846/).
16. Mukamel, R., Ekstrom, A. D., Kaplan, J., Iacoboni, M., & Fried, I. (2010). Single-neuron responses in humans during execution and observation of actions. Current biology : CB, 20(8), 750–756. https://doi.org/10.1016/j.cub.2010.02.045 (https://pubmed.ncbi.nlm.nih.gov/20381353/).
17. Rizzolatti, G., Fadiga, L., Gallese, V., & Fogassi, L. (1996). Premotor cortex and the recognition of motor actions. Brain research. Cognitive brain research, 3(2), 131–141. https://doi.org/10.1016/0926-6410(95)00038-0 (https://www.sciencedirect.com/science/article/pii/0926641095000380?via%3Dihub).
18. Rizzolatti, G., Fadiga, L., Matelli, M., Bettinardi, V., Paulesu, E., Perani, D., & Fazio, F. (1996). Localization of grasp representations in humans by PET: 1. Observation versus execution. Experimental brain research, 111(2), 246–252. https://doi.org/10.1007/BF00227301 (https://pubmed.ncbi.nlm.nih.gov/8891654/).
19. Rizzolatti, G., Fabbri-Destro, M., & Cattaneo, L. (2009). Mirror neurons and their clinical relevance. Nature clinical practice. Neurology, 5(1), 24–34. https://doi.org/10.1038/ncpneuro0990 (https://pubmed.ncbi.nlm.nih.gov/19129788/).
20. Rizzolatti, G., & Sinigaglia, C. (2015). A curious book on mirror neurons and their myth: Review of Gregory Hickok’s The Myth of Mirror Neurons: The Real Neuroscience of Communication and Cognition (https://bpb-us-e1.wpmucdn.com/sites.ucsc.edu/dist/0/158/files/2015/04/Rizzolatti-Sinigaglia-Review.pdf).
21. Southgate, V., & Hamilton, A. F. (2008). Unbroken mirrors: challenging a theory of Autism. Trends in cognitive sciences, 12(6), 225–229. https://doi.org/10.1016/j.tics.2008.03.005 (https://pubmed.ncbi.nlm.nih.gov/18479959/).
22. Tarhan, L. Y., Watson, C. E., & Buxbaum, L. J. (2015). Shared and Distinct Neuroanatomic Regions Critical for Tool-related Action Production and Recognition: Evidence from 131 Left-hemisphere Stroke Patients. Journal of cognitive neuroscience, 27(12), 2491–2511. https://doi.org/10.1162/jocn_a_00876 (https://pmc.ncbi.nlm.nih.gov/articles/PMC8139360/).
23. Ventoulis, I., Gkouma, K. R., Ventouli, S., & Polyzogopoulou, E. (2024). The Role of Mirror Therapy in the Rehabilitation of the Upper Limb's Motor Deficits After Stroke: Narrative Review. Journal of clinical medicine, 13(24), 7808. https://doi.org/10.3390/jcm13247808 (https://pubmed.ncbi.nlm.nih.gov/39768730/).
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1h 39min
January 04, 2025 #74: Actualización en espasticidad V
En este episodio, resumimos varios artículos científicos sobre espasticidad, en cuanto a conceptualización, neurofisiología, evaluación y tratamiento. Es una forma de actualización anual sobre esta temática tan estudiada en neurociencia. Hablamos sobre nuevos estudios de neuroimagen sobre la espasticidad, consensos sobre evaluación y desarrollos emergentes de tratamientos médicos.
Referencias del episodio:
1. Cho, M. J., Yeo, S. S., Lee, S. J., & Jang, S. H. (2023). Correlation between spasticity and corticospinal/corticoreticular tract status in stroke patients after early stage. Medicine, 102(17), e33604. https://doi.org/10.1097/MD.0000000000033604 (https://pubmed.ncbi.nlm.nih.gov/37115067/).
2. Gal, O., Baude, M., Deltombe, T., Esquenazi, A., Gracies, J. M., Hoskovcova, M., Rodriguez-Blazquez, C., Rosales, R., Satkunam, L., Wissel, J., Mestre, T., Sánchez-Ferro, Á., Skorvanek, M., Tosin, M. H. S., Jech, R., & members of the MDS Clinical Outcome Assessments Scientific Evaluation Committee and MDS Spasticity Study group (2024). Clinical Outcome Assessments for Spasticity: Review, Critique, and Recommendations. Movement disorders : official journal of the Movement Disorder Society, 10.1002/mds.30062. Advance online publication. https://doi.org/10.1002/mds.30062 (https://pubmed.ncbi.nlm.nih.gov/39629752/).
3. Gracies J. M. (2005). Pathophysiology of spastic paresis. I: Paresis and soft tissue changes. Muscle & nerve, 31(5), 535–551. https://doi.org/10.1002/mus.20284 (https://pubmed.ncbi.nlm.nih.gov/15714510/).
4. Gracies J. M. (2005). Pathophysiology of spastic paresis. II: Emergence of muscle overactivity. Muscle & nerve, 31(5), 552–571. https://doi.org/10.1002/mus.20285 (https://pubmed.ncbi.nlm.nih.gov/15714511/).
5. Gracies, J. M., Alter, K. E., Biering-Sørensen, B., Dewald, J. P. A., Dressler, D., Esquenazi, A., Franco, J. H., Jech, R., Kaji, R., Jin, L., Lim, E. C. H., Raghavan, P., Rosales, R., Shalash, A. S., Simpson, D. M., Suputtitada, A., Vecchio, M., Wissel, J., & Spasticity Study Group of the International Parkinson and Movement Disorders Society (2024). Spastic Paresis: A Treatable Movement Disorder. Movement disorders : official journal of the Movement Disorder Society, 10.1002/mds.30038. Advance online publication. https://doi.org/10.1002/mds.30038 (https://pubmed.ncbi.nlm.nih.gov/39548808/).
6. Guo, X., Wallace, R., Tan, Y., Oetomo, D., Klaic, M., & Crocher, V. (2022). Technology-assisted assessment of spasticity: a systematic review. Journal of neuroengineering and rehabilitation, 19(1), 138. https://doi.org/10.1186/s12984-022-01115-2 (https://pubmed.ncbi.nlm.nih.gov/36494721/).
7. He, J., Luo, A., Yu, J., Qian, C., Liu, D., Hou, M., & Ma, Y. (2023). Quantitative assessment of spasticity: a narrative review of novel approaches and technologies. Frontiers in neurology, 14, 1121323. https://doi.org/10.3389/fneur.2023.1121323 (https://pubmed.ncbi.nlm.nih.gov/37475737/).
8. Levin, M. F., Piscitelli, D., & Khayat, J. (2024). Tonic stretch reflex threshold as a measure of disordered motor control and spasticity - A critical review. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, 165, 138–150. https://doi.org/10.1016/j.clinph.2024.06.019 (https://pubmed.ncbi.nlm.nih.gov/39029274/).
9. Li, S., Winston, P., & Mas, M. F. (2024). Spasticity Treatment Beyond Botulinum Toxins. Physical medicine and rehabilitation clinics of North America, 35(2), 399–418. https://doi.org/10.1016/j.pmr.2023.06.009 (https://pubmed.ncbi.nlm.nih.gov/38514226/).
10. Qin, Y., Qiu, S., Liu, X., Xu, S., Wang, X., Guo, X., Tang, Y., & Li, H. (2022). Lesions causing post-stroke spasticity localize to a common brain network. Frontiers in aging neuroscience, 14, 1011812. https://doi.org/10.3389/fnagi.2022.1011812 (https://pubmed.ncbi.nlm.nih.gov/36389077/).
11. Suputtitada, A., Chatromyen, S., Chen, C. P. C., & Simpson, D. M. (2024). Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity: A Modified Scoping Review. Toxins, 16(2), 98. https://doi.org/10.3390/toxins16020098 (https://pubmed.ncbi.nlm.nih.gov/38393176/).
12. Winston, P., Mills, P. B., Reebye, R., & Vincent, D. (2019). Cryoneurotomy as a Percutaneous Mini-invasive Therapy for the Treatment of the Spastic Limb: Case Presentation, Review of the Literature, and Proposed Approach for Use. Archives of rehabilitation research and clinical translation, 1(3-4), 100030. https://doi.org/10.1016/j.arrct.2019.100030 (https://pubmed.ncbi.nlm.nih.gov/33543059/).
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1h 1min

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