Cognitive Therapeutic Exercise in Stroke: Learning, Sensitivity, and Motor Control

Post-stroke neurorehabilitation was addressed as a complex clinical challenge due to the diversity of motor, sensory, perceptual, cognitive, communicative, and behavioral sequelae that conditioned functionality and participation. It was argued that movement was not understood as a purely muscular or reflex phenomenon, but as a behavior organized by the central nervous system and closely linked to cognitive processes. Within this framework, Cognitive Therapeutic Exercise or the Perfetti Method was described as an approach that interpreted recovery as a teaching-learning process in pathological conditions. The method was based on the directed activation of attention, perception, memory, language, comparison, and mental imagery to influence functional reorganization. It was indicated that the intervention was structured through problem exercises, usually excluding vision, favoring tactile and kinesthetic information and the use of therapeutic aids. Likewise, the concept of “Motor Specificity” was incorporated to replace a reduced reading of spasticity, identifying manifestations that limited evolved motor behaviors: abnormal reaction to stretching, abnormal irradiation, elementary patterns, and muscle recruitment alterations. A three-degree progression was presented, from tasks focused on perceptual and tonic control to activities with predominantly autonomous programming and execution. The reviewed background reported promising results in upper limb, balance, and gait, although methodological limitations and the need for higher-quality evidence were recognized.