Motor relearning programme

Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.

1. Motor Relearning Programme Dr. Maheshwari Harishchsndre Assistant Professor M.P.Th (Neurosciences) DVVPF College of Physiotherapy , Ahmednagar

2. Objectives Explain the motor relearning programme Describe steps in the execution of the programme 4/10/18 2 MRP

3. Contents What is MRP Factors of MRP Effectiveness of MRP Sections of MRP Steps of MRP Equipments used Quality of rehabilitation 4/10/18 3 MRP

4. MRP Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction. Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt . Components of activities & conscious elimination of unnecessary muscle activity. In rehabilitation programme involve – real life activities included. 4/10/18 4 MRP

5. Concentrate over the essential movement components such as – standing & walking Based on 3 factors – 1. Elimination of unnecessary muscle activity 2. Feedback 3. Practice 4/10/18 5 MRP

6. Relearning of the everyday activities contained in which patient was skilled before the condition . For effective use of MRP therapist should have the following problem solving skill- i.e recognition analysis decision making action taking re-evaluation 4/10/18 6 MRP

7. Effectiveness of MRP Recognition & analysis the problem Select the most essential missing component Explain clearly to the patient by speech & demonstration Monitor the patients performance &give verbal feedback 4/10/18 7 MRP

8. 5. Re-evaluate throughout each session 6. Positive feedback 7. Provide an enriched environment in which patient will be motivated towards recovery of mental & physical abilities 4/10/18 8 MRP

9. Sections of MRP 7 sections – representing the essential functions of everyday life Upper limb function Orofacial function Sitting up from supine Sitting Standing up & sitting down Standing walking 4/10/18 9 MRP

10. Steps of MRP Analysis of function – Observation Comparison Analysis 2. Practice of missing components Explanation + instruction Practice (verbal feedback & manual guidance) 4/10/18 10 MRP

11. 3. Practice of activity Explanation + instruction Practice Progression –increase complexity, add variety, decrease feedback + guidance 4. Transference of learning Opportunity for practice Consistency of practice Involvement of relatives & staff Positive reinforcement Stimulating enviornment 4/10/18 11 MRP

12. Upper limb function 1. The ability to see what one is doing ? 2. The ability to make postural adjustments which occur with arm movt 3. Sensory information Essential component – reaching shoulder in abduction, flexion, extension, elbow flexion & extension. Major functions of hand is grasp, release & manipulate objects 4/10/18 12 MRP

13. Step 1 – Analysis – common problem & compensatory strategies Arm & hand Analysis of painful shoulder Step 2&3 – practice of UL function Step 4 – transference of training into daily life He/she must not suffer secondary injury, not allowed to develop non-learned use phenomenon, conc over essential component 4/10/18 13 MRP

14. Oro-facial function Activities like – swallowing, facial expression, ventilation, speech production. So affect eating, communication & socialization. Resultant drooling of saliva or water, aspiration & difficulty ingesting the food. Swallowing task – essential components are – jaw closure- lip closure- elevation of the post 3 rd of tongue – close of oral cavity –elevation of lat border of tongue. 4/10/18 14 MRP

15. Step 1 - Analysis – observation of alignment & movt of lips, jaw, tongue, eating, drooling Lack of control over oro - facial mus Will result in – Step 2 &3 - position , intraoral techniques, practice Step 4 - feedback 4/10/18 15 MRP

16. Sitting up from supine Essential components – turning on side rotation , flexion of neck, shoulder along with protraction. Step 1 – Analysis- Step 2&3 – practice of missing component Step 4 – transference daily life 4/10/18 16 MRP

17. sitting Essential component – body alignment Step 1 – Analysis- Step 2&3 – practice of missing component Step 4 – transference daily life 4/10/18 17 MRP

18. Standing up & sitting down Essential components – foot placement, trunk forward with hip flexion, extension of neck & spine Sitting component – trunk pattern, extension of neck & spine, knee flexion. Step 1 – Analysis- Step 2&3 – practice of missing component Step 4 – transference daily life 4/10/18 18 MRP

19. Standing Essential components – postural adjustment, feet position, erect trunk, hip in front of ankles. Step 1 – Analysis- Step 2&3 – practice of missing component Step 4 – transference daily life 4/10/18 19 MRP

20. walking Essential components – Missing components Step 1 – Analysis- Step 2&3 – practice of missing component Step 4 – transference daily life 4/10/18 20 MRP

21. It is not necessary for a patient to perfect on one section, before going on to another section MRP should commence as soon as the patient is medically stable. If bed ridden – start the programme which he/she can manage- like oro -facial function, upper limb function. 4/10/18 21 MRP

22. Three imp. Point in practice of MRP Activities or motor tasks are practice either entirely or broken down into their components Techniques – verbal & visual feedback, instruction & manual guidance Method of progression – should not waste time in practicing what he/she can do 4/10/18 22 MRP

23. Equipments used Low bed of convenient height- for practice of standing up & sitting down Several small steps Common objects for retraining hand function Walking sticks (if necessary) 4/10/18 23 MRP

24. Factors improved Quality of rehabilitation Early start Rehabilitation plan Consistency of goal Motivation Mental stimulation Educational programme Planning for discharge 4/10/18 24 MRP

25. Summary MRP Effectiveness sections Steps Equipments Quality of rehabilitation 4/10/18 25 MRP

26. Questions Motor relearning programme - 15 M Write in detail any one section of MRP -5M Enumerate sections of MRP – 3M 4/10/18 26 MRP