Motor Relearning Programme ( MRP ) .pptx

Motor learning involves learning a skilled task and then practicing with a goal in mind until the skill is executed automatically (Schmidt & Wrisberg 2007). For example, learning to play a song on the piano initially takes a lot of thought and practice before the task is automatic and executed skillfully.
motor relearning program enhances the self-regulation of cerebral blood flow to rebuild cerebral blood circulation, and increases cerebral blood flow through training of muscle strength, balance, coordination, sitting position, standing, walking, upper limbs and head, face and oral cavity functions.

1. Motor Relearning Programme (MRP) Dr. Yukta Suresh Telrandhe [email protected] II-MPT, Department of Neuro-Physiotherapy Maharashtra Institute Of Physiotherapy, Latur Maharashtra, India – 413 531.

2. CONTENTS Specific learning objective Introduction Factors affecting motor learning Steps of MRP Sections of MRP Effects and uses of MRP Summary References 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 2

3. Intended learning objective At the end of this session you should be able to know about: Describe the concept of motor relearning programme with the factor affecting it. Explain the steps and sections of motor relearning programme. List the effects and uses of motor relearning programme. 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 3

4. Introduction The concept of motor relearning programme (MRP) was developed by Janet Carr and Roberta Shepherd and their book on the same was published in 1982. 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 4

5. Motor learning is a complex process occurring in the brain in response to practice or experience of a certain skill resulting in changes in the central nervous system. It allows for the production of a new motor skill.it often involves improving the smoothness and accuracy of movement and is necessary for developing controlled movement and calibrating simple movements like reflexes. Retraining of motor learning requires understanding of normal movement and analysis of motor dysfunction. 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 5

6. Factors Affecting motor learning Verbal instructions Practice Active participation and motivation Possibility of errors Postural control Memory feedback 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 6

7. Effects and uses of MRP Helps the patient to recognize & analyse the problem Patient selects the most essential missing component of the task to practice and build it slowly. Helps to monitors the patients performance through self evaluation of the task practiced Provides feedback to the patients on their movements Provides an enriched feedback to the patient will be motivated towards recovery of their mental & physical abilities. 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 7

8. Four steps in the Motor Relearning Programme 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 8

9. Step of MRP Analysis of task : observation, comparison and analysis Practice of missing component : Explanation (for identification of goal), instruction, practice (along with verbal and visual feedback and manual guidance) Practice of task : Explanation (for identification of goal), instruction, practice (along with verbal and visual feedback and manual guidance),progression by increasing the complexity, add Variety, decrease feedback and guidance, re-evaluation and encourage flexibility. Transference of Learning : opportunity to practice, consistency of practice with positive reinforcement, Organisation of self-monitored practice with positive, structured and stimulating learning environment, involvement of relatives and staff. 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 9

10. Sections of MRP There are seven sections representing the essential functional of everyday life: Upper limb function Oro-facial function Sitting up from supine Sitting Standing up and sitting down Standing Walking 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 10

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12. Sections of MRP (contd.) Upper limb function: reaching activity, grasp release and manipulate objects Oro-facial function: eating, swallowing, facial expression, ventilation, speech. Sitting up from supine: turning to the side, flexion of neck and shoulder along with protraction Sitting: body alignment. Standing up and sitting down: foot placement, forward bending of the trunk with hip flexion, extension of neck, spine and knee flexion while sitting. Standing: postural adjustment, feet position, erect trunk, hip in front of ankles Walking: pattern, limb placement, gait parameters, arm swing. 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 12

13. UPPER LIMB FUNCTION The major function of the hand is to grasp, release and manipulation object for specific purposes. Hence the essential components are: radial deviation combined with wrist extension, wrist flexion and extension holding an object, palmar abduction and rotation at the carpometacarpal (CMC) joint of the thumb flexion and conjunct rotation of the metacarpophalangeal (MCP) joints of the individual joints with the IP joints in some flexion supination and pronation of the forearm while holding an object. 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 13

14. Oro- facial function Following stroke all the activities are affected interfering with eating, communication and socialization. Inefficient swallowing which causes the greatest dysfunction which result in drooling, aspiration and difficulty ingesting the food bring about a poor nutritional state. Swallowing is a highly complex and integrated neuromuscular task. The essential components- Jaw closure, lip closure, elevation of the posterior third of the tongue to close off posterior oral cavity, elevation of lateral borders of tongue. Analysis of orofacial function involves- observation of the alignment and movement of lips, jaws and tongue, intraoral digital examinational of tongue and cheeks, observation of eating and drinking, difficulty with open jaw, poor lip seal, immobile tongue. 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 14

15. Sitting up from supine Use the hands to leverage and swing the legs over the side of the bed, it is practical and more effective for the patient to be assisted to turn onto his intact side and sit up from this position. Essential components- turning on the side-rotation and flexion of neck, hip and knee flexion, flexion of shoulder and protraction of the shoulder girdle rotation within the trunk. Sitting up over the side of the bed – lateral flexion of the neck, lateral flexion of trunk , legs lifted and lowered over the side of the bed. 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 15

16. Sitting The ability to achieve sitting position requires that the body alignment be appropriate to each task and that the correct preparatory and ongoing postural adjustments can be made as shifts in center of gravity (COG) occur throughout performance of the task. 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 16

17. Standing up and sitting down Essential components:- Standing up- foot placement, inclination of trunk forward by flexion of hips with extended neck and spine, movement of the knees backwards, extension of hips and knees for final standing alignment. Sitting down: Inclination of the trunk forward by flexion of hips with extended neck and spine, movement of knees forward and knee flexion. 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 17

18. SUMMARY Concept of motor relearning programme. Factors affecting motor relearning Step and sections of motor relearning programme. Effect and uses of motor relearning programme. 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 18

19. REFERENCES Chan DYL., Chetwyn CHC, Derrick KSA. Motor relearning programme for stroke patients: a randomized controlled trail. Clinical rehabilitation;2006 Mar. 20(3):191-200. Robert g., Kisner S. what is the motor relearning approach to developing motor relearning approach to developing motor control in a hemiplegic shoulder? Physical medicine and rehabilitation :Medscape. 2019 4/3/2024 Motor Relearning Programme Dr. Yukta telrandhe (PG-II) 19

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