MOTOR RELEARNING PROGRAM
MOTOR RELEARNING PROGRAM
1.
THEORY:
·
Carr and shepherd (1987,1989,2003)
developed a motor relearning program for stroke that provide guidelines for a training program for stroke patient
based on principles of neuroscience, motor control and learning ,biomechanics, exercise
physiology, cognitive psychology and human ecology.
·
This program differed from the Bobath
approach at the same time in which patients were often predominantly passive
recipient of treatment by prompting an
active role of patients.
·
Retraining of motor control basing on
understanding of normal movement and analysis of motor dysfunction.
·
Emphasis of motor control program is on
practice of specific activities the training of cognitive control over muscle
and movement.
2.
ASSUMPTION:
·
The main assumption’s underpinning this
approach are that regaining activities of daily living after stroke requires a
relearning process that is similar to the learning process for non-impaired people.
·
In addition, practice needs to be task
and context specific.
·
Normal movement is thought to consist of
essential components that are used to performance many different activities.
3.
AIM
OF THE MOTOR LEARNING PROGRAM:
·
The motor relearning program are the patient
to relearn everyday tasks such as reaching
and manipulation ,balance sitting and standing, walking , standing up
and sitting down ,bed mobility ,and oral facial function .
·
This requires the patient to regain
controlled muscle activity and normalization of movement components in to
functional synergies.
·
To restore or maintain soft tissue
extensibility ,muscle strength as well as fitness.
4.
TRANING
INVLOVES TASK AND CONTEXT SPECIFIC
ACTIVITIES:
·
The main role of the therapist is to
facilitate the motor relearning program process by identifying the patients
problems and by analyzing movement through observation comparison with normal
movement.
·
The therapist also identifies those
components that are thought to be missing or poorly controlled.
·
Using goal setting, instruction,
feedback, and manual guidance, the therapist teaches the patient to perform
these so called missing components.
·
These are then practiced followed by
training of the task In a more functional
context to promote transfer.
·
The patients is encouraged to practice
relevant task extensively not only under
supervision of the therapist but also independently using both physical and
mental practice in a variety of environment.
5.
EFFECTIVENESS
OF MOTOR RELEARNING PROGRAMME:
·
Recognition and analysis the problem
·
Select the most essential missing
component
·
Explain clearly to the patient by speech
and demonstration
·
Monitor the patients performance and
give verbal feedback
·
Re-evaluate throughout each session
·
Positive feedback
·
Provide an enriched environment in which
patients will be motivated towards recovery of mental and physical
6.
SECTIONS
OF MOTOR RELEARNING PROGRAM:
·
Seven sections representing the
essential functions of everyday life
1. Oral
facial function
2. Bed
mobility
3. Upper
limp function: reaching and manipulation
4. Sitting
5. Standing
up and Sitting down
6. Standing
7. Walking
7.
STEPS
IN MOTOR RELEARNING PROGRAME:
·
STEP:1
Analysis of task
Ø Observation
Ø comparison
Ø Analysis
·
STEP:2
Practice of missing component
Ø Explanation-identification
of goal
Ø Instruction
Ø Practice
plus verbal and visual feedback plus manual guidance
·
STEP:3
Practice of task
Ø Explanation-identification
of goal
Ø Instruction
Ø Practice
plus verbal and visual feedback plus manual guidance
Ø Re-evaluation
Ø Encourage
flexibility
·
STEP:4
Transference of training
Ø Opportunity
to practice in context
Ø Consistency
of practice
Ø Organization
of self –monitored practice
Ø Structure
learning environment
Ø Involvement
of relatives and staff
8.
MRP:SECTIONS
BASED ESSENTIAL COMPONENT AND PRACTICE:
8.1. Oro facial function
·
Essential component:
Ø Swallowing
task- jaw closure ,lip closure, elevation of the post 3rd tongue,
close of oral cavity ,elevation of lateral border of tongue
·
Practice:
Ø Step-1:
Analysis observation of alignment and movement of lips ,jaw, tongue
Ø Step-2
and 3: Position, intra oral techniques
Ø Step-4:
feedback
8.2.Upper
limp function: reaching and manipulation
·
Essential component:
Ø Reaching
shoulder in abduction, flexion, extension, elbow flexion and extension
Ø Major
functions of hand is grasp, manipulate object and release
·
Practice:
Ø Step-1:
Analysis common problem of arm /hand and compensatory strategies
Ø Step-2
and 3: Practice of upper limp function
Ø Step-4:
Transference of training into daily life activities
8.3.Bed
mobility
·
Essential component:
Ø Turning
on side to side
Ø Supine
up to sitting-turning on side rotation, flexion of neck ,shoulder along with
protaction
·
Practice:
Ø Step-1:
Analysis
Ø Step-2
and 3: Practice of missing component
Ø Step-4:
Transference daily life
8.4.Sitting
·
Essential component:
Ø Body
alignment
·
Practice:
Ø Step-1:
Analysis
Ø Step-2
and 3: Practice of missing component
Ø Step-4:
Transference daily life
8.5.Standing
up and sitting down
·
Essential component:
Ø Foot
placement ,trunk forward with hip flexion, extension of neck spine
Ø Sitting
–trunk pattern, extension of neck and spine, knee flexion
·
Practice:
Ø Step-1:
Analysis
Ø Step-2
and 3: Practice of missing component
Ø Step-4:
Transference daily life
8.6.Standing
·
Essential component:
Ø Postural
adjustment ,feet position, erect trunk, hip in front on angle
·
Practice:
Ø Step-1:
Analysis
Ø Step-2
and 3: Practice of missing component
Ø Step-4:
Transference daily life
8.7.Walking
·
Essential component:
Ø Gait
pattern or cycle, gait terminology
Ø Missing
components
·
Practice:
Ø Step-1:
Analysis
Ø Step-2
and 3: Practice of missing component
Ø Step-4:
Transference daily life
9.
IMPORTANT
POINT IN PRACTICE OF MOTOR RELEARNING PROGRAM:
·
Activities or motor task are practice
either entirely or broken down into their components
·
Techniques –verbal and visual feedback,
instruction and manual guidance
·
Method progression - should not waste
time in practicing what he/she can do
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