Motor Relearning Program Flashcards
What is MRP?
Motor Relearning Program
What is dynamic system theory?
- Movement produced from interactions of multiple sub-systems within person, task, environment
- Sub system self organize
- Non linear process with steady changes occurring
What is plasticity? how is it different in intact and lesions brains?
- Ability of CNS to adapt & reorganize
- In intact brain it is the process of learning
- In lesioned brain recovery of function is spontaneous, requires reorganization
What is the task oriented approach?
- Approach to patient management emerging from dynamic systems and motor learning theories
- Use of functional task to which target neuromuscular & musculoskeletal system to treat motor behavior
Describe MRP
- Task oriented approach to examination & intervention
- Relearning will occur with opportunities for extensive, meaningful, task oriented training in a stimulating environment
What are some general principles of MRP
- Early imitation of rehab
- Rehab environment should be mentally stimulating and use functional equipment
- Motivation
- Education & consistency
What is the general structure of MRP intervention?
- Training motor control via task oriented exercise
- Restoration of Optimal Functional performance
- Opportunities for practice
What are the 4 critical actions established by MRP?
- Standing up & sitting down
- Walking
- Reaching & manipulation
- Balance
T/F: MRP uses functional training within the 4 critical actions of everyday life to analyze each task, determine what is missing, train patient in missing aspects, and put missing pieces together to train the entire daily activity.
True
What are the 4 steps for implementing MRP approach?
- Step 1: Observation/ Analysis of Task
- Step 2: Practice of Missing Components
- Step 3: Practice of task
- Step 4: Transference of training
What is the breakdown of step 1 of MRP approach?
- Observation
- Comparison
- Analysis (identification of impairments)
What is done in step 2 of the MRP approach?
- Explantation - Identification of the areas to address in context of task (focus on most critical to that task)
- Instruction
- Practice + verbal & visual feedback + manual guidance
What is done in step 3 of the MRP approach?
- Explanation & identification of goal
- Instruction
- Practice (verbal/ visual feedback, manual guidance & similar conditions)
- Re evaluation
What is done in step 4 of the MRP approach?
- Opportunity to practice in & out of context
- Consistency of practice
- Organization of self-monitored practice
- Structured learning environment
- Involvement of family & staff
How does MRP describe strength impairments?
- Decrease contractility (force)
- Slowness of movement & prolonged rise to peak force
- Timing of muscle forces
- Intersegmental control
How does MRP describe coordination impairments?
Speed/force of movement, amplitude of displacement, directional accuracy
What does MRP refer to spasticity as?
Intrinsic stiffness & adaptive shortening
What are the impairments MRP recognizes?
- Strength
- Coordination
- Somatosensory (tactile)
- Proprioception (position & passive movement sense)
- Perceptual - Cognitive
- Soft tissue flexibility (adaptive shortening)
- Intrinsic stiffness & adaptive shortening
What are the muscle strengthening principles?
- Task oriented (concentric & eccentric)
- Intensive to mild fatigue
- Resistance & repetition to patient ability & focus area
- Increase load to improve strength
- Increase rep to improve endurance
- Increase speed to improve power
Which is more effective passive or active stretching?
Active
How is somatosensory training performed?
- Direct selective attention to the sensory aspects of functional tasks
- Manipulate task in a functional way that provides different sensory experiences
How is perceptual cognitive training performed?
- Focusing attention on appropriate cues
- Scanning environment
- Integrate moving objects into treatment when able
What are the critical factors for learning?
- Motivation
- Attention
- Instructions & demonstration
- Feedback
- Practice & intensity
How can attention be improved?
- External focus of attention
- Concrete goal
- Ask patient to reflect on performance
How should instructions & demonstrations be given early on?
- Frequent but brief
- Cue most critical missing aspect (detail) in context of goal
- Use demo/videos, mirrors
How should instructions & demonstration be given later on?
- Cue goal
- Decrease instructions & demos
How should be feedback be given?
- Visual, auditory, tactile
- Focused, deliberate & decreased over time
- Specific to patients needs
What should the approach for the action of standing up & sitting down look like?
- Repetitive practice of LE flexion/extension
- Carryover to stance phase of gait, stair negotiation, squat & recover
- Vary task & contextual factors while avoiding compensations
What is the emphasis on when training walking?
Support & push off, balance of COM over changing BOS, & control of ankle/knee during swing
What should training focus on when training for walking?
- Functional strength training to load limbs equally
- Treadmill training
- Over ground walking
- Environmental modifications
What should the treatment approach look like when the goal is to improve reaching & manipulation?
- UE movement driven by functional target
- Simple repetitive exercises
- Functional strength training
- Training of bimanual activities
What is the emphasis on when improving balance?
Strength, power/ endurance, coordination, sensory & perceptual processes & cognition
Name some way to integrate MRP into practice
- Have patient attempt functional task prior to initiation of treatment
- Ask them to reflect on performance, then provide them with focused & deliberate feedback most critical to task
- Use mental practice
- Treat those critical aspects using task oriented exercise, then practice the whole task using functional objects
- Fade feedback & input
- Increase challenge of task as treatment progresses
