Motor Relearning
Programme
Dr. Preeti Ganachari
Dept. Of Neurophysiotherapy
Mgm Institute Of Physiotherapy
Chh. Sambhajinagar
Introduction
• The Motor Relearning Programme (MRP) was developed by the
Australian physiotherapists Janet Carr and Roberta
Shepherd.
• It is a task-oriented approach to improving motor control,
focusing on the relearning of daily activities.
• It is strongly based on theories in kinesiology that emphasize a
distributed (rather than a hierarchal) motor control model.
Motor Relearning Programme
• Focus on practice of missing task components and whole
tasks, and transference of learning
• Examples: Use of “real-world” environments. “Forced use” of
affected UL
Inc. activity UL muscles
Stretching of key UL muscles
Feedback and guidance
Basic Description & guidelines
• The programme is composed of guidelines for evaluating and
improving daily functions like:
• Upper limb function
• Oro-facial function
• Sitting up from supine
• Sitting
• Standing up and sitting down
• Standing
• Walking
• Each section is composed of a description of normal activity
(essential movement components).
• Mastery of a section is not necessary before going onto another
section.
• There is no intent of progressing from one section to the next; the
order of sections is not important.
• The patient must always be actively participating in the activity
(without resistance) and given some opportunity to make mistakes.
Intervention
4 Steps
• Analysis of task
• Practice of missing component
• Practice of task
• Transference of learning
Analysis of Task
• Observation
• Comparison
• Analysis
Practice of Missing Components
• Explanation- Identification of goal
• Instruction
• Practice + Verbal + Visual feedback + Manual guidance
Practice of Task
• Explanation – Identification of goal
• Instruction
• Practice +verbal + visual feedback + manual guidance
• *Progression:-
Increase complexity
Add variety
Dec. feedback & guidance
Re-evaluation
Encourage flexibility
Transference of learning
• *Opportunity to practice
• *Consistency of practice
+ve reinforcement
• *Organization of self-monitored
Practice
• *Structured & stimulating
learning environment
• *Involvement of relatives and staff
Strategies for instructing the
patient
• Verbal instruction is kept to a minimum. The therapist identifies
the most important aspect of the movement on which the
patient will concentrate.
• Visual demonstration is provided by the therapist’s
performance of the task, focusing on one or two most
important components.
• Manual guidance helps to clarify the model of action by
passively guiding the patient through the path of movement or
by physically constraining inappropriate components.
• Accurate, timely feedback about the quality of performance
helps the patient to learn which strategies to repeat and which
ones to avoid.
• Consistency of practice facilitates development of skill in task
performance.
• Motor tasks are either practiced in entirety or broken down into
components. The practice of each component is immediately
followed by the practice of the entire activity.
• Techniques principally comprise verbal and visual feedback and
instruction, and manual guidance.
• Passive movement during demonstration should not persist
>1-2 times
• Body alignment should be monitored consistently
Acceptable methods of
progression
• Decrease in manual guidance and feedback
• Alteration in speed
• Increase in variety
Limitation
• Focus on active learning indicates limited applicability in
patients with severe cognitive deficits.