Motor Relearning Program

What are the major assumptions of MRP?

-training of the MC based on an understanding of the kinematics and kinetics of normal movement, MC processes, and ML

-emphasis on practice of specific motor tasks and the training of controlled muscle action

-brain has the ability to recover via plasticity

-info & action are related via the action system

-biomechanical necessities are essential to activity (critical components)

-pt consciously practices motor tasks

What is muscle action?

muscles are grouped together into functional synergies that are specific to particular tasks

What is posture specificity?

there is little transfer of training effect from one position to another with posture

Knowledge of ________ between limbs and segments is critical to the understanding of movement, rarely does one body part function in ______.

interactions (synergy)

isolation, independently

What are the critical components for a sit to stand?

-feet under knees

-forward trunk translation, with trunk in extension and hip flexion

-forward translation of knees/lower limb segments

-trunk, knee, hip extension

-symmetrical

What is postural adjustment?

the order in which muscles activate is dependent on the task being performed

T or F: The posture system is separate from the movement sysem

False

What are the critical factors for optimizing the ability to balance?

1. easy start at practicing balancing in an upright position

2. intensive practice of simple movements that only require a small excursion of COG; as more control is gained, larger excursions and more complexity

3. harness support should be available for those who can't stand independently

4. computerized force plate system can provide feedback

5. exercises to strengthen LEs

6. practice activities in different environments

7. stretching program

8. activities should challenge pts to the limits of their stability (discourage UE support)

What may be some musculoskeletal secondary complications?

pain, stiffness, GH subluxation

What are ways to avoid secondary musculoskeletal complications?

passive stretching, positioning, active movement with assistance, modified training with reaching

What are the critical factors for optimizing outcome for UE function?

1. easy start to stimulate muscle activity

2. easy start to preserve muscle length and prevent stiffness & prevent injury to GHJ

3. task related exercise and training

4. intensive practice of a variety of tasks with different objects

5. prevent learned non-use

6. avoid restraint of involved limb (sling)

What are the 2 critical components of learning a motor skill?

1. identifying what it is that needs to be learned

2. understanding the ways through which the goal can be accomplished

During the early stages of learning, should there be more or less feedback?

more immediate and frequent feedback at this point

As the pt is moving away from the early stages of learning, how should feedback from the PT be adjusted?

decreased & face away augmented feedback, so the pt can use naturally occurring intrinsic feedback mechanisms that gives the pt the opportunity to self correct and problem solve

What needs to happen for meaningful practice and change to occur outside of PT sessions?

PTs must permit unsupervised practice by enabling a safe and independent practice

T or F: Increased strength can cause increased walking speed

True

In regards to UE use during tasks, should the following methods be used or not: constraint therapy and/or restraint thrapy?

can use CONSTRAINT therapy, but no restraints

-this causes forced use of the affected limbs

Is disordered motor control a primary or secondary motor impairment?

secondary

Is adaptive motor patterns a primary or secondary motor impairment?

secondary

Is loss of dexterity a primary or secondary motor impairment?

primary

What are the components of MRP?

1. analysis of task

2. practice of missing components

3. practice of task

4. transference of training

Describe the 1st step of MRP.

analysis of task

-look at what the pt is having trouble with and evaluate which pieces are the problem

Describe the 2nd step of MRP

practice of missing components

- can train or target ROM, spasticity, or a specific part of the task that is missing (like doing the PART aspect of part-whole training)

Describe the 3rd step of MRP.

practice of task

-doing the whole task after practicing the missing components

-"putting the pieces together"

Describe the 4th step of MRP

transference of training

-practicing the task in a different condition somehow

-at this step, can incorporate Gentile's taxonomy (change environment, object, variability, etc)