Motor Relearning Program (MRP) Notes

Motor Relearning Program (MRP)

Neurological Physiotherapy II (AHPT 2234)

  • Lecturer: Nurul Amirah Mustapa, Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, IIUM

Learning Objectives

  • Learning
  • Mechanisms of recovery
  • Elimination of unnecessary muscle activity
  • Feedback
  • Practice
  • Adjustment to gravity

Mechanisms of Recovery

  • Theories propose brain recovery after stroke:
    1. Neural sprouting within CNS
    • a) Regeneration: New growth of damaged neurons → re-innervate the denervated areas
    • b) Collateral sprouting: New growth in undamaged neurons → innervate the denervated areas
  • Widespread synaptic changes may underlie physiological mechanism for relearning or compensatory process responsible for recovery.

Mechanisms of Recovery (cont.)

  1. Behavioral strategy change
    • a) A form of substitution → body responds using different mechanisms to achieve motor goals
    • b) Examples:
      • Different sensory cues used to guide movement
      • Functional substitution: recovered movements produced differently from lost movements but achieve the same goal → Focusing on the usage of affected limbs

Mechanisms of Recovery (cont.)

  1. Reorganization of brain
    • a) Practice particular activities often → automatic and easy reorganization of brain

MRP Approach

  1. Analysis of abnormal movement patterns of different tasks
    • Focus on relearning daily activities
    • Correction of abnormal patterns
    • Repetitive practice of tasks
    • Facilitate development of new motor programs or refinement of existing programs to improve task performance in different environments and daily life situations
    • NEUROPLASTICITY
  2. Sequential and function-based concepts in training → enhancing patients' functional recovery after stroke

Elimination of Unnecessary Muscle Activity

  • Early stage of stroke → patient may demonstrate inability to move the affected side (transient flaccidity or hypotonia)
  • Gradually, return of muscle function (movement) occurs. However, patients tend to make several movement errors.
  • Examples of errors:
    • Tendency to activate incorrect muscles for a particular motor task
    • Move the intact side instead of the affected side
    • Strong motor contraction in compensation of poor motor control

Elimination of Unnecessary Muscle Activity (cont.)

  • Movement errors occur due to abnormal synergies developed after regaining motor control following stroke
  • Examples: Stroke patient in sitting position may develop flexor overactivity and contracture of lower limb
  • Ways to eliminate unnecessary muscle activity:
    • Encourage movement of the intact side to assist the affected side
    • Examples:
    • Side lying to sitting over the bed: use intact leg to assist lowering the affected leg
    • MOTOR RELEARNING PROGRAM (MRP)

Feedback in MRP

  • Visual feedback: Remind patient to watch what they are doing
  • Verbal feedback: Given by therapist to monitor patient’s performance → Right or wrong
  • Therapist needs to correct any abnormal movement/activity

Practice

  • Necessary prerequisite for acquiring skills in motor performance
  • Practice activities directly related to ADL
Frequency of Repetitions for Optimal Recovery
  • Frequency of rehab using MRP: 1 hour/day, 6 days/week for 6 weeks

MRP Effectiveness

  • Frequency of rehab using MRP: 6 days/week for 6 weeks
  • MRP is effective in improving functional balance, functional mobility, and quality of life

Adjustment to Gravity

  • Human body is perpetually submitted to the force of gravity
  • Whole motor system is organized towards either counteracting or utilizing the effects of the force of gravity
  • Discount the force of gravity through supine lying position and sitting with fully body supported
  • Movement of body → causes shift of gravity and body disequilibrium → tendency to FALL
  • Training MRP with adjustment of gravity:
    • Movement of body may cause disequilibrium or fall due to the shift of gravity, thus, appropriate posture adjustment is essential
    • Ensure patient has good control over body balance in various positions while training MRP
    • Therapist must ensure that they don’t position themselves too close to the patient → to enable patient to adjust their posture

References

  • Carr J. H. & Shepherd, R. B (1985). A Motor Relearning Programme for Stroke (2nd ed.). William Heinemann Medical Books.
  • Chan, D. Y., Chan, C. C., & Au, D. K. (2006). Motor relearning programme for stroke patients: a randomized controlled trial. Clinical rehabilitation, 20(3), 191–200. https://doi.org/10.1191/0269215506cr930oa
  • Immadi, Suneel & Achyutha, Kiran & Reddy, Amaranth & Tatakuntla, Krishna. (2015). Effectiveness of the Motor Relearning Approach in Promoting Physical Function of the Upper Limb after a Stroke. International Journal of Physiotherapy. 2. 386. 10.15621/ijphy/2015/v2i1/60047.