Motor Relearning Program

Question 1

What is MRP?

Answer 1

Motor Relearning Program

Question 2

What is dynamic system theory?

Answer 2

• Movement produced from interactions of multiple sub-systems within person, task, environment
• Sub system self organize
• Non linear process with steady changes occurring

Question 3

What is plasticity? how is it different in intact and lesions brains?

Answer 3

• 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

Question 4

What is the task oriented approach?

Answer 4

• 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

Question 5

Describe MRP

Answer 5

• Task oriented approach to examination & intervention
• Relearning will occur with opportunities for extensive, meaningful, task oriented training in a stimulating environment

Question 6

What are some general principles of MRP

Answer 6

• Early imitation of rehab
• Rehab environment should be mentally stimulating and use functional equipment
• Motivation
• Education & consistency

Question 7

What is the general structure of MRP intervention?

Answer 7

• Training motor control via task oriented exercise
• Restoration of Optimal Functional performance
• Opportunities for practice

Question 8

What are the 4 critical actions established by MRP?

Answer 8

• Standing up & sitting down
• Walking
• Reaching & manipulation
• Balance

Question 9

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.

Answer 9

True

Question 10

What are the 4 steps for implementing MRP approach?

Answer 10

• Step 1: Observation/ Analysis of Task
• Step 2: Practice of Missing Components
• Step 3: Practice of task
• Step 4: Transference of training

Question 11

What is the breakdown of step 1 of MRP approach?

Answer 11

• Observation
• Comparison
• Analysis (identification of impairments)

Question 12

What is done in step 2 of the MRP approach?

Answer 12

• 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

Question 13

What is done in step 3 of the MRP approach?

Answer 13

• Explanation & identification of goal
• Instruction
• Practice (verbal/ visual feedback, manual guidance & similar conditions)
• Re evaluation

Question 14

What is done in step 4 of the MRP approach?

Answer 14

• Opportunity to practice in & out of context
• Consistency of practice
• Organization of self-monitored practice
• Structured learning environment
• Involvement of family & staff

Question 15

How does MRP describe strength impairments?

Answer 15

• Decrease contractility (force)
• Slowness of movement & prolonged rise to peak force
• Timing of muscle forces
• Intersegmental control

Question 16

How does MRP describe coordination impairments?

Answer 16

Speed/force of movement, amplitude of displacement, directional accuracy

Question 17

What does MRP refer to spasticity as?

Answer 17

Intrinsic stiffness & adaptive shortening

Question 18

What are the impairments MRP recognizes?

Answer 18

• Strength
• Coordination
• Somatosensory (tactile)
• Proprioception (position & passive movement sense)
• Perceptual - Cognitive
• Soft tissue flexibility (adaptive shortening)
• Intrinsic stiffness & adaptive shortening

Question 19

What are the muscle strengthening principles?

Answer 19

• 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

Question 20

Which is more effective passive or active stretching?

Answer 20

Active

Question 21

How is somatosensory training performed?

Answer 21

• Direct selective attention to the sensory aspects of functional tasks
• Manipulate task in a functional way that provides different sensory experiences

Question 22

How is perceptual cognitive training performed?

Answer 22

• Focusing attention on appropriate cues
• Scanning environment
• Integrate moving objects into treatment when able

Question 23

What are the critical factors for learning?

Answer 23

• Motivation
• Attention
• Instructions & demonstration
• Feedback
• Practice & intensity

Question 24

How can attention be improved?

Answer 24

• External focus of attention
• Concrete goal
• Ask patient to reflect on performance

Question 25

How should instructions & demonstrations be given early on?

Answer 25

- Frequent but brief - Cue most critical missing aspect (detail) in context of goal - Use demo/videos, mirrors

Question 26

How should instructions & demonstration be given later on?

Answer 26

- Cue goal - Decrease instructions & demos

Question 27

How should be feedback be given?

Answer 27

- Visual, auditory, tactile - Focused, deliberate & decreased over time - Specific to patients needs

Question 28

What should the approach for the action of standing up & sitting down look like?

Answer 28

- Repetitive practice of LE flexion/extension - Carryover to stance phase of gait, stair negotiation, squat & recover - Vary task & contextual factors while avoiding compensations

Question 29

What is the emphasis on when training walking?

Answer 29

Support & push off, balance of COM over changing BOS, & control of ankle/knee during swing

Question 30

What should training focus on when training for walking?

Answer 30

- Functional strength training to load limbs equally - Treadmill training - Over ground walking - Environmental modifications

Question 31

What should the treatment approach look like when the goal is to improve reaching & manipulation?

Answer 31

- UE movement driven by functional target - Simple repetitive exercises - Functional strength training - Training of bimanual activities

Question 32

What is the emphasis on when improving balance?

Answer 32

Strength, power/ endurance, coordination, sensory & perceptual processes & cognition

Question 33

Name some way to integrate MRP into practice

Answer 33

- 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