PHYSIOHEALER.

Important points to consider for MRP(Stroke Patients):

It Includes:

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.

Inappropriate methods of progression.

Performance of motor activities in the neurodevelopmental sequence.

Passive ROM exercise to resistive exercise.

Parallel bars to quad cane.

Wide to narrow base of support
and Roll over before sitting balance.

Equipment:

Objects that can be used as normally operative regulatory conditions for tasks.

Unnecessary equipment.

Parallel bars and canes.

Splints / braces that hold the ankle in dorsiflexion.

Effectiveness:

Depends on the therapist’s knowledge of biomechanics and motor control and problem-solving ability.

The therapist must recognize and analyze the motor problem, select the most essential missing component,effectively teach the patient the required movement and monitor the patient’s response.

At last,give meaningful feedback and create an environment that promotes a drive toward recovery and relearning.

Limitation:

Spasticity is not considered a significant residual problem of stroke.However,no management is recommended to reduce abnormal muscle tone.

Focus on active learning indicates limited applicability in patients with severe cognitive deficits.

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.

Theoretical underpinnings of the MRP:

Postural adjustments are anticipatory and ongoing.

Changes occur in muscular organization of a person occur simultaneously with the plan to move and prepare the person for performing the task.

Motor behavior emerge as a result of context or regulatory conditions in the environment (performer-environment interaction).

Postural adjustments can be learned only in the context of task performance.

Skilled motor performance is defined as the ability to perform in different ways according to variations in environmental demands.

Deficits in generating appropriate models of action are the primary problem following stroke and not spasticity or pathologic movement synergies.

Stereotypic movement patterns are compensatory strategies that result when movement is attempted.

Development of abnormal movement patterns in stroke:

1.Attempt to move

2.Obstacles to efficient movement

3.Diminished soft tissue extensibility

4.Impaired balance

5.Postural insecurity and resultant fixation patterns.

6.Specific muscle weakness

7.Compensatory movement strategy.

8.Repeated practice of the compensatory strategy.

9.Learned use of the compensatory strategy.