Motor Relearning Programme

Dr. Maheshwari Harishchsndre

Assistant Professor
M.P.Th (Neurosciences)
DVVPF College of Physiotherapy,
Ahmednagar
 Objectives
1. Explain the motor relearning programme
2. Describe steps in the execution of the programme

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 Contents
• What is MRP
• Factors of MRP
• Effectiveness of MRP
• Sections of MRP
• Steps of MRP
• Equipments used
• Quality of rehabilitation

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 MRP
• Retraining of motor control basing on
understanding of normal movement &
analysis of motor dysfunction.
• Emphasis of MRP is on practice of specific
activities, the training of cognitive control
over muscles & movt. Components of
activities & conscious elimination of
unnecessary muscle activity.
• In rehabilitation programme involve – real
life activities included.
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• Concentrate over the essential movement
components such as – standing & walking

• Based on 3 factors –
1. Elimination of unnecessary muscle
activity
2. Feedback
3. Practice
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• Relearning of the everyday activities
contained in which patient was skilled
before the condition .

For effective use of MRP therapist should

have the following problem solving skill-
i.e recognition
 analysis
 decision making
 action taking
 re-evaluation
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 Effectiveness of MRP
1. Recognition & analysis the problem

2. Select the most essential missing

component

3. Explain clearly to the patient by speech &

demonstration

4. Monitor the patients performance &give

verbal feedback
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5. Re-evaluate throughout each session

6. Positive feedback

7. Provide an enriched environment in which

patient will be motivated towards
recovery of mental & physical abilities

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 Sections of MRP
• 7 sections – representing the essential
functions of everyday life
1. Upper limb function
2. Orofacial function
3. Sitting up from supine
4. Sitting
5. Standing up & sitting down
6. Standing
7. walking
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 Steps of MRP
1. Analysis of function –
• Observation
• Comparison
• Analysis

2. Practice of missing components

• Explanation + instruction
• Practice (verbal feedback & manual
guidance)
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3. Practice of activity
• Explanation + instruction
• Practice
• Progression –increase complexity, add
variety, decrease feedback + guidance

4. Transference of learning
• Opportunity for practice
• Consistency of practice
• Involvement of relatives & staff
• Positive reinforcement
• Stimulating enviornment
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 Upper limb function
1. The ability to see what one is doing?
2. The ability to make postural adjustments
which occur with arm movt
3. Sensory information

Essential component – reaching shoulder in

abduction, flexion, extension, elbow flexion
& extension.
• Major functions of hand is grasp, release &
manipulate objects
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• Step 1 – Analysis – common problem &
compensatory strategies
• Arm & hand
• Analysis of painful shoulder

• Step 2&3 – practice of UL function

• Step 4 – transference of training into daily life

• He/she must not suffer secondary injury, not
allowed to develop non-learned use
phenomenon, conc over essential component
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 Oro-facial function
• Activities like – swallowing, facial
expression, ventilation, speech production.
• So affect eating, communication &
socialization.
• Resultant drooling of saliva or water,
aspiration & difficulty ingesting the food.
• Swallowing task – essential components
are – jaw closure- lip closure- elevation of
the post 3rd of tongue – close of oral
cavity –elevation of lat border of tongue.
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• Step 1 - Analysis – observation of
alignment & movt of lips, jaw, tongue,
eating, drooling
• Lack of control over oro- facial mus
• Will result in –
• Step 2 &3 - position , intraoral techniques,
practice
• Step 4 - feedback

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 Sitting up from supine
• Essential components – turning on side
rotation , flexion of neck, shoulder along
with protraction.

• Step 1 – Analysis-
• Step 2&3 – practice of missing component
• Step 4 – transference daily life

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 sitting
• Essential component – body alignment

• Step 1 – Analysis-
• Step 2&3 – practice of missing component
• Step 4 – transference daily life

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 Standing up & sitting down
• Essential components – foot placement,
trunk forward with hip flexion, extension of
neck & spine
• Sitting component – trunk pattern,
extension of neck & spine, knee flexion.
• Step 1 – Analysis-
• Step 2&3 – practice of missing component
• Step 4 – transference daily life
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 Standing
• Essential components – postural
adjustment, feet position, erect trunk, hip
in front of ankles.
• Step 1 – Analysis-
• Step 2&3 – practice of missing component
• Step 4 – transference daily life

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 walking
• Essential components –
• Missing components

• Step 1 – Analysis-
• Step 2&3 – practice of missing component
• Step 4 – transference daily life

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• It is not necessary for a patient to perfect
on one section, before going on to another
section

• MRP should commence as soon as the

patient is medically stable.

• If bed ridden – start the programme which

he/she can manage- like oro-facial
function, upper limb function.

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• Three imp. Point in practice of MRP

1. Activities or motor tasks are practice

either entirely or broken down into their
components
2. Techniques – verbal & visual feedback,
instruction & manual guidance
3. Method of progression – should not
waste time in practicing what he/she can
do
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 Equipments used
• Low bed of convenient height- for practice
of standing up & sitting down

• Several small steps

• Common objects for retraining hand

function

• Walking sticks (if necessary)

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• Factors improved Quality of rehabilitation
1. Early start
2. Rehabilitation plan
3. Consistency of goal
4. Motivation
5. Mental stimulation
6. Educational programme
7. Planning for discharge
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 Summary
• MRP
• Effectiveness
• sections
• Steps
• Equipments
• Quality of rehabilitation

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 Questions
• Motor relearning programme - 15 M
• Write in detail any one section of MRP -5M
• Enumerate sections of MRP – 3M

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