Motor Re-learning Program
The Motor Relearning Programme (MRP) is a treatment approach that was developed by the
Australian physiotherapists Janet Carr and Roberta Shepherd.
Principles and Assumptions
It involves retraining of motor control based on understanding of normal movement and
analysis of motor dysfunction.
The patient actively participates in the training with the guidance of therapists.
MRP is designed according to the theories of biomechanics, sports science, neuroscience and
cognitive psychology specifically to common motor disturbance in stroke patients.
The learning and training content of the program is designed individually according to the
motor disturbance in different patients.
The motor training in the program is closely related with functional activities of daily life.
MRP can be commenced as soon as a patient is medically stable.
For learning to take place, practice should be done outside the rehabilitation room, relatives
and staff should be encouraged to participate and trained to give consistent feedback and
any assistance where necessary.
MRP works on the principle of Neuroplasticity - the ability of the brain to change and repair
itself.
Motor re-learning involves elimination of unnecessary muscle activity.
Motor re-learning requires constant feedback and practice.
Importance of interrelationship between postural adjustment and movement.
Training motor control, not muscle strength.
Maximum functional recovery in contrast to compensatory strategy.
Early start, consistent approach and challenging environment is necessary for motor-
relearning
Hands off problem solving principle – during MRP, the therapist does not touch the patient,
there is no passive movement performed. Feedback is given to the patient. Whereas in
Bobath, hands on approach is used.
Distribution of motor control – all systems of the body work in a co-ordinated manner to
perform a particular task.
Motor tasks are practiced as a complete entity. If necessary, individual components are
practiced separately, followed by practice of the entire entity.
Essential components are observable displacements of joints listed for each motor task. They
serve as a baseline for comparison of a patient’s performance with the normal performance.
Motor relearning is based on 3 factors:
Elimination of unnecessary muscle activity
Feedback
Practice
Strategies for instructing the patient:
Verbal instruction is kept to minimum . Therapist identifies the most important
aspect of the movement on which the patient will concentrate.
Visual demonstration is provided by the therapist ’s performance of the task ,
focussing on one or two most important components.
Manual guidance is provided to clarify the model of action by passively guiding
the patient through the path of movement or by physically constraining
inappropriate components.
Accurate, timely feedback about the quality of performance helps the patient to
learn which strategies to repeat and which ones to avoid.
Consistency of practice facilitates development of skill in task performance.
Steps in Motor relearning program
1. Analysis of function
a. Observation
b. Comparison
c. Analysis
In this stage, the missing component that needs to be trained is identified.
Eg: If gait analysis of patient is done, first ask the patient to walk normally and observe him
walking. Compare the affected and unaffected side. Then decide which component of gait
cycle is missing.
2. Practice of missing components
a. Explanation of missing component to patient
b. Instruction
c. Practice + verbal feedback and manual guidance
Explain the missing component to the patient.
Guide the patient accordingly so that the missing component is practiced.
Make the patient practice the missing component.
By observing the patient’s performance, provide him appropriate feedback, manual guidance
specific to the missing component.
Eg: If during gait analysis, knee flexion is absent, that means knee flexion is the missing
component.
Explain this to the patient and give him instructions about how the gait pattern is performed.
Make the patient practice it. Provide feedback and manual guidance.
3. Practice of activity
a. Explanation – identification of goal
b. Instruction
c. Practice + verbal feedback + visual feedback + manual guidance
d. Progression – increase complexity, add variety, decrease feedback and guidance, re-
evaluation, encourage flexibility
In this stage, re-evaluation of the task is done to see how much the patient has improved.
Activity should be performed to develop neuroplasticity.
4. Transference of learning
a. Opportunity for practice
b. Consistency of practice
c. Positive reinforcement
d. Practice
e. Stimulating environment
f. Involvement of relatives and staff
Transfer of normal training is done to challenging environment so that the individual can
perform the same task with same ease in a different environment. Patient should be made to
practice it regularly, while providing him continuous feedback.
Eg: Once a patient is able to walk normally, place obstacles in his path.
Training should be goal oriented.
Sections of MRP
1. Upper limb function
2. Orofacial function
3. Sitting up from supine lying
4. Sitting
5. Standing up and sitting down
6. Standing
7. Walking
Assumptions
1)Regaining the ability to perform motor tasks such as walking, reaching and standing
up involves a learning process, and the disabled have the same learning needs as the non-disabled
(i.e. they need to practise, get feedback, understand the goal etc.).
2)Motor control is exercised in both anticipatory and on-going modes and postural
adjustments and focal limb movements are interrelated.
3)Motor control of a specific motor task can be regained by practice of that specific
motor task in their various environmental contexts.
4)Sensory input related to the motor task helps to modulate action.
Techniques
Upper limb function
Step 1: Analysis of essential components and missing components (compensatory
strategies)
Step 2 and 3
practice of UL function
Step 4
transference of training into daily life.
Orofacial function
Activities like swallowing, chewing, facial expression, ventilation, speech production.
So they affect eating, communication and socialization.
Resultant drooling of saliva or water, aspiration and difficulty ingesting food.
Swallowing task – essential components are – jaw closure – lip closure – elevation of
the posterior 3 rd of tongue – close of oral cavity – elevation of lateral border of tongue
Step 1 – analysis of essential component and missing component (compensatory
strategy)
Step 2 and 3 – position, intraoral techniques, practice
Step 4 – feedback
Sitting up from supine
Step 1 - Analysis - Essential components and missing components (compensatory
strategies)
Step 2 and 3 – practice of missing component
Step 4 – transfer of training
Sitting
Step 1 – Analysis
Essential component and missing component (compensatory strategy)
Step 2 and 3 – practice of missing component
Step 4 – transfer of training
Standing up and sitting down
Step 1 – Analysis of standing up and sitting down
Essential components and compensatory strategies
Step 2 and 3 – practice of missing components
Step 4 – transference of training to daily life
One way of making this task of standing up easier it to provide a higher chair which eliminates some
of the difficulty involved in generating force. Members of staff and the patient’s relatives
need to understand the basic
b i o m e c h a n i c a l p r i n c i p l e s i n v o l v e d h o w t o a s s i s t t h e p a t i e n t a n d h o w t o reinfo
rce and monitor his performance.
Balanced Standing
Step 1 – Analysis
Essential components – postural adjustment, feet position, erect trunk, hip in front of
ankles
Missing components/compensatory strategies
Step 2 and 3 – practice of missing component
Step 4 – transference of training
Walking
Step 1 – Analysis
Essential components and analysis of missing components (compensatory strategy)
Step 2 and 3 – practice of missing component
Step 4 – transference of training
