Carr & shepherd’s motor relearning programme for individuals

Introduction  Developed by Australian physical Therapists  Contemporary movement science theory & research

 Relevant to OT  Emphasize of daily activities  Provides task oriented strategy for improving motor control

Remediation of motor behavior through contemporary approaches  Influenced by  Contemporary skill acquisition theory  Motor development theories   Emphasize  Motor performance using  functional task  Consider factors  Other than CNS damage that may affect performance   Include (to improve task

performance)

 Remediation of

performance components  Modification of environment

Stress the practice that fits the nature of the task Reject assumptions of  reflex hierarchical model of

motor control  Traditional developmental theories

MRP – cognitive motor learning theory

THEORETICAL FRAMEWORK  Dynamical systems model of motor control  Contemporary theories in movement control  Distributed control or dynamical systems  ECOLOGICAL THEORY 

Regulatory conditions in the environment

 POSTURAL ADJUSTMENTS  Closed loop versus open loop system  Response versus anticipatory  Both task and context specific

THEORETICAL FRAMEWORK  COMPENSATORY STRATEGIES  Prevention of abnormal muscle shortening  

Appropriate postural adjustment in bed, when sitting Maintain muscle length through variety of motor task

 Prevention of fixation patterns  Sense of postural security  Kinematics of UE & LE movements  Prevention of compensations caused by weakness  Change the position of the task  Teach which are inefficient compensations – AVOID  Teach to consciously eliminate muscle activity  Provide manual guidance to direct

 ANALYSIS OF NORMAL MOTOR PERFORMANCE OF FUNCTIONAL TASK  MOTOR LEARNING  Nature of practice  Neurodevlopmental sequence of intervention

LEARNED USE OF THE COMPENSATORY STRATEGY REPEATED PRACTICE OF THE COMPENSATORY STRATEGY COMPENSATORY MOVEMENT STRATEGY

ATTEMPT TO MOVE • Obstacles to efficient movement • Diminished soft tissue extensibility • Impaired balance • Postural insecurity & resultant fixation patterns • Specific muscle weakness

INTERVENTION 1.

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Upper limb function Orofacial function Sitting up over the side of the bed Balanced sitting Standing up & sitting down Balanced standing walking

EVALUATION 1.

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Any missing components Incorrect timing of components within a movement pattern The absence of specific muscle activity Presence of any excessive or inappropriate muscle activity Compensatory motor behavior

EVALUATION  Analysis of performance of each of seven categories of

daily activities  Published normative description of author  Normal kinesiology – kinetics & kinematics  Studies done with subjects with hemiplegia

 Model of the action

 Gravitational torque values

TREATMENT ď‚— Five strategies of teaching 1.

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Verbal instruction Visual demonstration Manual guidance Accurate timely FB about quality of performance Consistency of practice facilitates development of skill in task performance

EVALUATION & TREATMENT OF SELECTED FUNCTIONAL ACTVITIES  Balanced sitting  Common signs of balance impairments     

Use of wide BOS Tendency to hold breath & maintain stiff body posture Strategy of shuffling feet Use protective support by UE Tendency to lean forward or backward

EVALUATION & TREATMENT OF SELECTED FUNCTIONAL ACTVITIES  Standing up & sitting down  Balanced standing  Take steps prematurely  To move proximal

 Upper limb function  Impaired scapular movement  Impaired control over deltoid muscle  Excessive & unnecessary elbow F, shoulder IR, forearm Pronation

The four steps of motor relearning program 1.

Analysis of task 1.

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Observation Comparison Analysis

Practice of missing components 1.

Explanation – identification of goal Instruction Practice + verbal & visual FB + manual guidance

Practice of task 1.

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Explanation – identification of goal

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Instruction Practice + verbal & visual FB + manual guidance Reevaluation Encourage flexibility

Transference of training 1.

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Opportunity to practice in context Consistency of practice Organization of self monitored practice Structured learning environment Involvement of relatives & staff

Common problems in hand  Difficulty maintaining wrist extension while attempting  

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grasp Difficulty extending & flexing MP joints Difficulty abducting & opposing the thumb for grasp and release Tendency to flex the wrist &/ or extend the extend the fingers and thumb excessively when attempting to release objects Tendency to pronate the forearm excessively while grasping objects Inability to maintain grasp while moving the arm Difficulty cupping the hand