Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

Copy of Carr and Richardson's Motor Re-learning Program

No description
by

Chai Kul

on 18 December 2013

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Copy of Carr and Richardson's Motor Re-learning Program

Carr and Richardson's
Motor Re-learning Program

Developed by Australian physiotherapists Janet Carr and Roberta Shepherd
A task-oriented approach to improving motor control and focusing on the relearning of daily activities. Treatment techniques are based on extensive studies of how normal movement occurs during functional tasks.

1.Upper limb function
2.Oro-facial function
3.Sitting up from supine
4.Sitting
5.Standing up and sitting down
6.Standing
7.Walking

7 categories of functional daily activities
It emphasizes performer-environment interaction. Motor behaviors emerge as a result of context or regulatory conditions in the environment. Therefore, movement patterns are practiced in context of tasks, rather than exercises.
It is strongly based on theories that emphasize a distributed rather than a hierarchal motor control model. The order of sections is not important and mastery of a section is not necessary before going onto another section.
Deficits in generating appropriate models of action are the primary problem following stroke. Therefore, stereotypic movement patterns result when movement is attempted leading to compensatory strategies. Carr & Shepherd discourage the early use of compensatory strategies and clients are taught to avoid abnormal compensation for weak muscles.
INTERVENTIONS
AND PROCEDURES

1. Analysis of Task
a.Observation
b.Comparison
c.Analysis
2. Practice of Missing
Components
a. Identification of goals
b. Instruction
c. Practice with verbal
and visual feedback
and manual guidance

3.Practice of Task
a.Identification of goals
b.Instruction
c.Practice with verbal and
visual feedback and
manual guidance
d. Progression
e. Reevaluation

4.Transference of Learning
a.Opportunity to practice
in context
b.Consistency of practice
and positive reinforcement
c.Organization of self-monitored practice
d.Structured and stimulating
learning environment
e.Involvement of relatives
and staff

BALANCE
Ability to maintain an upright posture against the dynamically changing effects if gravity on our body segments.
BALANCED SITTING
COMPONENTS OF SITTING ALIGNMENT:
• Feet and knees close together
• Symmetrical weight-bearing / sitting
• Hip flexion with trunk extension
• Head balanced on level shoulders

COMPONENTS OF BALANCE REACTIONS:
• Lateral shift in the center of gravity
Lateral neck flexion
Lateral trunk flexion (pelvic elevation, shoulder depression)
• Backward shift in the center of gravity
Forward neck and trunk flexion
PROCEDURES / WHAT TO DO:
•Observe sitting alignment
Sitting on a firm base with feet flat on the floor
Knees and feet a few inches apart
Hands on the lap
•Test the ability to adjust to self-initiated movement of head, trunk and limbs
Looking behind, up
Grasping an object from the floor
Lifting the intact leg and foot
Reaching in various directions
•Test the displacement of weight sideways and backward (equilibrium reactions)

COMPENSATORY RESPONSES:
•Wide base of support (placement of the feet and / or knees apart)
•Voluntary restriction of movement (holding the breath or maintaining a stiff body posture)
•Shuffling of the feet instead of adjusting using appropriate body segments
•Leaning forward or backward when the center of gravity shifts sideways
•Use of protective support by the upper limbs (grabbing for support, holding arms out sideways or forward) with minimal shifts in the center of gravity

BALANCED STANDING
COMPONENTS OF STANDING ALIGNMENT:
•Feet a few inches apart
•Symmetrical weight-bearing
•Extended knees and hips
•Hips over feet
•Erect trunk
•Shoulders over hips
•Head balanced on level shoulders

COMPONENTS OF BALANCE REACTIONS:
•Lateral shift in the center of gravity
Lateral neck flexion
Lateral trunk flexion (pelvic elevation, shoulder depression)
•Backward shift in the center of gravity
Neck extension
Forward trunk inclination at the hips
Ankle dorsiflexion

PROCEDURES / WHAT TO DO:
•Observe standing alignment
•Test the ability to adjust to self-initiated movement of head, trunk and limbs
Looking behind, up
Grasping an object from the floor
Standing on one leg
Reaching in various directions
•Test the displacement of weight sideways and backward (equilibrium reactions) with feet a few inches apart

COMPENSATORY RESPONSES:
•Wide base of support (placement of the feet and knees apart)
•Voluntary restriction of movement (holding the breath or maintaining a stiff body posture)
•Shuffling of the feet instead of adjusting using appropriate body segments
•Stepping sideways or backward as soon as the center of gravity moves
•Leaning backwards when the center of gravity shifts sideways
•Proximal (instead of distal) movement of parts when shifting the center of gravity
•Use of protective support by the upper limbs (grabbing for support, holding arms out sideways or forward) with minimal shifts in the center of gravity

Indications and Contraindications
•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.

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
PRECAUTIONS
•Carr and Shepherd caution against excessive physical handling as a technique to teach patients the model of action.

•Verbal instruction is kept to a minimum. The 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, focusing on one or two most important 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.

•OTs must design safe, individualized methods for each patient that continually include that person's emerging capacities into daily self-care and leisure performance.

•Precaution against prescribing universal methods for ADL that contradict our goals for optimum motor performance

LAST NA YEY!
EVIDENCE
Best Evidence for Task-Related Training.
•Intervention used: Task-Related Circuit Training.
The treatment group was subjected to strengthening of lower limb and practicing of functional tasks that involved the lower limbs. The control group was subjected to practicing the upper limb. The treatment resulted in immediate and retained improvement in walking distance, speed, without assistive devices and standing balance. There were no significant changes in upper limb strength or dexterity.
Reference: Dean, Richards, & Malouin, 2000. (as cited in Trombly).

REFERENCES
Carr, J. H., & Shepherd, R. B. (1987). A motor relearning programme for stroke (2nd ed.). Oxford: Butterworth-Heinemann.
Handout by Prof. Edward James R Gorgon. (2009). Motor relearning programme. College of Allied Medical Professions, University of the Philippines Manila.
Radomski M. & Latham C. (2008). Occupational therapy for physical dysfunction. Wolters Kluwer: Lippincott Williams and Wikins.
Full transcript