Interference Effect of Prior Explicit Information on Motor Sequence Learning in Relapsing-Remitting Multiple Sclerosis Patients

What is it about?

Multiple sclerosis (MS) is the most common inflammatory demyelinating disease of the central nervous system in young adults and is usually diagnosed in individuals between the ages of 20 and 40 years. This disease is almost twice as common in women as in men. MS affects 2.5 million persons worldwide and approximately 350,000 Americans with as many as 300 persons being diagnosed each week (2, 4). The onset of the disease at a young age causes long-term disability and significant psychological problems for the patients and their families (5). This early onset also results in an increased need to provide appropriate treatment and rehabilitation techniques to reduce disability and improve one’s quality of life (5–7). A wide range of rehabilitative approaches have been employed to reduce disability and improve one’s quality of life (1). These approaches range from more traditional strategies to newer techniques emphasising the learning and practice of functional motor skills (1, 8–9), as it has been found that practice is critical for mastery of motor skills (10). In this approach, the rehabilitation therapist acts as a facilitator, using many kinds of techniques such as instructions, physical or verbal guidance, and feedback to improve learning (11). Rehabilitation therapists use these instructions to guide their patients toward an optimal motor solution (12). As such, rehabilitation therapists dedicate considerable therapeutic time providing instruction to patients. However, regardless of the enormous amount of effort and time devoted to training individuals throughout rehabilitation, there are not many studies that have considered the effect of explicit information (EI) on the neurologic patients’ implicit learning (4, 10). In addition, to date, there has been no general agreement on how implicit motor skill learning is supported by instructions of verbal EI in any population.

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Photo by National Cancer Institute on Unsplash

Photo by National Cancer Institute on Unsplash

Why is it important?

Some studies suggest that explicit learning has a detrimental effect on implicit learning when cognitive capacity and working memory are reduced, such as in a cerebral vascular accident or healthy aged participants (27–29). These studies imply that simple practice without instruction and with general performance feedback, as opposed to explicit instruction, may lead to more efficient performance. This explanation could have direct implications for instructional techniques in applied settings (23). Studies in MS patients suggest that the ability of MS patients to learn motor skills is partially preserved (30–31). However, the impact of EI on implicit learning in this population has not been considered in any studies. As such, the purpose of this study was to investigate the impact of EI on motor-sequence learning in MS patients. It compared the effect of simple non-instructed practice of repeated sequences with general performance feedback and explicit instruction on motor-sequence learning in MS patients.

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