Motor fluency deficits in the sequencing of actions in schizophrenia

Many everyday activities depend on the capacity to organize and smoothly execute motor sequences. The authors tested the hypothesis that a sequencing deficit is associated with schizophrenia. They used a new method to distinguish between lower and higher order mechanisms for the impairment. The 1st task involved triggered sequences in which sensory information from 1 movement was the cue for initiation of the following movement. Results showed that the motor sequences were performed as fluently in patients as in controls. The 2nd and 3rd tasks involved sequences in which the entire movement sequence could be preplanned. Patients executed the sequences less fluently than controls but only under the condition where action sequences were required. Furthermore, the patients' fluency deficit increased with sequence complexity. The high discrimination power of Task 3 gave the authors a means to control for a potential psychometric confound involving differential discriminating power and to argue in favor of a specific higher order motor fluency deficit in patients with schizophrenia. It is suggested that basic lower order mechanisms that integrate sensory information with outgoing motor commands are preserved in schizophrenia, whereas higher order integrative mechanisms that are required for the smooth coordination of motor sequences are impaired.