A clinical examination of OPTIMAL theory application in people with multiple sclerosis: a proof-of-concept study and implications for rehabilitation practice

We investigated the potential to improve motor learning and performance in people with multiple sclerosis (PwMS) with OPTIMAL theory conditions. OPTIMAL theory predicts that three main factors [i.e. autonomy support (AS), enhanced expectancies (EE), and external focus (EF)] facilitate performance and learning. We examined whether the implementation of all three combined in a consecutive manner during practice would be beneficial for the motor learning and performance in a clinical population facing physical, cognitive, and emotional challenges. Thirty PwMS with mild-to-moderate disability (Expanded Disability Status Scale = 2.0-5.0) were randomly assigned to one of two groups (optimized and control) and practiced a novel motor-cognitive task involving rapid square-stepping to memorized patterns. Following a pretest (no group difference), optimized group participants practiced under each of three factors across practice phase (EE: feedback after good trials; AS: choice of mat color; and EF: external focus to the mat). Control group participants practiced under neutral conditions. The optimized group had significantly shorter movement times than the control group in the practice phase [174.7 (27.4) s vs. 236.8 (35.8) s, P  < 0.0001], on the 24-h retention test [69.3 (9.3) s vs. 159.7 (15.5) s, P  < 0.0001], and the 24-h transfer test [146.1 (14.9) s vs. 223.1 (38.9) s, P  < 0.0001]. Thus, optimized practice combining AS, EF, and EE enhanced motor skill learning. Key factors in the OPTIMAL theory can be used to improve patients' motor learning. Further studies are warranted to extend these proof-of-concept observations for potential clinical applications.