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L. Moumdjian1,2, J. Six2, T. Vervust3, J. Geys1, C. Van Der Linden1, M. Goetschalckx1, M. Leman2, P. Feys1
1Faculty of Rehabilitation Sciences, Hasselt University, Rehabilitation Research Center, Hasselt, Belgium, 2Institute of Psychoacoustics and Electronic Music, Ghent University, Faculty of Arts and Philosophy, Ghent, Belgium, 3NaMiFab - UGent Expertise Center for Nano- and Microfabrication, Ghent University, Dept. of Information Technology and Dept. of Electronics and Information Systems, Ghent, Belgium
Background: Motor and cognitive impairments are prevalent in multiple sclerosis. To target these symptoms during a training intervention a suited approach is needed, covering both motor and cognitive aspects. This may be achieved with an embodiment theory approach in which the body and mind are seen as two systems that can't be separated from each other.
Purpose: To investigate if persons with multiple sclerosis (PwMS) compared to healthy controls (HC) a) could learn a cognitive sequence in an embodied setting (i.e. learning the cognitive sequence through a series of steps) and b) if embodied learning had an effect on the participant’s motor performance (absolute and variability). In addition, embodied learning during three different feedback modalities was applied to investigate if modality type had an effect on motor or cognitive performance during the learning.
Methods: Participants were asked to perform a standardised learning protocol which consisted of learning a cognitive sequence (a pattern of 7 steps) in three different feedback modalities: melodic, sound and visual. The embodied learning protocol was performed on a custom made platform made of interactive multi-media tiles. The protocol ended by asking participants to perform a 15 minute delayed recall task. Here participants performed the learnt sequence (pattern of steps) on the multi-media tiles while no feedback was received. The mean inter-step-intervals (ISI), standard deviations of ISI and the accuracy of the sequence performed at the delayed recall task were used as outcome measures. In addition, symbol digit modality test (SDMT) was used to account for the factor of information processing speed during embodied learning.
Results: A total of 31 PwMS and 30 HC participated. In the melodic condition, 70% of the HC learnt the sequence. While in all three modalities, on average, half of the participants learnt the sequence and performed it without any mistakes. PwMS performed the embodied learning task on average slower (p=.0069) and with more variability (p=.0056) compared to HC irrespective of modality. The task was performed faster and with less variability between those who learn the sequence compared to those that did not (p<.0001). A significant interaction was found between learning and modality (p=.0457); indicating that only in the sound condition, those who learnt performed the task significantly faster compared to those that did not (p<.0001). A significant interaction was found between the SDMT and modality (p=.0187); indicating that during the melodic condition only, the task was performed with less variability with those with a higher SDMT (p=.0040).
Conclusion(s): Learning a cognitive sequence in an embodied setting was feasible in PwMS and HC irrespective of modality type. Sequence learning had an effect on the motor performance (both in terms of absolute and variability) and was dependent on the modality type.
Implications: Embodied learning with an emphasis on melodic feedback modalities could be considered as a promising approach in rehabilitation of PwMS, yet the development of methods and techniques incorporating this approach into clinical practice are warranted.
Funding, acknowledgements: The Methusalem project (awarded by the Flemish Government) at UGent and the UHasselt BOF grant for funding this study.
Keywords: Multiple sclerosis, Feedback modality (melody, sound, visual), Motor and cognitive performance
Topic: Neurology: multiple sclerosis
Did this work require ethics approval? Yes
Institution: Leading: UZ Gent
Committee: Medical Ethical Committee
Ethics number: B670201837795
All authors, affiliations and abstracts have been published as submitted.
