Date Presented 03/27/20
Schizophrenia is commonly understood as a mental illness, but a growing body of evidence indicates that it is a complex neurological condition that profoundly impacts motor performance and learning. Thus, functional skills and participation are significantly affected. This scoping review aims to understand motor-learning processes in adults with schizophrenia with the goal of expanding our ability to support functional skill development in this population.
Primary Author and Speaker: Lee Westover
Additional Authors and Speakers: Katherine Dimitropoulou
PURPOSE: Schizophrenia is a serious mental illness, which can comprehensively affect function via positive and negative symptoms, cognitive impairment, sensory processing deficits, and skill deficits in motor, and process domains (Ayres & Panickacheril, 2015; Bailliard and Wingham, 2017). Much is known about symptomatology, motor and processing deficits but little is known about abilities and learning in this population. The purpose of this scoping review is to understand motor learning in individuals with schizophrenia and indicators of motor learning abilities depicted in the literature.
DESIGN: This review was conducted using the Joanna Briggs Institute protocol for scoping reviews.
METHOD: We have conducted a literature search using the following terms and their Boolean combinations: schizophrenia, adults, motor learning, motoric learning, motor memory, procedural memory, motor skill acquisition. The search was conducted in 9 databases: The search was conducted in October 2018 in the following databases: PubMed, Ovid, CINAHL, Cochrane Library, Embase, PsychInfo, OTSeeker, and SCOPUS. Two independent raters conducted a title/abstract review and full text review using Covidence, a cloud-based review management tool. The inclusion criteria used are: research articles (any year), any discipline, written in English-language, published in peer-reviewed journals, focusing on measuring motor learning in adults with schizophrenia. Conflicts were resolved by discussion. An evidence table was completed to describe included studies. Categories for data extraction included: geographical area of study, study setting participant identifying characteristics, sample location, age of onset, medications, interventions, and outcomes.
RESULTS: The initial number of articles obtained was 1547. After removal of duplicates, 1089 abstracts were in screening. Fifty-six studies were included in full-text screening, with 17 excluded for wrong study design, dissertation, or not including motor learning. Thirty-nine articles were considered eligible for data extraction. Preliminary review of 17 out of the 39 articles revealed a number of themes: study setting, gender, assessment method, brain areas and functions, and outcome indicators for measuring motor learning. Most studies were conducted in North America (n=9), and Europe (n=5) – representing a limited geographic area. A number of articles (n=5) did not report the type of facility (setting) in which the study was conducted. Male subjects are over-represented at 76%, while the schizophrenia affects males and females at similar rates (Li, 2016). Assessments used to measure motor learning were often related to the visual system: saccades (n=4), eye blink conditioning (n=2), and prism adaptation (n=1). Rotor pursuit tasks (n = 4) and finger tapping tasks (n = 3) are also represented. Involved brain areas implicated by the researchers include anatomical regions such as the frontal lobe, the basal ganglia (n=4), the cerebellum (n=5) but mostly association cortices and processing networks. Motor learning does appear to be impaired in adults with schizophrenia, but how they learn motor tasks and interventions to improve motor learning remain largely unexplored.
CONCLUSION: Understanding learning and motor learning processes in individuals with schizophrenia may provide significant insights on designing treatment protocols that target functional skills in this population. Motor learning deficits frequently affect individuals with schizophrenia, the magnitude and impact of these issues in skill development, function and participation is unknown in this population.
References
Ayres, H., & Panickacheril John, A. (2015). The assessment of motor and process skills as a measure of ADL ability in schizophrenia. Scandinavian Journal of Occupational Therapy, 22(6), 470-477.
Bailliard, A. L., & Whigham, S. C. (2017). Linking neuroscience, function, and intervention: A scoping review of sensory processing and mental illness. American Journal of Occupational Therapy, 71(5), 7105100040p1-7105100040p18.
Li, R., Ma, X., Wang, G., Yang, J., & Wang, C. (2016). Why sex differences in schizophrenia? Journal of Translational Neuroscience, 1(1), 37.
