{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:19:06Z","timestamp":1792001946080,"version":"4.4.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p>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\u2005=\u20052.0\u20135.0) 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, <jats:italic toggle=\"yes\">P<\/jats:italic>\u2005&lt;\u20050.0001], on the 24-h retention test [69.3 (9.3) s vs. 159.7 (15.5) s, <jats:italic toggle=\"yes\">P<\/jats:italic>\u2005&lt;\u20050.0001], and the 24-h transfer test [146.1 (14.9) s vs. 223.1 (38.9) s, <jats:italic toggle=\"yes\">P<\/jats:italic>\u2005&lt;\u20050.0001]. Thus, optimized practice combining AS, EF, and EE enhanced motor skill learning. Key factors in the OPTIMAL theory can be used to improve patients\u2019 motor learning. Further studies are warranted to extend these proof-of-concept observations for potential clinical applications.<\/jats:p>","DOI":"10.1097\/mrr.0000000000000653","type":"journal-article","created":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T17:00:23Z","timestamp":1734454823000},"page":"18-24","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["A clinical examination of OPTIMAL theory application in people with multiple sclerosis: a proof-of-concept study and implications for rehabilitation practice"],"prefix":"10.1097","volume":"48","author":[{"given":"Zahra","family":"Khalaji","sequence":"first","affiliation":[{"name":"Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamid","family":"Salehi","sequence":"additional","affiliation":[{"name":"Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Nezakat Alhosseini","sequence":"additional","affiliation":[{"name":"Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Lewthwaite","sequence":"additional","affiliation":[{"name":"Rancho Research Institute at Rancho Los Amigos National Rehabilitation Center, Downey, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Wulf","sequence":"additional","affiliation":[{"name":"Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, Nevada, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,12,18]]},"reference":[{"key":"R1-20250206","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.copsyc.2017.04.005","article-title":"Optimizing motivation and attention for motor performance and learning.","volume":"16","author":"Lewthwaite","year":"2017","journal-title":"Curr Opin Psychol"},{"key":"R2-20250206","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1177\/09637214211046199","article-title":"Translating thoughts into action: optimizing motor performance and learning through brief motivational and attentional influences.","volume":"30","author":"Wulf","year":"2021","journal-title":"Curr Dir Psychol Sci"},{"key":"R3-20250206","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.3758\/s13423-015-0999-9","article-title":"Optimizing performance through intrinsic motivation and attention for learning: the optimal theory of motor learning.","volume":"23","author":"Wulf","year":"2016","journal-title":"Psychon Bull Rev"},{"key":"R4-20250206","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.humov.2018.05.006","article-title":"Onward and upward: optimizing motor performance.","volume":"60","author":"Chua","year":"2018","journal-title":"Hum Mov Sci"},{"key":"R5-20250206","doi-asserted-by":"crossref","first-page":"102661","DOI":"10.1016\/j.humov.2020.102661","article-title":"Maximal force production requires optimal conditions.","volume":"73","author":"Singh","year":"2020","journal-title":"Hum Mov Sci"},{"key":"R6-20250206","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/geronb\/gbad120","article-title":"Optimizing motor learning in older adults.","volume":"79","author":"Khalaji","year":"2024","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"key":"R7-20250206","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.gaitpost.2011.12.003","article-title":"Motor learning benefits of self-controlled practice in persons with parkinson\u2019s disease.","volume":"35","author":"Chiviacowsky","year":"2012","journal-title":"Gait Posture"},{"key":"R8-20250206","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1177\/0269215515570377","article-title":"Does attentional focus during balance training in people with Parkinson\u2019s disease affect outcome? 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