Implicit Motor Learning in Adults Who Have Recovered from COVID-19

The coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is primarily known as a respiratory condition (1). However, COVID-19 has also been shown to lead to long-term cognitive dysfunctions referred to as long COVID (2, 3). To date, over 590 million people have recovered from COVID-19, including individuals who have experienced high fever and underwent oxygen therapy during hospitalization (4). As secondary outcomes of the disease, individuals with high fever or those treated with oxygen therapy have been shown to develop central nervous system deficits, affecting primarily the frontal and temporal regions of the cerebral cortex (5). One way to examine if COVID-19 survivors endured damage to the neurologic systems is through testing implicit motor learning (6, 7). Thus, the main objective of the proposed study is to investigate implicit motor learning in adults who have recovered from COVID-19. We will assess motor sequence learning of 225 adults aged 18 to 65 through a Serial Reaction Time Task (SRTT). Participants will be asked to press computer keys corresponding to visual stimuli appearing at fixed spatial locations on a computer screen as quickly as possible (8). The stimuli will be presented in a fixed learning sequence. Reaction times then begin to decrease with consecutive training blocks, and proceed to increase when the switch occurs from a fixed sequence to a random sequence of stimuli. We will compare implicit motor learning between five groups of individuals: 1) individuals who were not infected, 2) individuals who were asymptomatic, 3) individuals who were symptomatic but not hospitalized, and 4) individuals who were hospitalized. It is hypothesized that individuals who had a disabling fever as result of COVID-19 and individuals who underwent oxygen therapy will have lower reaction time performance when compared to individuals who were asymptomatic and who were not infected. We also hypothesize that individuals who experienced fever and/or underwent oxygen therapy but who are more physically active will perform better on the SRTT compared to individuals who are not active. We will control for sex, age and physical activity levels. To assess physical activity level, we will administer the International Physical Activity Questionnaire - Short Form (IPAQ-SF). We will also collect socio-demographic and health status information through an online questionnaire. Performance of SRTT will be calculated as the percentage of correct trials per block divided by the average reaction time on that block. The data will be analyzed using IBM SPSS Statistics 28.0, and alpha will be set at .05 to establish statistical significance. We will analyse the data for univariate outliers and conduct relevant tests for parametric assumptions. We will test normality with the Shapiro-Wilk test and we will validate the repeated-measures ANCOVA with the Mauchly’s sphericity test. A repeated-measures ANCOVA with disease severity and block type as within-subject factors will be performed. This exploratory study could give a platform for future research to investigate and focus on developing therapies to counteract long Covid symptoms and improve motor-learning patterns. 1. Gorbalenya AE, Baker SC, Baric RS, de Groot RJ, Drosten C, Gulyaeva AA, et al. Severe acute respiratory syndrome-related coronavirus: The species and its viruses–a statement of the Coronavirus Study Group. BioRxiv. 2020. 2. Health NIf, Excellence C. COVID-19 rapid guideline: managing the long-term effects of COVID-19. NICE Guidel. 2020:1-35. 3. Woo MS, Malsy J, Pöttgen J, Seddiq Zai S, Ufer F, Hadjilaou A, et al. Frequent neurocognitive deficits after recovery from mild COVID-19. Brain communications. 2020;2(2):fcaa205. 4. Statista. Number of coronavirus (COVID-19) cases, recoveries, and deaths worldwide as of September 12, 2022. 2022. 5. Duan K, Premi E, Pilotto A, Cristillo V, Benussi A, Libri I, et al. Alterations of frontal-temporal gray matter volume associate with clinical measures of older adults with COVID-19. Neurobiology of stress. 2021;14:100326. 6. Nitsche MA, Schauenburg A, Lang N, Liebetanz D, Exner C, Paulus W, et al. Facilitation of implicit motor learning by weak transcranial direct current stimulation of the primary motor cortex in the human. Journal of cognitive neuroscience. 2003;15(4):619-26. 7. Magill R, Anderson D. Motor learning and control: Concepts and applications. . 11 ed: New York, NY: McGraw-Hill; 2017. 8. Brown RM, Robertson EM, Press DZ. Sequence skill acquisition and off-line learning in normal aging. Plos one. 2009;4(8):e6683.