Movement disorders; does stuttering belong here?

Dave Rowley, De Montfort University: Leicester, UKSuzana Jelčić Jakšić, Children’s Hospital, Zagreb, Croatia

Personal comment

Hey all, Towards the middle of last year I started stuttering when talking. I figured it was a growing pain so I shrugged it off and thought it would work itself out eventually but............ It's a new year and the darn stutters are still here. When I practice on my own it's not there. I'm relaxed, the talking seems smooth and I sound fine. When it comes to the real thing though it gets all FU#$^D up. I dread speaking in some situations.

HELP!!!!!!

Personal comment: The Yips

Hey all, Towards the middle of last season I started getting the yips when chipping. I figured it was a growing pain so I shrugged it off and thought it would work itself out eventually but............ It's a new season and the darn yips are still here. The only problem is, is that when I practice it's not there. I'm relaxed, the stroke seems smooth and the ball tracks to the hole well. When it comes to game time though it gets all FU#$^D up. I dread not hitting the greens now on par threes. Any help will do, I wanna break 80 and this is where I need to improve to do it. HELP!!!!!!

The Yips: Definition

This syndrome is characterized by an inability to appropriately complete a golf stroke, most often putting and chipping strokes. Most individuals with the yips describe a jerking or shaking movement that interrupts their swing. In many cases the yips are disabling and the golfer, including professional tour players, give up golfing. The etiology is poorly understood and scientific study of the yips has been minimal. (Charles H. Adler, Mayo Clinic)

The Yips: Video

Bernhard Langer

Personal comment

I've personally been through it. It was the most painful experience of my life. Not that it was physically painful but more soulfully. See can you imagine not being able to do something you really love doing and try hard at. Well, that's how i felt. To the point where tears would roll down my cheeks and I'd feel disappointment with myself every night driving back home thinking where did I go wrong.

Stuttering in my opinion is a mental condition. You are asking your body to do something that it can’t or refuses to do. Talking on the other hand is where your body memory is constantly in use and your mind and mouth work mutually. Put two and two together it is basically telling you that you are forcing yourself to do something that your mouth doesn't want to do. Thus, your mind is not allowing your mouth to speak.

Personal comment: Dartitis

I've personally been through it. It was the most painful experience of my life. Not that it was physically painful but more soulfully. See can you imagine not being able to do something you really love doing and try hard at. Well, that's how i felt. To the point where tears would roll down my cheeks and I'd feel disappointment with myself every night driving back home thinking where did i go wrong.

Dartitis in my opinion is a mental condition. You are asking your body to do something that it can’t or refuses to do. Darts on the other hand is a game where your body memory is constantly in use and your mind and hand work mutually. Put two and two together it is basically telling you that you are forcing your hand to do something that it doesn't want to do. Thus, your mind is not allowing your hand to release the dart.

Dartitis: Definition

A state of nervousness which prevents a player from releasing a dart at the right moment when throwing.

Dartitis: Video

Eric Bristow (WC 80, 81, 84-6)

Focal dystonia

Burn (2006) argues that The Yips and Dartitis are examples of focal dystonia.

He defines a focal dystonia as:

‘An abnormal movement characterised by sustained muscle contraction, frequently causing twisting and repetitive movements or abnormal postures’.

Task specific focal dystonia

Adler (2010) sees The Yips as a form of task specific focal dystonia.

Prevalence of The Yips

In a survey of 2,630 advanced golfers (handicap <12) a total of 1,031 (39%) golfers (986 men and 45 women) responded, and 541 (52%) reported experiencing the yips. (Smith, et al. 2000)

Subtypes in the Yips

Stinear, Coxon, Fleming, Lim, Prapavessis & Byblow (2006)

This study provides evidence in support of two The Yips subtypes. Type I is related to impaired movement initiation and execution, whereas Type II is related to performance anxiety.

Anxiety & stuttering

In both stuttering and The Yips there is a degree of performance/state anxiety.

Menzies et al. (2008) found that about 60% of adults who stutter received a blinded diagnosis of social phobia.

Stuttering as a task specific disorder

Stuttering is a task specific disorder—that is, oral-motor dysfunction becomes apparent only during speech and not during humming, singing or chewing.

Stuttering may reflect an instability or loss of control in brain function rather than a loss of function — which makes stuttering similar to some other motor control disorders such as tremor, dystonia or Gilles de la Tourette’s syndrome (TS)

(Ludlow & Loucks, 2003).

The Yips

The emerging picture is of a complex loop of brain centers integrating perception, emotion, and movement that is subject to disruption at varying points with resulting movement deficits that can be quite similar. (Mangum, 2004).

The role of the basal ganglia

Could it be that anxiety in a stutterer (limbic system) through the intervention of the hippocampus (feed forward loop and learning) provokes a temporary dysfunction in the dopamine transmitter from the substantia nigra, which provokes a temporary imbalance in the basal ganglia which result in a temporary loss of inhibitory control which provokes stuttering and other involuntary movements. In other words, is it possible to integrate these three elements and thus relate anxiety to the physiologic factors in Stuttering? (Bijleveld, 1992).

The role of the basal ganglia

Focal hand dystonia has been linked with basal ganglia dysfunction in the "release" of prepotent motor programs by inhibition of inhibition.

Amygdala and septo-hippocampal circuitry

Current neuroscience distinguishes "defensive avoidance" in the amygdala circuitry from "defensive approach" in the septo-hippocampal circuitry. The former is related to fear, panic, phobia, and flight behavior, and the latter to generalized anxiety and dread or "anticipatory frustration" (Gray and McNaughton, 2000; LeDoux, 1992; LeDoux, 1996).

The septo-hippocampal network

The septo-hippocampal network mediates dread and anticipatory frustration and generates hesitation and vacillation behaviors.

This may be worth investigating in PWS

Conclusion

We were initially interested in the link between problems involving taking action (e.g. joining traffic on a roundabout) and stuttering-like behaviour in trumpet players.

However in the end we chose to focus on stuttering, and two sports related movement disorders: the yips and dartitis.

Conclusion

We have shown there to be a number of similarities between stuttering and movement disorders

Stuttering is different in one major sense, however, it is preventing communication, which we think people would agree is much more important in the quality of life than golf or darts

Nevertheless, highlighting these similarities through personal experiences as well as through an examination of the scientific literature in each field may help us to think about different approaches to the understanding of stuttering.