Generally speaking, there is no call to interrupt treatment once it is
commenced, although occasionally we have found this desirable. The
fatigue of the first few days, almost unavoidable as it is, and
accompanied by new sensations, need occasion no alarm. We should
acquaint our patient of its explanation, and so obviate the mental
depression which its existence is apt to engender. Its ephemeral nature
will soon become plain, for a rest of a few days suffices for its
disappearance.
In some instances resort to procedures reminiscent of antagonistic
gestures seems to have been of avail.
One of our patients,[223] suffering from facial tic, was directed to
perform, as far as practicable, the opposite movements to her grimaces.
If her mouth was drawn to the right, she forthwith made a corresponding
twitch to the left; if her mouth was shut spasmodically, she was
instructed to open it widely and quickly. By such simple methods,
applied to all her tics, speedy control was regained, and once she had
mastered the theory of the process, the practice of regular exercises
and the development of antagonistic movements soon effected a complete
cure.
Training of the antagonists has also been recommended by
Hartenberg,[224] in a case of scratching tic. The patient was urged to
approximate the hand to the affected cheek very slowly, and almost at
the moment of contact the order was given to extend the arm briskly;
this gesture of opposition, moreover, was stimulated by faradisation to
the extensors of the forearm. The method, of course, is practically
identical with that adopted by Frenkel,[225] of Heiden, who provoked
energetic contractions of antagonistic groups by teaching the patients
to overcome increasing resistances. Prudence, however, must be observed
in carrying out these ideas, otherwise we run the risk of replacing one
tic by another.
* * * * *
After the above general sketch of the essentials of the method, we may
give examples of its application to particular instances.
For a tic of the eyelids, in especial for blinking tics, we make the
patient open and shut the eyes to order, keep them closed or apart for a
space, shut one eye and then the other, and repeat the same sequence in
different positions of the head. It is a good plan to enjoin
simultaneous action of the oral musculature. The cessation of tonic
contractions of the eyelids with opening of the mouth has been remarked
several times, and Oppenheim finds an analogy in the observations of
Gunn and Helfreich, who have seen ptosis disappear as the mouth is
opened.
If the eyeballs are involved in a tic, insist on dissociating the
movements of head and eyes; make the patient follow an object slowly
with his eyes while the head is stationary; or let the head deviate to
right or left, up or down, while the eyes remain fixed on some
particular point.
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