Our Director’s Experience

Interactive Metronome can help particularly with Tourette syndrome, as our director, Matthew McNatt, attests. Matthew grew up with a moderate case of Tourette syndrome, with moderate to severe dystonic tics, a few vocal tics, and no coprolalia. Years ago, at the time he completed Interactive Metronome as a patient, his clinician was told that Matthew was the first test case in the United States for the application of IM to Tourette. Matthew experienced a life-changing, over 80% reduction in his tics from IM alone. It was then he purposed to provide this simple and profound educational intervention to others.

Matthew also temporarily lost the ability to walk while completing IM as a patient: for a disconcerting couple of hours, his brain struggled to choose between the deliberate movements Matthew was accustomed to or the natural movements being trained by IM. More IM training quickly remedied Matthew’s loss of motor control, enabling Matthew to move fluidly, gracefully… even to dance. Wow! Matthew’s experience with IM left him very convinced of its power, and also of the need for prerequisite and complementary interventions when appropriate.

Visual and Auditory Closure

Interactive Metronome makes such a difference for Tourette, Matthew thinks, because it’s so successful at training closure—including visual closure, auditory closure, haptic closure, and temporal closure. Since closure is rarely a conscious process, difficulties with closure can be difficult to relate to… and difficult to understand. Let’s look at each type of closure in turn:

Types of Closure

•   Imagine seeing an object but having your vision partially obscured. Good visual closure would enable your brain to compensate for the obstruction, effectively “filling in” missing pieces to discern what the object is. Individuals with Tourette usually struggle with visual closure.

•   Imagine listening to a teacher in a noisy classroom. Good auditory closure would enable your brain to hear each of the teacher’s words distinctly—separable from one another and separable from the background din of the classroom. Individuals with Tourette often hear speech as a string of sounds and then try to separate the sounds into words. Positively, since strings of sound can sometimes be separated into funny statements, individuals with impaired auditory closure may pick up on and enjoy puns more readily. Negatively, since strings of sound can sometimes be separated into words that don’t convey what the speaker intended, individuals with impaired auditory closure may frequently mishear what was said, especially in the presence of background noise.

Haptic Closure

Types of Closure, Continued…

•   Finally, imagine feeling a touch, movement of clothes on the skin, or movement of muscle or joint inside your body. Good haptic closure would enable you to discern the significance of that touch or movement, likely concluding it wasn’t a threat to your well being, and usually dismissing it as insignificant. Individuals with Tourette often struggle to discern the significance of such touch or movement, yet they keep trying. Displaying a hallmark of a difficulty achieving closure, they quite literally don’t know when to stop gathering information—or when to stop responding to what they perceive.

Moreover, once individuals with Tourette achieve closure—for the moment, prior to IM training—their perceptions are often quite inflexible. Especially when young (before social conventions have taught them to suppress such insistence), they’re likely to insist they saw, heard, or felt something in a particular way, even if no one else agrees. Given the tremendous effort an individual with Tourette expends in deciding (s)he finally has enough information to judge a perception complete or action appropriate, it’s no wonder that few individuals with Tourette are eager for more information that may call their judgment into question.

Training Closure

With every beat, IM calls a trainee’s attention back to the task at hand—back to the stimulus, and back to the expected response. If the trainee’s attention drifts, there’s nothing (s)he can do to make amends, but it really doesn’t matter: another opportunity is available within a second. If someone with Tourette tries to wait for more information, surprise: they can’t… but here comes the next opportunity to respond in time to the information available. Still don’t have enough information to respond? That’s okay… but they’d better choose to respond quickly, because another reference tone is on its way! Interactive Metronome’s recurrent demand builds closure and, with its requirements of openness to new information, also builds flexibility. Even more flexibility is developed by IM’s requirement that brain hemispheres sometimes alternate in initiating movement, helping to effect efficient interhemispheric integration.

With its largely fluid, no-pause movements, Interactive Metronome also develops the ability to keep moving fluidly, despite sensory distractions. Skin crawling? Keep going. How soon can you “lose yourself in the beat”? For people with Tourette, this can be a godsend. People with Tourette are often aware of sensations that most people efficiently block from consciousness. Many report feeling some “flow” of energy along their nerves. This “internal energy” becomes “blocked,” often near areas of muscle spasticity. Tics get things “unstuck” or “unblocked”—even if simply by overwhelming sensory nerves in the area with ample additional activity. Improved closure helps individuals with Tourette to stop attending to these sensations, unless they can do something productive about them.

Differentiation and Closure

The difficulty individuals with Tourette have in responding to neuronal irritation is frequently compounded by poor neurological discrimination: when most individuals with Tourette Syndrome try to move one part of the body, their brains often send commands to parallel or surrounding parts of the body. When they want to move one arm, for instance, both arms move—though the arm they did not intend to move might twitch only slightly, while the arm they intended to move completes the desired motor pattern. Muscle spasm is easily triggered in the area that moved incompletely and is frequently exacerbated at the original site, since tics do little to resolve neuronal irritation. (The exacerbation at the original site does, however, trigger the release of endorphins, whose pleasant numbing reinforces the tic.)

Physiologically, since one would expect extra dopamine to be produced to facilitate indiscriminate movement (movement of both arms, in our example), it is not surprising that excess dopamine is a suspected cause of many Tourette symptoms and a frequent target of pharmacological intervention. For many, Interactive Metronome may be a helpful complement—or even alternative.

The Power of IM Training

A reduction in tics—though a real possibility—is never a central goal in IM training at the McNatt Learning Center, which provides IM training strictly as an educational intervention. During Interactive Metronome training, individuals with Tourette move fluidly, frequently suppressing tics to execute movements in time to a steady reference tone. Once habituated, the fluidity of these movements (uncharacteristic of most tics) expands the movement repertoire of many individuals with Tourette, whose movements may have beforehand been described as “robotic.” Since fluid movement through an expanded range of motion can sometimes indirectly alleviate muscle spasm, hypertonicity, and/or a concomitant lactic acid buildup, this expanded repertoire alone is important: it provides an alternative to the “direct” attempt many individuals with Tourette make to relieve these sensations through tics.

The closure that develops through Interactive Metronome training is important, too. It empowers people with Tourette to spontaneously stop attending to confusing sensations, unless they can do something productive about those sensations (using patterns learned in Feldenkrais, for instance, to alleviate them).

A Potential of IM Training

Developing closure may also prove vital to people with schizophrenia. Individuals with schizophrenia, in contrast to those with Tourette, can often achieve closure—but the closure they achieve is impermanent. Their perceptions or responses are fragile, open to intrusion of new information (from the outside or from their own mind) at any time.

Though our director, Matthew, has not yet trained any individuals with schizophrenia using Interactive Metronome, he’s excited about the potential Interactive Metronome may have for the schizophrenic population—for much the same reason he’s excited about the potential IM has for individuals with Tourette syndrome: Interactive Metronome trains closure.

If you’d like to give Interactive Metronome a try, or investigate whether Interactive Metronome training may be appropriate for you, why not give us a call today?