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May 11, 2022 • 41 mins

The yips has been described as a wiring problem in the brain. But what is a wiring problem in the brain? It may be dystonia, a neurological movement disorder that causes involuntary muscle spasms or jerks, and on this episode of Losing Control, host Justin Su’a talks with Dr. Steven Frucht, a neurologist who has been treating people who suffer from movement disorders for decades. And for a broader exploration of how we move, you’ll also meet two neuroscientists whose cutting edge work focuses on the neural control of movement, or how the brain controls the body: Dr. Alaa Ahmed and Dr. Lena Ting.  

  • Dr. Alaa Ahmed, professor at the University of Colorado, Boulder
  • Dr. Steven Frucht, a neurologist and movement disorder clinician at NYU Langone Health
  • Dr. Lena Ting, professor at Emory University and Georgia Tech
  • Aaron, a musician who suffers from dystonia

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Episode Transcript

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Speaker 1 (00:00):
Losing Control is a podcast from Sports Illustrated Studios and
I Heart Radio. I'm Justin Stewa, and yes, this is

(00:37):
Losing Control. The guitarist you just heard playing the Blues
suffers from a movement disorder. Out of respect his privacy,
I'll call him Errand, which is a pseudonym. It's hard
for me to show you the worst thing because I
can't do it, you know, So I can't show it
to you because I literally can't do it. But I
used to play. I can't do it. I just you know,

(01:01):
if it sounds like Aaron is playing the guitar in
a doctor's office, that's because he is playing the guitar
in the doctor's office. And what Erin can't do is
play like he used to because he suffers from a
form of dystonia, in this case, musicians dystonia, which is
a movement disorder that causes involuntary muscle spasms or jerks.

(01:22):
It's almost like the gyroscope in your wrist shuts down,
it moves around arbitral. I mean, the main problem is
twisting of the risk involuntarily. It's extremely frustrating because the
sensation of your body refusing to obey. The mental command

(01:42):
is you know, upsetting as well as as practically frustrating.
It's really it's you know, produced to kind of despair
when you keep trying to over We got to perform
a simple task and you can't do it. If you've
been listening to Losing Control, you've heard athletes described something
that sounds awfully similar. And that's because dystonia and the

(02:03):
yips are closely related. In fact, in some cases, the
YIPS is dystonia, and that's what we're getting into today.
Now we've talked about what the yips feel like and
how those who have the yips learned to live with it.
But today on Losing Control, we're exploring some of the
science and the pathology of the yips and taking a

(02:24):
look under the hood to get a better sense of
how we move our bodies. You're going to hear from
a neurologist who is an expert on movement disorders, Dr
Stephen Fruct, as well as two neuroscientists, Dr Lena Ting
and Dr Aliyah Ahmad, who each study the neural control
of movement, and towards the end of the episode, we'll

(02:44):
check back with Aaron the guitar player. It's the science
of the yips. Today on Losing Control. I'm justin Suah
and this is Losing Control of podcast about one of
the strangest phenomena in sports, the yips, or when an
athlete or elite performers suddenly finds themselves unable to do
the thing that they do better than almost everyone else

(03:07):
on the planet. If you're listening for the first time, welcome,
but if you want the full experience, head back to
episode one. Losing Control is a podcast told through conversations
with athletes, coaches, neuroscientists, and more, and it's in order.
Each episode features a first hand perspective that contributes a
piece to the puzzle that is the yips. Along the way,

(03:28):
you'll learn about some of the challenges that high performers
face and the mental work that enables them to do
what they do. Not only that, you'll hear how you
can incorporate these tools, strategies, and mindsets into your own life.
Because it's not just about losing control, it's about getting
it back. So let's get started. Dr Stephen fruct is

(03:48):
a neurologist and movement disorder clinician, and I spoke to
him at his office at n y U Langone, a
major medical center in New York City. Dr Fruct has
been working with movement disorder patients for any years, and
he has a particular interest in musicians, whom he calls
athletes of the small muscles. To kick off our conversation,

(04:09):
I asked him about what athletes and musicians have in common.
So training of elite athletes is very similar to training
of elite musicians. Musicians, for the most part, are athletes
of the small muscles, and musicians are very similar to

(04:31):
athletes in that they drill precise movements to the point
where those movements become automatic. They can do them almost
perfectly without consciously thinking about them. In athletes, some use
the term flow. They're in the flow and they're in
the zone and everything is working. Now for musicians that

(04:53):
that can happen as well, but we speak more of
what's called the automatic pilot. So what is the automatic pilot?
When you're first learning a new work, even if you're
an elite performer, you have to do a lot of
hard work. Pianist wants to learn a new piano concerto
twenty five minutes that they haven't played before. It's going

(05:14):
to take months for them to learn them, and they're
going to start out with pencil and paper in hand,
going through the music, figuring out the fingerings that work
for them, playing slowly using a metronome, and slowly building
up the speed over time. Think back to what Dr
Frux said earlier. Musicians are athletes of the small muscles. First,

(05:36):
a musician practices a piece of music, and then as
they internalize it, they begin to refine specific passages. In
the learning process, they are thinking about individual movements, they're
thinking about individual passages. They're thinking about what it is
they have to learn how to do. At a certain point,

(05:58):
the automatic pilot has been trained so that when they're
playing that passage, they're not thinking about their hands anymore.
They're thinking about the musical conviction, about color, about expression, etcetera.
So we're in the brain is that put down? Where
is the automatic pilot? It's almost better to think about

(06:20):
what is the automatic pilot than where because information in
the brain is not stored in one specific location. When
we're learning, we are using what's called the cortex of
the brain, the outer regions of the brain that we
are consciously aware of to do the motor program. Once

(06:41):
something is encoded in the automatic pilot, it is almost
certainly subcortical. It's deeper within the brain so that we
are not consciously thinking about it. But it's not just
in one area of the brain. It's in a series
of networks of connections and connectivity of for brain regions

(07:01):
that control the motor system. And it's deeply encoded, so
much so that if you have a musician who played
a concerto twenty years ago and learned it when they
were young, if they suddenly get a call that they
have to go play this piece in three days, they
can get it back. Sometimes they can play the piece

(07:25):
fairly flawlessly, even not having played it in fifteen or
twenty years. Now. They're not thinking about how to play
the piece. They're activating their automatic pilot, which then kicks
in and they simply do it without active conscious thought.
This is a window into how we ottomize movements, and
these outomized movements are exactly what the YIPS impacts. The

(07:48):
brain is as powerful, if not more powerful, then the
most amazing supercomputer we can build. And if everything about
that supercomputer works prefect except for one program Microsoft Word
and every time you boot up that particular program, it's
a little bit virused. It doesn't quite work the way

(08:11):
it shouldn't, but everything else works fine. About the leader.
That is the analogy for a patient with dystonia. Their
hand can work perfectly, typing, writing, playing their instrument in
every way except that one passage that triggers this problem.
Do you remember Aaron playing the guitar earlier in the episode.

(08:32):
It's not that he's completely unable to play the guitar anymore,
but he's unable to pick and strum in very specific ways.
Now what we see over time is over you know, months,
sometimes over several years, that problem starts to expand. It
expands to other types of passages involving that finger. It

(08:54):
then spreads, usually to an adjoining finger, so that any
time they approach the instrument, they are triggering involuntary movements
in the hand and an inability to play. So it's
it's almost like an erosion of the the automatic pilot,
if you will. Still, in most of these patients, the

(09:16):
hand does everything else normally, and that's why people who
experience this might describe it as psychological, because other movements
that utilize the same muscles work just fine. The automatic
thing that musicians do when they experience this is they
blame themselves. They say, I'm out of shape, I need

(09:37):
to work harder, I just need to practice more. So
it's very common for people to just lock the practice
room door and to continue to work and work and work,
assuming that it's their fault. That, of course, is counter
productive in the development of of dystonia because it's not
their fault. That simply happened. Dystonia is not a psychological problem.

(10:00):
For a large part of the twentieth century, many individuals,
many physicians, thought that dystonia was a psychological disorder. It
turns out that's complete nonsense. It has nothing to do
with neuroses. It has nothing to do with a psychological problem.
This is a problem within the brain. Now, how do

(10:22):
we know that. Once sophisticated brain imaging became available m
R what's called PET scanning, etcetera, people began to study
these patients and what they found was that when you
take a patient who has dystonia and you actually look
and measure at how the brain activates when they perform

(10:44):
a task, the brains of patients with dystonia are activating
with a pattern that's very different from those who don't
have dystonia. This is a disorder of the brain. It's
a disorder of motor control. Stress can exact orbit, it
can make it worse. But this is not a pure
psychological problem. Musicians and athletes may attract the most attention,

(11:10):
but they are not the only people who suffer from dystonia.
The most common form of focal dystonia occurring with a
task that we see in the clinic is what's called
writer's cramp. Writer's cramp is a task specific dystonia that
makes it very difficult to write with a pen or pencil.

(11:30):
So this was the first form of what's called a
task specific dystonia that was described about a hundred and
fifty years ago, and still for most neurologists who don't
see musicians or athletes, this is the form of focal
dystonia that they're going to see in the clinic. In
terms of other occupations, so any occupation that requires repetitive,

(11:56):
highly attended tasks performed over years can be affected. So
you can see individuals who are using their hands, such
as watch repairs. You can see dystonia affecting the hands
of surgeons, an endless list of of individuals who perform

(12:21):
those sorts of tasks. It's just that more musicians and
athletes have been described in the literature, and they've attracted
more attention because of the impact of dystonia on their
professional careers. That that that has gained so much attention.
Now you might be wondering, is the answer to the
big YIPS mystery and identifiable neurological disease? Not entirely. Sometimes

(12:47):
people use words like the yips too not refer to dystonia.
So people may say, oh, I got the yips when
I was playing golf, and they're not talking about a
disorder where there's a breakdown in motor control or involuntary
movements that are occurring. They're talking about a performance anxiety

(13:10):
related problem where they lose the ability to do that.
But when we neurologically use that term yips, we're thinking
of it as d estonia. Whether the collection of experiences
that we commonly refer to as the yips is dystonia
or not is a question that we're not going to

(13:32):
be able to give a definitive answer to on this podcast.
And there's a lot about destonia that we still don't know.
The more I see of dystonia, the more I realize
how that will I know? This is a never ending prospect.
In many ways, dystonia is a window onto everything we
don't know about motor control and motor learning. We don't know,

(13:55):
for example, why certain musicians developed and others don't. We
also don't know what is the proximate trigger, why did
it happen to a given individual, and why. In some
individuals it's progressive and becomes the real problem very quickly,

(14:16):
and in others it may take years to do that.
All these things are complete unknowns, but there is one
thing we do know. Like Dr Fux said, dystonia is
not a psychological problem, and if some of these symptoms
sound familiar, it might be worth talking to a doctor.
When we're back, we're shifting from neurology to neuroscience, and

(14:38):
specifically to the neural control of movement. After this, I'm
justin sua and this is losing control from musician to athletes,
and from elite performers to the rest of us. Part

(14:59):
of the hip story is that movement is something we
take for granted, something we don't fully appreciate until we
can no longer do some activity the way we once could.
In the second half of today's episode, we're delving further
into the how of movement and considering how our understanding
of movement might inform our understanding of the yips. My

(15:23):
name is Lena Ting. I'm a professor at Emery University
and Georgia Tech. Dr Ting is a mechanical engineer and
a neuroscientist. As a mechanical engineer, when I was a student,
I always felt that we didn't know enough about the
physics of the body, and if we knew that, then
we would understand what the brain needs to do to

(15:46):
control it. On the other hand, if you go to
a neuroscience realm, it's what's in the brain that allows
the body to move. And both perspectives are partially all
right and partially wrong, And so my research is really
focused at the center where we can't really dissociate one
from the other. Doctor team researches neuro mechanics, and this

(16:08):
is a quote how movement intention translates to action through
the complex interplay between the nervous system and the muscular
skeletal system. Let's start with the building blocks motor modules.
So the idea with motor modules is that our bodies,
especially as humans, are highly flexible and multifunctional. Right, we

(16:29):
can run, we can skip, we can dance, But in
order to achieve any one well coordinated task, we have
to control our body parts together in a functional way.
So the way I'm going to coordinate my leg muscles
for walking is going to be different than for swimming. Perhaps,

(16:51):
or maybe there are some similarities there. Think about the
number of actions or motor modules that compose a single movement,
and then think about how these movements function to create
something like running, skipping, dancing, plane an instrument, or swimming.
At the level of parts, A good analogy is language.

(17:12):
There are letters, words, and finally sentences. The idea is
that your nervous system learns these coordination patterns, and so
each person has to learn the physics of their body
and say, oh, when I'm reaching, I'm going to coordinate
it this way. When I'm trying to push, I'm going
to control it one way, or pull I'm going to

(17:32):
control it another way. And then it sort of forms
the syllables or the words of movements, so you can
put them together in different ways. I asked Dr Team
to talk about the fluency of a baby, a dancer,
and an athlete in the language of movement, it's quite
different depending on if you're a novice or an expert,

(17:54):
and especially in the case of the baby, so there's
different levels. It's there's like a grammar of movement, just
like in language. Right the baby's learning syllables, then words
and sentences. The dancer is trying to put those words
together into some kind of creative expression, and the athletes
trying to achieve whatever goals are necessary to excel at

(18:17):
their sport. Movement also has distinctive style or character. So
the idea of motor style is really based on this
idea that we all form our own motor modules, these
building blocks of movement that are tailored to my body
but also dependent on my experience. If I'm a dancer

(18:38):
and I've trained my motor modules in a particular way
to be artistic and to do certain dance moves, We've
shown that those ballet dancers will use those same modules
for walking, and so the fact that they have trained
themselves in a very specific way tends to shape these

(19:00):
motor modules that they use for everyday living. And so
I think That's why we can tell just by somebody
how somebody walks, whether they are a dancer or they're
a football player. And that just shows us that the
act of walking itself can be achieved in many, many
different ways, and each of us is going to learn
our own way to do it that still falls within

(19:23):
the laws of physics that are set by our bodies.
I've been very inspired by speech accents in sort of
understanding individual movement styles or motor accents, and speech is
actually a motor task. So if I learned to say
my vowels in a particular way, then when I speak

(19:44):
a language that's my own or foreign to me, I'm
going to have a particular way of doing that. And
I think that principle applies to movements as well. So
we've talked about how movement is structurally similar to language,
and also about how the way each of us move
is unique in the same way each of us uses

(20:05):
language is unique. But how do the yips figure into
this picture? I want to go back to motor modules.
It's interesting when we talk about motor modules, were typically
talking about something very automated, something that athletes might refer
to as muscle memory. So it's not really in your muscles,
it's in your nervous system, and it's the learned pattern

(20:27):
that you have learned for your body to move. And
we've shown that those motor modules might differ a little
bit between a ballet dancer and a non ballet dancer
and are shaped by our training. But when you're training,
you're also involving the higher levels of your brain, right,
so in your in your brain and your motor cortex.

(20:48):
And there is an idea that the motor cortex is
more like a tutor for learning how to move, but
it can also take over in certain situations when we
have to bring conscious awareness to our movements, and a
lot of times that's in learning or if you're hyper
aware of you know what you're doing, and usually the
advice is not to think about the movements in any

(21:10):
kind of athletic or sort of musical or dance performance, right,
So it could be a shifting from one way to
control movement to another one that is more conscious. On
the other hand, that's also possible that the motor module
itself is broken, and in rehabilitation studies with people with

(21:34):
neurological disorders, we see that those motor modules do change
in stroke or in Parkinson's disease, and the role of rehabilitation,
which I think is basically training for people with movement impairments,
shows that it may be possible for people to break
out of those broken modules due to neurological impairments. So

(21:57):
I think that the mechanisms of the nervous system aren't
that different from rehabilitation to highly trained athletes, and so
that plasticity should be available to both people with poor
movements as well as those who are highly skilled. Let
me unpack some of this. On the one hand, there's
this idea of a broken motor module, a specific formally

(22:18):
ottomized movement that no longer works the way it once did.
On the other hand, there's a shifting of an ottomized
movement from something that is done unconsciously to something that
is done deliberately. And the good news is that in
both cases, because our brains are plastic, we can work
to rehabilitate broken movements, and we can also learn how

(22:42):
to re outomize movements which have become deliberate. In other words,
it is possible to retrain the brain. I had one
more question for dr ting whatever movements were working on,
what should we try to remember? What advice does she
have based on her understand of neural mechanics and the

(23:02):
neural control of movement. Our brains are plastic, so they
can change, and whatever we practice is going to reinforce
the connections in our nervous system. And I think that
is particularly important in focusing on the basics of movement,
because those bad habits of movement are are difficult to

(23:25):
unlearn later. And then there's this other idea that sometimes
in high stress situations people will choke, and I'll say
I've had experience with that in my own athletic endeavors,
and the ideas that we're too focused on the outcomes
rather than on how we're playing. Are we making good decisions?

(23:46):
Are we moving in an efficient way? And being more
worried about are they watching me? Are am I gonna
let my teammates down? Am I gonna let my coach down?
And that causes you to shift the control up to
your kind of cortex less automated movements, and it's probably
not conducive to the highest levels of skill or of performance.

(24:13):
So what I would recommend, and this is based on
both my personal and my professional experience is to train
your brain to move in the right ways. That means
drills and things could be important, as well as enjoy
the act of playing your sports or doing your musical performance,

(24:34):
because all of that is going to reinforce the automaticity
of movement and the need not to be worried about outcomes,
but on having good form and making good decisions. Focus
on what you can control. We'll be back with more
on the relationship between decision making, mental states and movements

(24:58):
after this. I'm justin Suah and this is losing control.
Today we've been looking at the science of the gifts
as well as into how the brain and the body
create movement. Dr Aliyah Ahmed also studies the neuro control
of movement, but her work incorporates decision making and value,

(25:19):
and we're going to look specifically at the relationship between
movement and value. But first, as always, I asked Dr
Ahmed for her perspective on the YIPS. I mean, the
one obvious thing is that there is a dystonia, that
there could be a neurological condition, but putting that aside,
the other potential is that it is something psychological. Wait

(25:42):
a minute earlier in the episode, didn't Dr Frock emphatically
say that dystonia isn't psychological. He did, but that's not
what we're talking about here. Every movement is a decision
where you have to weigh the costs and the rewards
and the risk. The relationship between the movement decisions we

(26:03):
make and what we value is a subject of Vigor,
a book Dr Ahmed wrote with Reza Shadmir. What the
book is looking at is it's it's exploring this idea
that our movements are window to the mind. There are
two big questions that are asked when it comes to
the brain. You know, one is how do we choose
what to do? How do we make decisions? And when

(26:23):
do we make bad decisions? And how can we fix that?
And then the other question is, well, you know what
determines the characteristics of the movements that follow. So essentially
that's really what the what the book is going after.
We're trying to explore this idea that the neural circuits
that control our decisions are also involved in controlling our movements.

(26:45):
In your book, you write about two different people arriving
at an airport. One walks towards a waiting car, any
other runs to hug their family. Can you talk about
that a little bit please? Um, Yeah, Well I've I've
always liked that example, and it's so true. It's just anecdotal,
but it it is. It's so true. And I also
whenever I come back from a from a trip, I'm

(27:07):
always just just running through the airport generally, even though
no one's waiting for me. I'm just so happy to
be home. And you know we talk about running, running
to hug a love one and just walk into your
car just to an acquaintance. Well, I think that what's
happening is that love is a reflection of what we value.
And our goal in the book is to show that
how we value something affects how we move and and

(27:31):
so that's really that's the that's that connection right there.
Love is value, and we move faster than things that
we value more. And in this book we focus on
how value can affect vigor for the speed um with
which we move, But there are many other aspects to
movement that that are also choices that will also be

(27:53):
influenced by by value. I want to talk about that
a little bit. That's a really interesting point because as
you're dipped as you're talking about love, I'm thinking about
other emotions. I'm thinking about what role does anger play
on movement? What role does anxiety play on movement? What
role does positivity and joy play on movement? How? How

(28:16):
do emotions infuse movement? Yeah, that that's you know, that's
a great question. We really focus on reward and we
focus on value, not directly on emotion. But you can
kind of link the two and say, you know that
punishment is really aversive, right, and it leads to anxiety

(28:38):
and uh, and reward you can link with joy. In
our book, we look at movements. You know, how you
choose your movements, how you choose characteristics of your movements.
US and others have looked at also learning, So how
do you learn? Uh? And one of the things that
people have found is that when you learn something, you
can give people different types of feedback. You know, you

(28:59):
can give them rewarding feedback, Oh, you did great, and
the better they do, you give them more reward. Or
you can also you could have the this you could
have the same training regiment, but with punishment. You could
be punishing people for when they don't do well enough.
And you can imagine that was the punishment leads to
kind of greater feelings of anxiety. And what's interesting is

(29:20):
that you know after training and whether whether you have
a group of subjects that have been exposed to rewarding
training with reward, another group that's been trained with punishment,
and immediately after training, both groups are the same. They
they they've achieved similar performance. But then if you follow
up with them weeks or months later, you find that

(29:40):
the group that was that learned under the rewarding paradigm,
that learning stuck with them, whereas the group that learns
under the punishment paradigm that learning was no longer retained.
So that you know that the emotional state in which
you're in can potentially influence just how those memories are
laid down, at least over the at least over the

(30:02):
long term, how you're coaching, or how you're being coached.
You can have a big impact on the durability of
the movements you're training, And the same is true for
your mental state. There'sn't a strong scientific basis for this. Yeah,
I always feel that you I wanted a temper things,
but to come at it from a place of love
is so beneficial. Science suggests that you know this is

(30:24):
you're able to learn better and longer in addition to
also choosing to train. But also I think that this
allows you to perform more optimally, to have an improved
perception of your of your body, proof perception of your
your capabilities, and thus you're able to move in the

(30:45):
best way that you can. So I think that it's
um it's good to to always be in a in
a in a positive, in a positive place when you
are training and when you are performing these these amazing,
amazing skill Dr Ahmed has first hand experience of the
relationship between mental states, decision making, and movements. When we spoke,

(31:09):
she had recently broken her leg in a skiing accident,
and it wasn't the first time. I actually broke my
leg skiing ten years ago uh as well. And I
always worried that because I'm in this line of research,
I know that when people are feel threatened, they make
bad movement choices. And I was always afraid that. I

(31:33):
always worried that I would never get it back into
skiing because I would be so um so terrified that
I would actually then screw up my movements I fall again.
And so I've always been very cognizant of that over
the years is that I make sure that when I'm
when I'm skiing, I'm always very comfortable and I'm in
a happy place, and I and I and I only

(31:55):
go on runs that I feel comfortable with. Not that
I'm being excessively cautious, but I make sure that I'm
that I'm comfortable with them, because I know if I
am terrified, I'm going to make a bad movement decision
and potentially fall. I want to go back to something
dr Ahmed just said, why do people make bad movement
decisions when they feel threatened? So one reason why why

(32:17):
people may also fail under a threat is that things
can feel threatening all of a sudden. It's one there's
high stakes. And one reason for why people can choke
under these high stakes situations is that instead of seeing
them as potentially rewarding, they just think of them as
a potential loss. They just think of the loss that

(32:38):
could be incurred, and it's like the brain makes this
mental switch. So this may relate to other questions, now
that I think about it, where UM Usually we think
of UM the things that we're going to attain in
terms of their the reward value. But sometimes your brain
can can frame it differently and it's very subtle. Or
instead of you thinking of what you stand to gain,

(32:59):
you think about what you stand to lose. And people
tend to be very much more sensitive to losses than gains,
and so then this could in theory lead to um
if you start thinking about things in terms of what
you can lose as opposed to what you can gain,
that this can also influence your how you move them.

(33:20):
If there was one thing you wish everyone knew about
how the brain controls movement, what would that be? We
don't really appreciate the complexity involved in our movements and
the flexibility until something really goes wrong. So you know,
I've I broke my leg. I'm hobbling around on crutches.

(33:40):
Of course, I you know, I miss being able to
walk on two legs, But even beyond that, I am
amazed at how I'm able to adjust to walking with crutches. Like,
my brain is constantly learning how I can move better
and stabilize myself better and perform tasks with two hands

(34:04):
while I'm using my crutches, And I think that that
is really just um as is amazing. It's it's remarkable.
Really all these tiny things that we do unconsciously, if
you will, to adapt to new environments. You've heard it before,
but our brains are incredible machines, and even basic motor

(34:26):
control still remains well out of the reach of our
scientific understanding. My post doc advisor Daniel Wolpert always had
this great example to just illustrate how hard it is
to make a movement. So he would say, you know,
you look, you know, we can build a computer now
that can beat any grandmaster at chess. So we have

(34:48):
solved that problem, but we still can't build a robot
that will manipulate the chess piece with the dexterity of
even a six year old child. That probably it's definitely
decidedly unsolved. I want to go back to Dr frut,
the neurologists you met at the beginning of this episode.

(35:08):
We take for granted the fact that we automatically go
through our day and go through our lives, moving through space,
but control of even what looked like simple movements is
a delicate balance, and they're quite an extraordinary thing. Dr
Fruct once said that neurology used to be thought of

(35:31):
as a specialty where you observe something but you couldn't
help people. How has this changed? The joke about neurology
used to be the neurologists were thought of as a
boat tie wearing uh, you know, individuals who sat in
armchairs and thought great thoughts and never did anything to

(35:51):
help somebody. Not just movement disorders, but many areas of
neurology epilepsy, had ache, sleep, medicine, stroke, this, this is
a therapeutic field now, and particularly movement disorders were you know,
we of course we think our field is the best field,
because that's why we went into it. But what's available

(36:14):
even in movement disorders therapeutically now compared to when I
was first training twenty five years ago, is night and day.
So you know, for the average patient who walks into
the office with any sort of movement disorder, we can
help them. Well, we can actually improve their quality of life,

(36:34):
which is quite an extraordinary thing if you think about it.
You know, we can't do everything. There are certainly areas
of neurology that have been very challenging, like the Demensia's
and Alzheimer's disease, et cetera. But for many areas, and
particularly movement disorders, this is a therapeutic field. Do you
think we're getting closer to finding a reliable cure for

(36:55):
focal dystonia and the yips? We used to think that
that was a complete impossibility. I no longer think that now.
I think there are people who, for one reason or another,
have a tremendous benefit from various treatments and even returned
to a state that may be very difficult to to

(37:17):
see that they have dstonia anymore. The real question is
can you put the genie back in the bottle? Can
you take a musician who has developed estonia, or an
athlete who has developed estonia and reset the motor network
so that they are back to the pre dystonia state.

(37:38):
I wouldn't assume that it's impossible anymore. Remember Aaron, the
guitar player you heard earlier, he received treatment from musicians
d estonia. The day we spoke to him at Dr
Frux's office, I asked him how he felt and what
relief he hoped he might experience. I feel guardedly optimistic,

(37:58):
you know what I mean, Because has been going on
so long, it's hard to imagine that it would suddenly,
I would suddenly go back at all to be clear,
Aaron wasn't receiving treatment to reset his motor network, as
Dr Fuk put it on the day we were able
to sit in on his appointment. However, he did receive

(38:18):
a treatment, one in a series of injections of bachulen
um toxin commonly known as botox, which may effectively reduce
the symptoms of dystonia and even make it possible for
Aaron to play the guitar like he once could. I'd
just like to be able to play in music like
I can, you know, hypothetically playing alright, I used to

(38:39):
be able to play. Thank you next time on losing control,

(39:02):
we're looking into one of the things that the YIPS
isn't performance anxiety, and you'll hear from Gwendolyn Mock, a
concert pianist and retired tennis pro Marty Fish next time
on Losing control. A sincere thank you to our guests.
Dr Aliah Ahmad, a professor at the University of Colorado,

(39:24):
Boulder who studies the neural control of movement. Dr Stephen Fruct,
a neurologist and clinician at n y U lang Own
who has been working with movement disorder patients and studying
movement disorders for more than twenty years. Dr Lena ting
A professor at Emory University and the Georgia Institute of Technology,

(39:45):
whose research is at the cutting edge of advancing our
understanding of how we move. And finally, Aaron, a musician
who suffers from d estonia. Special thanks to Dr Patrick Drummond.
Thank you so much for listening, and don't forget to
rate and subscribe. I'm Justin Sua, your host, and you
can find me on Instagram and Twitter at Justin Sua.

(40:08):
That's j U s t I N s u A.
You could also check me out on the Increase Your
Impact podcast. Losing Control is a podcast from Sports Illustrated
Studios and I Heart Radio. Original music by Jerem Suah.
Michael McDowell is our producer, editing, mixing, and additional production

(40:29):
assistance by Will Stanton. This episode was fact checked by
Zoey Mullock at s I Studios. Max Miller is supervising producer,
and Brandon Getchus and Matt Lipson are executive producers at
I Heart Radio. Sean ty Toone is our executive producer.
For more podcasts from I Heart Radio, visit to I
heart Radio app, Apple podcasts, or wherever you get your podcasts.

(40:52):
This podcast does not provide medical advice, and nothing you
here on this podcast is intended or implied to be
a substitute for profession no medical consultation, diagnosis, or treatment.
Always seek the advice of your physician or other qualified
health provider with any questions you may have regarding your health.
Never disregard professional medical advice or delay in seeking it

(41:15):
because of something you have heard on this podcast.
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