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Demography
Tourette syndrome is found in all cultures, racial and social groups, with the most case reports coming from the UK and the USA. A recent survey compiled by Carroll and Robertson (2000) documented findings from 3,500 Tourette syndrome cases in 22 countries including South Africa. Overall, it was found that the characteristics of Tourette syndrome were independent of culture, race or social class, and that the symptoms, tics and noises, are very similar, irrespective of the country of origin. However, most studies and reviews agree that Tourette syndrome appears 3 to 6 times more frequently in males than in females (Bruun & Bruun, 1994; Comings et al., 1990; Kurlan, 1993; Leckman & Cohen, 1998; Shapiro et al., 1988). Females, on the other hand, are more likely to display obsessive-compulsive symptoms without the related tics (Chase et al., 1992).
Furthermore, Comings (1990) and Shapiro et al. (1988) stated that there is no evidence that any of the demographic or illness-related variables significantly distinguish patients with Tourette syndrome from normal controls: parents’ age at time of patient’s birth, birth order, birth weight, history of abortions, parental complications, patient’s medical history, or family medical history. However, other authors, Lees (1985), and Lucas and Rodin (1973) reported possible birth complications of 25% and 40% in their samples irrespectively.
The tic disorder
Tics are short, sudden, recurrent, purposeless, non-rhythmic, involuntary movements (motor tics or twitches) or sounds (vocal/phonic tics or noises) that occur out of a background of normal motor activity. Tic disorders present themselves on a continuum from mild to severe. Tics may be so mild that no one notices them, or they may be so severe that they disrupt the person’s life and the lives of those around them (Kurlan, Behr, Medved & Como, 1988; Lees, 1985).
Both motor and vocal tics can be divided into two subcategories: simple and complex. Simple motor tics are the most characteristic type of tics and are symptomatic of all types of tic disorders. They usually involve one muscle group and produce one basic movement. Often, the first symptom is a rapid muscle spasm in a small area of the face around the eyes and mouth. After a short time, they may disappear never to return. Twenty to 25% of children have these tics at one time or another. Examples are eye blinking, squinting, rolling of the eyes, head twitching or shoulder shrugging (Caroll & Robertson, 2000). Complex motor tics involve more than one muscle group, moving in a certain sequence.
These tics may consist of a series of simple tics that follow in a stereotyped but meaningless repetitive sequence, such as touching the chin, touching the chest and shrugging a shoulder; touching the chin, touching the chest and shrugging a shoulder, or any other tics that are repeated in the same way each time. Furthermore, these tics may also consist of more co-ordinated and complicated movements that appear to be purposeful to those watching, when they really are not. Most often these tics start in the upper body and move down. Examples are bending over, snapping the fingers, pinching, spinning around while walking or pulling on clothing. Some patients may even hurt themselves without meaning to. For example, patients may snap their fingers so many times a day that they get blisters (Dornbush & Pruitt, 2000; Kurlan, 1993; Moe, 2000; Robertson, 2000).
Simple vocal tics consist of a variety of brief, inarticulate noises and sounds, such as throat clearing, grunting, coughing and excessive sniffing. These noises are made by tic-like movements of the vocal apparatus and have no meaning to the patient. Patients are often able to soften the sound of this tic or disguise it in some way. Complex vocal tics on the other hand are a bit more puzzling. They may consist of sounds turned into syllables, words, a series of words, phrases or even sentences. Some patients’ sounds get very loud, even becoming explosive. In rare cases, the sound could become an obscenity or curse word (Bruun & Bruun, 1994; Carroll & Robertson, 2000; Moe, 2000). Sometimes the patient is able to change the bad word or phrase, so it sounds acceptable. For example, ’up yours’ becomes ’ oh, sores’ (Moe, 2000 p.16).
Other more rare complex motor and vocal tics may occur with tic disorders. Complex motor tics may include copropraxia (making involuntary obscene gestures such as the V or middle finger signs), and echopraxia, or echokinesishead twitching or shoulder shrugging (Caroll & Robertson, 2000). Complex motor tics involve more than one muscle group, moving in a certain sequence.
These tics may consist of a series of simple tics that follow in a stereotyped but meaningless repetitive sequence, such as touching the chin, touching the chest and shrugging a shoulder; touching the chin, touching the chest and shrugging a shoulder, or any other tics that are repeated in the same way each time. Furthermore, these tics may also consist of more co-ordinated and complicated movements that appear to be purposeful to those watching, when they really are not. Most often these tics start in the upper body and move down. Examples are bending over, snapping the fingers, pinching, spinning around while walking or pulling on clothing. Some patients may even hurt themselves without meaning to. For example, patients may snap their fingers so many times a day that they get blisters (Dornbush & Pruitt, 2000; Kurlan, 1993; Moe, 2000; Robertson, 2000).
Simple vocal tics consist of a variety of brief, inarticulate noises and sounds, such as throat clearing, grunting, coughing and excessive sniffing. These noises are made by tic-like movements of the vocal apparatus and have no meaning to the patient. Patients are often able to soften the sound of this tic or disguise it in some way. Complex vocal tics on the other hand are a bit more puzzling. They may consist of sounds turned into syllables, words, a series of words, phrases or even sentences. Some patients’ sounds get very loud, even becoming explosive. In rare cases, the sound could become an obscenity or curse word (Bruun & Bruun, 1994; Carroll & Robertson, 2000; Moe, 2000). Sometimes the patient is able to change the bad word or phrase, so it sounds acceptable. For example, ’up yours’ becomes ’ oh, sores’ (Moe, 2000 p.16).
Other more rare complex motor and vocal tics may occur with tic disorders. Complex motor tics may include copropraxia (making involuntary obscene gestures such as the V or middle finger signs), and echopraxia, or echokinesis (imitation of another person’s movements). Complex vocal tics may include coprolalia (inappropriate and involuntary uttering of obscenities or socially objectionable words or phrases). Coprolalia is also known as the swearing tic or the F-word tic. In many cases, as mentioned earlier, the patient may be able to change the bad word or phrase so that it sounds acceptable, but if not, this then becomes one of the most, if not the most, distressing and disabling symptoms of a tic disorder. Echolalia (repeating the last word or phrase of another person) and palilalia (repeating one’s last word) also form part of the more rare complex vocal tics (Carroll & Robertson, 2000; Comings, 1990).
CHAPTER 1 INTRODUCTION
1.1 Introduction
1.2 Aims of study
1.3 Overview of study
1.4 Conclusion
CHAPTER 2 THEORETICAL OVERVIEW OF TOURETTE SYNDROME
2.1 Tourette syndrome
2.2 Clinical features: A Spectrum disorder
2.3 Conclusion
CHAPTER 3 THEORETICAL OVERVIEW: EXECUTIVE FUNCTION AND THERAPEUTIC HORSE RIDING
3.1 Executive function
3.2 Therapeutic horse riding
3.3 Conclusion
CHAPTER 4 METHODOLOGY
4.1 Introduction
4.2 Research design
4.3 Data analysis
4.4 Instruments
4.5 Conclusion
CHAPTER 5 RESULTS
5.1 Introduction
5.2 Results of the individual tests
5.3 Qualitative results
5.4 Conclusion
CHAPTER 6 DISCUSSION
6.1 Introduction
6.2 Executive performance
6.3 Limitations
6.4 Recommendations
6.5 Contributions
6.6 Conclusion
REFERENCES
