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.
When the lips are the seat of involuntary muscular action, have the patient show his teeth, open and shut his mouth, purse his lips; make him speak and conform his expression to his speech; let him read aloud slowly, and fix his attention on his subject.
As a specimen of treatment for a facial tic, we may cite the subjoined programme:
Every day, and three times a day, at the same hours—nine, one, and six—the patient is to look at himself for two minutes in a mirror, preserving absolute immobility the while; to read aloud for two minutes, to speak in front of the glass for two minutes, to walk backwards and forwards in front of the mirror for two minutes. During the ten minutes of these exercises he will endeavour to keep his facial musculature under control. If the tic assert itself in the course of one of the exercises, he will recommence the latter, if necessary twice; the third time he will leave it till the next séance.
For tics of the head and neck, such as tossing tics and mental torticollis, inclination and rotation movements are indicated, of which an instance may be quoted:
Mademoiselle R. is quick in learning how to correct her muscular faults. Her actions are gradually becoming more complete and ample, and if she performs her allotted task with little animation, at the least there is no question of her indefatigable willingness. In less than a month she has been able to fix her regard, open her eyes widely, turn her head, uninterrupted either by halts or twitches; she can remain motionless in front of a looking-glass for as long as a minute. Equally satisfactory progress hat been made in the art of reading aloud; she breathes more regularly, and articulates more distinctly.
Thus the patient has come to realise that she need but give her attention to the involuntary movements for them to cease, and there has been a synchronous advance in her mental activity and power of concentration. Her nonchalance and timidity have diminished; she is no longer indifferent to her surroundings, nor furtive in her glances; she enters into conversation with zest, and her movements are characterised by decision.
Take another example of treatment, for a case of mental torticollis: