University of Chicago neurologist, LPGA team up to study golf and the brain

July 18, 2000

On July 22-23, a few foursomes of professional women golfers will lend their minds to University of Chicago neuroscientists to help them understand how adults learn complex new skills. The findings should help physicians learn how rehabilitation strategies can be improved for people recovering from damage to the brain, such as a stroke.

Eight to 12 LPGA Tour professionals who played in the U.S. Women's Open will take part in a study to determine how their brains coordinate a complex physical task at which they excel: the golf swing.

"We know very little about how the brain manages to program rapid, highly skilled movements like this," said neurologist John Milton, M.D., Ph.D., associate professor of neurology at the University of Chicago and director of this study. "Yet these movements -- playing a musical instrument, hitting a golf ball, casting a fishing line -- typically are the very ones that make life enjoyable."

The researchers will use functional MRI, a non-invasive imaging method that can detect small changes in blood flow within the brain, to determine which parts of their brains professional golfers use when preparing to swing a club. Milton's team will also study a matched group of amateur women golfers, of varying skill levels, to see how their brains acquire and store the commands that control this complex movement.

The long-range goal is to see how the older golfer's brain picks up this new skill, comparatively late in life or after damage to the nervous system.

"Preparing to swing a golf club is the perfect activity for this sort of study," said Milton, an avid golfer. "A good golf swing involves a very elaborate and somewhat unnatural series of movements, yet it takes place in a fraction of a second, much too quickly for the brain to make the necessary adjustments during the process."

Golfers make ideal subjects, he said, because "the mental-imagery process precedes the performance." An MRI scanner can accommodate a thinking golfer but is far too narrow for a full swing. In addition, "the very essence of the game involves performing the same task over and over with an emphasis on accuracy."

Golfers learn and refine this task through practice and repetition. When they play, they first concentrate on planning and visualizing a shot, a ten-second process referred to as the pre-shot routine. Then they try to execute something very like the planned swing.

"We want to determine," said Milton, "which parts of the brain participate in this pre-shot routine and whether this correlates with a golfer's skill level or age."

"Results from this cutting-edge research will not only assist professionals that work with individuals who are recovering from a stroke, but the information may also contribute to the growing interest in how the brain actually works when learning a complex motor skill like the golf swing," said Betsy Clark, Ph.D., the LPGA's director of education. "Information that we will gather about the pre-shot routine will also be invaluable to teaching professionals working with amateurs or our professionals."

Milton's team will also match up each professional golfer they study with a novice golfer. Then he plans to study how these novice golfers alter their brain activity over one year of instruction and practice.

For this study, the researchers will collect functional MRI images of each golfer's brain during her pre-shot routine for an approach shot to the green and for a putt. As they are being scanned, the golfers will see projected photographs of specific golf holes, taken for this purpose at the Merit Club, in Libertyville, a suburb of Chicago, with the cooperation of noted golf instructor Ed Oldfield, who directs the club.

The fMRI data should reveal the patterns of alteration of blood flow within the different regions of each golfer's brain as she prepares to make that shot. Increased blood flow to a region is a marker for heightened activity within that part of the brain.

Milton has been trying to orchestrate this unusual study for nearly two years. He first had to secure approval and cooperation from the LPGA and from the University's Institutional Review Board, which oversees all human research.

Only in the last 10 months, however, have the logistical details that made it possible, and affordable, begun to fall into place. The U.S. Women's Open is conveniently being played this year at the nearby Merit Club. On the same weekend, the University will begin to replace a heavily used MRI scanner, leaving it temporarily available for this project.

A devoted golfer himself, Milton has been studying and working with the LPGA's Clark in the LPGA's Teacher Education Program for Accessible Golf. This comprehensive training program is geared for golf professionals and rehabilitation specialists who work with golfers with disabilities. First offered by the LPGA Teaching and Club Professional (TC&P) Division in 1999 as part of the LPGA's accessible golf initiative, the teacher-education program will be part of a teacher certification program for accessible golf.

Milton also heads up an unusual new clinic at the University of Chicago Hospitals that uses the sport as a diagnostic and therapeutic tool.

"In young people, sports medicine is all about orthopedics," said Milton, "but we find that as people move beyond the age of 45, it tends to be more and more about problems associated with the aging nervous system; hence, neurologists need to become involved."

The clinic assesses the sensory and motor skills of patients who have a real or perceived loss of strength or coordination, through standard tests and by precise study of the patient's golf swing.

For many patients, golf then becomes part of medical therapy, an enjoyable form of exercise that can help aging athletes recover and regain confidence after a stroke or heart attack. Compliance with therapy is much higher among patients assigned to play the sport, said Milton, than among those presented with standard, but comparatively boring, exercise regimens.

Other patients come to the clinic in order to extend their golfing days, for guidance and tips on how to keep playing despite age-related health problems, such as hip or knee replacements.

"Golf," said Milton, "is one of the few sports that is played throughout life, even after nervous system damage, enabling the effects of an aging nervous system to be studied."

The LPGA Tour professionals will come to the Medical Center on Saturday. Studies on each volunteer will take about 90 minutes. Participating amateur golfers will be studied over the next six months.

Besides Milton, the research team includes the University's functional MRI group, headed by Steven Small, M.D., and Debbie Crews, Ph.D., an assistant research professor of exercise science at Arizona State University and a Class A LPGA teaching professional, with expertise in motor learning and exercise physiology.
The research is funded, in part, by a grant from the Brain Research Foundation.

University of Chicago Medical Center

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