Near-total functional recovery achieved in partial cervical spinal cord injury (50% injury) after 3 years of coordination dynamics therapy.

The present paper explains how an 18 year-old boy, who suffered an incomplete spinal cord injury (SCI) at the Cervical 5/6 levels, could achieve a near-complete recovery within 3 years of coordination dynamics therapy (CDT). The anatomically incomplete SCI was evident on MRI (Magnetic Resonance Imaging) which showed that 50% of the cord tissue was destroyed at the injury site. The administered CDT included the training of crawling, walking, running, jumping, and exercising on special CDT devices. Now 21 years old, this chronically injured young man cannot only walk independently, but he can also run and jump. He has attained full bladder control and is off all medications. The underlying mechanism contributing to this excellent recovery will have to be explained in the framework of the System Theory of Pattern Formation. In this framework the clinical improvement can be quantified in terms of coordination dynamics values, behavioural description of movement performance, analysis of motor patterns, and surface electromyography (sEMG) recorded during the movements. The impaired ability of the injured nervous system to self-organize is evidenced by deteriorated motor programs recorded with sEMG, unstable movement performances, and asymmetric attractor layouts in coordination dynamics recordings. On the other hand, the improvement of motor programs after CDT could also be measured by surface EMG, including measurements of antagonistic action of muscles and also by the improvement of the mean stability of motor patterns. These indicators of improving motor programs could be correlated with clinical improvement in certain motor performances like running and jumping. The recovery could mainly be achieved through a functional reorganisation as was indicated by the absence of significant improvement in the power of the quadriceps femoris muscles. The performances of turning on the special CDT device against high loads were diagnostic for the extent of repair of the integrative functions of the CNS. The cure of urinary bladder function is probably attributable to learning transfer from stereotyped, coordinated, integrative movements to the neural networks involved in bladder control. Since the patient received sub-optimal CDT, it took more than 3 years for the recovery. It appears that the repair of the integrative functions of the CNS need longer periods of time. But training such integrative movements is pivotal in inducing learning transfer from motor patterns to autonomic functions that resulted in the cure of urinary bladder function.

Overreaching in coordination dynamics therapy in an athlete with a spinal cord injury.

A motocross athlete suffered a clinically complete spinal cord injury (SCI) during competition. Although MRIs (magnetic resonance imaging) showed a complete spinal cord injury at the Thoracic 11/12 levels, surface EMG recordings indicated the survival of few tract fibres across the injury site. Six weeks after the accident the subject began intensive Coordination Dynamics Therapy (CDT) at an up-to-date therapy centre. The subject trained at his physical limits to induce structural and functional repair. Exercising at variable loads between 20 and 200N (on a special CDT and recording device) generated periods of overreaching and super-compensation. By plotting coordination dynamics values (kinesiology), including high-load exertion (200N) and hysteresis curves, periods of overreaching and super-compensation were made graphically visible. It was found that symmetrical improvements of central nervous system (CNS) functioning occurred during overreaching. Improvements in spinal cord functioning were achieved throughout one year of CDT in this chronically injured subject with an almost anatomically complete SCI. It is discussed that the measuring of CNS functions by means of recording coordination dynamics is a powerful and non-invasive tool ideal for exact quantitative and qualitative measurements of improvement (or change) in CNS functioning. Such diagnostics may be of particular importance in sport during training and before competition. Also, coordination dynamics might be used to measure the effects of prolonged exposure to reduced gravitational conditions on CNS functions, such as faced by astronauts.

Improvement after severe traumatic brain injury induced by coordination dynamics therapy: comparison with physiologic CNS development.

On the example of a 5-year longitudinal study of a boy who suffered severe traumatic brain injury, it is shown that there seems to be no limit as to the repair of the injured central nervous system (CNS) if Schalow Coordination Dynamics Therapy is administered. The treatment-induced improvement of CNS functioning was preceded by a transient worsening This observation is in accordance with the predictions of the theory of coordination dynamics. The dynamics of pattern formation are described in terms of the motion of low-dimensional order parameters. If the intrinsic coordination dynamics conflict with the trained movement patterns, a temporary increase in variability (loss of stability) of the required pattern can be observed. Such temporary worsening of coordination dynamics was observed during the repair of the injured CNS but not during the physiologic development of pupils between 7 and 19 years of age. The improvement achieved during 5 years of home treatment in the CNS functioning, as quantified by low-load coordination dynamics, was 11%; a further improvement of 38% could be achieved during 16 days of therapy under professional supervision. Therapy under professional supervision was approximately 100 times more efficient than the seemingly similar home therapy.

Integrative re-organization mechanism for reducing tremor in Parkinson's disease patients.

A special movement therapy, called coordination dynamics therapy, has been reported to have the potential to improve central nervous system (CNS) functioning in Parkinson's disease patients. Electromyography using surface electrodes (sEMG) showed that the rhythmic muscle activity leading to Parkinsonian tremor was generated in the patients by the impairment of two kinds of inhibition. First, some premotor spinal oscillators organized themselves in the CNS neuronal networks without strong adequate input and second, the oscillators synchronized their firing to give rise to rhythmic muscle activity and tremor. In this paper it will be shown that highly coordinated arm and leg movements, generated when exercising on a special coordination dynamics therapy device, can reduce Parkinsonian tremor in amplitude and frequency and improve CNS functioning in the short-term memory. sEMG measurements showed upon exercising on the special coordination dynamics therapy device that the motor program improved in the short-term memory and tremor muscle activity became coordinated with the volitional motor program and reduced in size and frequency. Higher load exercising seemed to better reduce tremor muscle activity, probably because the physiologic CNS organization was more integrative then and could 'bind' stronger simultaneous pathologic tremor activity. Moreover, the rhythmic synchronized motor unit firing in different arm and leg muscles was synchronized or coordinated and changed in frequency and amplitude. It is concluded that the integrative re-organization mechanism to reduce Parkinsonian tremor is the phase and frequency coordination between neuron firing of the physiologic neuronal network state, generated by the highly coordinated arm and leg movements, and the simultaneous pathologic tremor network state, generated by the uninhibited neurons, firing synchronized oscillatory.

Cerebral palsy improvement achieved by coordination dynamics therapy.

Low-intensity coordination dynamics therapy, including crawling, treadmill walking, jumping on spring-board and exercising on a special coordination dynamics therapy device, was applied for 3 months (4 hours therapy per week) to 8 cerebral palsy patients (average age 15 years, range 7-27). All patients improved. The organization of the CNS, quantified by the low-load coordination dynamics between arm and leg turning movements, when exercising on the special coordination dynamics therapy device, improved by 46 +/- 17% (range 33-60%) for forward and by 48 +/- 15% (range 22-66%) for backward moving. Also improved the exercised crawling, jumping and walking, although not as much as the CNS organization quantified by coordination dynamics. The motor programs of the tibialis anterior, gastrocnemius, biceps brachii, and triceps brachii muscles, measured by surface electromyography (sEMG), improved only little. Evidence is provided for sEMG being a very suitable tool for optimizing the movement performance and the therapy since sEMG records show under what exercise conditions the recorded motor programs are best. However coordination dynamics, i.e. the integrative parameter for quantifying CNS organization, is better to show the progress in CNS functioning than movement and EMG improvements. When the patients stopped therapy, the value of their coordination dynamics, worsened 24% after 6 months. In one patient the coordination dynamics therapy was continued intensively for further 3 month, including 20 hours exercise per week. The value of the coordination dynamics even improved altogether by 85% and 82% for forward and backward turning movements respectively, and simultaneously movements, vegetative (sleep) and higher mental functions (aggressivity, learning capacity) showed strong improvements. The improvements of coordination dynamics for low-intensity therapy (46%, for forward movements) and additional high-intensity therapy (85%) lie within the recovery range for stroke (70%) and brain injury (69%) after 3 months of intensive coordination dynamics therapy. There is therefore indication that the CNS functioning in cerebral palsy patients can be improved by learning as much as the CNS functioning can be repaired by re-learning in stroke and brain injury. The improvement of the CNS functioning suggests that cerebral palsy can partly be cured if intensive coordination dynamics therapy is administered for 1 to 2 years. It is further suggested that inabilities, including mental inability, are diseases which can partly be cured rather than inabilities.