Cure of urinary bladder functions in severe (95%) motoric complete cervical spinal cord injury in human.

Severe cervical Spinal Cord Injury (SCI) leads to quadriplegia, and autonomic dysfunctions. Bladder/bowel continence, cardiovascular performance, and breathing are impaired besides movements. Even though there are no fully restorative treatments for SCI, I report about a patient, who suffered a severe cervical, motoric complete SCI, in whom urinary bladder functions were fully repaired by functional and structural repair (limited regeneration of the cord) upon 2.5 years of Coordination Dynamics Therapy (CDT). On the repair of the blood circulation (no occurrence of pressure ulcers any more), breathing and motor functions was reported earlier. The mechanism that underlies this important repair of urinary bladder functions is the learning transfer from movements to bladder functions. The human bladder repair is analyzed at the neuron level, the collective variable level (System Theory of Pattern Formation), the movement, and the clinical diagnostic level.

Phase relation changes between the firings of alpha and gamma-motoneurons and muscle spindle afferents in the sacral micturition centre during continence functions in brain-dead human and patients with spinal cord injury.

1. Single-nerve fibre action potentials (APs) were recorded with 2 pairs of wire electrodes from lower sacral nerve roots during surgery in patients with spinal cord injury and in a brain-dead human. Conduction velocity distribution histograms were constructed for afferent and efferent fibres, nerve fibre groups were identified and simultaneous impulse patterns of alpha and gamma-motoneurons and secondary muscle spindle afferents (SP2) were constructed. Temporal relations between afferent and efferent APs were analyzed by interspike interval (II) and phase relation changes to explore the coordinated self-organization of somatic and parasympathetic neuronal networks in the sacral micturition centre during continence functions under physiologic (brain-dead) and pathophysiologic conditions (spinal cord injury). 2. In a paraplegic with hyperreflexia of the bladder, urinary bladder stretch (S1) and tension receptor afferents (ST) fired already when the bladder was empty, and showed a several times higher bladder afferent activity increase upon retrograde bladder filling than observed in the brain-dead individual. Two alpha2-motoneurons (FR) innervating the external bladder sphincter were already oscillatory firing to generate high activity levels when the bladder was empty. They showed activity levels with no bladder filling, comparable to those measured at a bladder filling of 600 ml in the brain-dead individual. A bladder storage volume of 600 ml was thus lost in the paraplegic, due to a too high bladder afferent input to the sacral micturition center, secondary to inflammation and hypertrophy of the detrusor. 3. In a brain-dead human, 2 phase relations existed per oscillation period of 160 ms between the APs of a sphincteric oscillatory firing alpha2-motoneuron, a dynamic fusimotor and a secondary muscle spindle afferent fibre. Following stimulation of mainly somatic afferent fibres, the phase relations changed only little. 4. In a paraplegic with dyssynergia of the urinary bladder also 2 phase relations (less stable) existed per oscillation period of 110 ms in a functional unit between the APs of a sphincteric alpha-motoneuron, a fusimotor and a secondary spindle afferent fibre. The phase relations changed with time following stimulation of mainly somatic afferents. A second functional unit organized by phase related interactions was phase related to the first functional unit. 5. Following painful bladder catheter pulling, the parasympathetic division was transiently activated several times in the paraplegic. At times of activation of the parasympathetic division, 3 broad phase relations occurred within and between the two functional units, indicating that the parasympathetic division in the sacral micturition and defecation center channeled an additional input to the somatic oscillatory firing neuronal networks driving motoneurons which innervate the external bladder and/or anal sphincters. 6. It is conceivable that the mutual inhibitory action of detrusor and external bladder sphincter has the capacity to recover, if the functional neuronal organization of the sacral micturition center is improved in the direction of more stable phase relations between the firings of neurons and neuronal ensembles by natural coordinated afferent inputs from continence organs, supraspinal neurons, and functionally connected neuronal networks. For supraspinal control and improvement of neuronal organization some kinds of bulbo-spinal-bulbo pathways have to exist or to be reconstructed by regeneration. 7. It will be shown in a following article that the sacral micturition centre can be repaired after spinal cord injury by a functional reorganization and limited regeneration of the human spinal cord by administering coordination dynamics therapy.

Scientific basis for learning transfer from movements to urinary bladder functions for bladder repair in human patients with CNS injury.

Coordination Dynamics Therapy (CDT) has been shown to be able to partly repair CNS injury. The repair is based on a movement-based re-learning theory which requires at least three levels of description: the movement or pattern (and anamnesis) level, the collective variable level, and the neuron level. Upon CDT not only the actually performed movement pattern itself is repaired, but the entire dynamics of CNS organization is improved, which is the theoretical basis for (re-) learning transfer. The transfer of learning for repair from jumping on springboard and exercising on a special CDT and recording device to urinary bladder functions is investigated at the neuron level. At the movement or pattern level, the improvement of central nervous system (CNS) functioning in human patients can be seen (or partly measured) by the improvement of the performance of the pattern. At the collective variable level, coordination tendencies can be measured by the so-called 'coordination dynamics' before, during and after treatment. At the neuron level, re-learning can additionally be assessed by surface electromyography (sEMG) as alterations of single motor unit firings and motor programs. But to express the ongoing interaction between the numerous neural, muscular, and metabolic elements involved in perception and action, it is relevant to inquire how the individual afferent and efferent neurons adjust their phase and frequency coordination to other neurons to satisfy learning task requirements. With the single-nerve fibre action potential recording method it was possible to measure that distributed single neurons communicate by phase and frequency coordination. It is shown that this timed firing of neurons is getting impaired upon injury and has to be improved by learning The stability of phase and frequency coordination among afferent and efferent neuron firings can be related to pattern stability. The stability of phase and frequency coordination at the neuron level can therefore be assessed integratively at the (non-invasive) collective variable level by the arrhythmicity of turning (coordination dynamics) when a patient is exercising on a special CDT device. Upon jumping on springboard and exercising on the special CDT device, the intertwined neuronal networks, subserving movements (somatic) and urinary bladder functions (autonomic and somatic) in the sacral spinal cord, are synchronously activated and entrained to give rise to learning transfer from movements to bladder functions. Jumping on springboard and other movements primarily repair the pattern dynamics, whereas the exactly coordinated performed movements, performed on the special CDT device for turning, primarily improve the preciseness of the timed firing of neurons. The synchronous learning of perceptuomotor and perceptuobladder functioning from a dynamical perspective (giving rise to learning transfer) can be understood at the neuron level. Especially the activated phase and frequency coordination upon natural stimulation under physiologic and pathophysiologic conditions among a and gamma-motoneurons, muscle spindle afferents, touch and pain afferents, and urinary bladder stretch and tension receptor afferents in the human sacral spinal cord make understandable that somatic and parasympathetic functions are integrated in their functioning and give rise to learning transfer from movements to bladder functions. The power of this human treatment research project lies in the unit of theory, diagnostic/measurement, and praxis, namely that CNS injury can partly be repaired, including urinary bladder functions, and the repair can partly be understood even at the neuron level of description in human.

The classification and identification of human somatic and parasympathetic nerve fibres including urinary bladder afferents and efferents is preserved following spinal cord injury.

UNLABELLED: Single-fibre extracellular action potentials were recorded with 2 pairs of wire electrodes from lower human sacral nerve roots during surgery. The roots from which was recorded from were used for morphometry. Nerve fibre groups were identified by conduction velocity distribution histograms of single afferent and efferent fibres and partly by nerve fibre diameter distribution histograms. The values of group conduction velocity and group nerve fibre diameter measured in the paraplegics were very similar to those obtained from brain-dead humans and patients with no spinal cord injury. Thus the classification and identification of nerve fibre groups remained preserved following spinal cord injury. Upon retrograde bladder filling the urinary bladder stretch and tension receptor afferent activities were increased; on two occasions they even fired when the bladder was empty. Two reasons are brought forward for a too small storage volume of the urinary bladder in paraplegics: too high afferent activity of the bladder due to changed receptor field transduction mechanisms and too low compliance. SUMMARY: 1. Single nerve fibre action potentials (APs) of lower sacral nerve roots were recorded extracellularly with 2 pairs of wire electrodes during an operation for implanting an anterior root stimulator for bladder control in 9 humans with a spinal cord injury and a dyssynergia of the urinary bladder. Roots that were not saved and that were used to record from were later used for morphometry. 2. Nerve fibre groups were identified by conduction velocity distribution histograms of single afferent and efferent fibres and partly by nerve fibre diameter distribution histograms, and correlation analysis was performed. Group conduction velocity values were obtained additionally from compound action potentials (CAPs) evoked by electrical stimulation of nerve roots and the urinary bladder. 3. The group conduction velocities and group nerve fibre diameters had the following pair-values at 35.5 degrees C: Spindle afferents: SP1 (65 m/s / 13.1 microm), SP2 (51/12.1); touch afferents: T1 (47/11.1), T2 (39/10.1), T3 (27/9.1), T4 (19/8.1); urinary bladder afferents: S1 (41 m/s / -), ST (35/-); alpha-motoneurons: alpha 13 (-/14.4), alpha 12 (65 m/s /13.1 microm), alpha 11 (60?/12.1)[FF], alpha 2 (51/10.3)[FR], alpha 3 (41/8.2)[S]; gamma-motoneurons: gamma(beta) (27/7.1), gamma 1 (21/6.6), gamma 21 (16/5.8), gamma 22 (14/5.1); preganglionic parasympathetic motoneurons: (10 m/s / 3.7 microm). 4. The values of group conduction velocity and group nerve fibre diameter measured in the paraplegics were very similar to those obtained earlier from brain-dead humans and patients with no spinal cord injury. Also, the axon number and the axon density of myelinated fibres of lower sacral nerve roots remain unchanged following spinal cord injury. Thus the classification and identification of nerve fibre groups remained preservedfollowing spinal cord injury. A direct comparison can thus be made of natural impulse patterns of afferent and efferent nerve fibres between paraplegics (pathologic) and brain-dead humans (supraspinal destroyed CNS, in many respects physiologic). 5. When changing the root temperature from 32 degrees C to 35.5 degrees C, the group conduction velocities changed in the following way in one case: SP2: 40 m/s (32 degrees C) to 50 m/s (35.5%), S1: 31.3 to 40, ST: 25 to 33.8, M: 12.5 to 13.8; alpha 2: 40 to 50, alpha 3: 33 to 40. The group conduction velocities showed different temperature dependence apart from SP2 fibres and alpha 2-motoneurons. 6. Upon retrograde bladder filling the urinary bladder stretch (S1) and tension receptor afferent (ST) activity levels were undulating and increased. As compared to activity levels detected in a brain-dead human, S1 (designates afferents, not cord segment) and ST afferents fired even when the bladder was empty, with an activity level similar to those observed in a brain-dead human with the bladder half filled. Two reasons are brought forward for an too small storage volume of the urinary bladder in paraplegics: too high afferent activity of the bladder due to changed receptor field signal transduction mechanisms and too low compliance. 7. With the newly developed 'coordination dynamics therapy', applied early after spinal cord injury, such complications of bladder functioning can be avoided; the bladder can causally be cured in severe spinal cord injury.

Partial cure achieved in a patient with near-complete cervical spinal cord injury (95% injury) after 3 years of coordination dynamics therapy.

This report describes a case of a now 20-year-old young lady with a severe spinal cord injury (SCI) at cervical 5/6 levels (ASIA A), in whom a repair of some spinal cord functions could be achieved within 3 years of optimal coordination dynamics therapy (CDT). Magnetic Resonance Imaging (MRI) showed a destruction of almost 95% of the cross-sectional area at the injury levels. The 5% (if at all) spared cord tissue most likely consisted of only sensory tracts, since no motor functions were preserved below the level of injury. A near-complete recovery of the important vegetative functions urinary bladder control, respiration, and vasomotor tone could be achieved. Her motor and sensory functions also improved to some extent, and she is off all medications. However, her motor recovery was limited and she is still wheel-chair-dependent. There is functional and structural (MRI) evidence that the human spinal cord regenerates upon CDT. The movement-based learning therapy included the training of supported crawling, up-righting, walking, running, jumping, balance training, and exercising on special CDT devices. The regeneration of the spinal cord started after more than one year of CDT, it was very limited but continuous, and gave rise to substantial functional recovery. The recovery induced by regeneration upon CDT was quantified in terms of transient increases of coordination dynamics values, the improvement of motor programs as assessed by surface electromyography (sEMG), the improvement of movement performances, and the increase of the spinal cord matter at the injury site, quantified by MRI. The similarity between the improvement at cellular and integrative (network) level during this regeneration and development is analyzed with respect to 'walking'. Comparing the effort, required to achieve substantial improvement in this case of severe cervical SCI (with 95% cord destruction; 5% spared tissue) with the effort required in the case of partial cervical SCI (50% destruction; 50% spared tissue), IT is noted that the 95% injury is 10 times more intractable. It is inferred that in severe SCI, the repair crucially depends on the percentage of the spared tissue (tracts fibres and neuronal networks) at the injury site. Improper handling of the patient therefore, as false transport or too late relief of spinal cord compression, may give rise to further mechanical damage of the cord tissue for which a later administered intensive cCDT cannot compensate for.

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.

Coordination impairment between the somatic and parasympathetic nervous system divisions in the human sacral micturition centre following spinal cord injury.

The detrusor-sphincteric dyssynergia is analyzed by comparing the natural impulse patterns of secondary muscle spindle afferents (SP2) contributing to continence (SP2 fibre activity changes are similar to detrusor pressure changes) and sphincteric motoneurons in a brain-dead human with those in patients with spinal cord injuries. In the brain-dead the sphincteric motoneurons, subserving continence, were inhibited at a time, when preganglionic parasympathetic efferents and a SP2 fibre increased their activity (physiologic). In paraplegics the sphincteric motoneurons were not inhibited (pathophysiologic). In the brain-dead, an SP2 fibre showed doublet firing (interspike interval (II) 10 to 14 ms) for low level parasympathetic activation and multi-ending regular firing for high parasympathetic activation. In one paraplegic with strong bladder dysfunction, the multi-ending regular firing was replaced by a repeated burst firing with a shortest II of 0.2 ms (transmission frequency = 5000 Hz). The pathologic firing patterns of the SP2 fibres, the detrusor-sphincteric dyscoordination, and hyperreflexia in paraplegics are most likely a result of neuronal network changes in the parasympathetic and somatic nervous system divisions of the sacral micturition center after spinal cord injury. It is discussed that urinary bladder functions can be re-learned.

Stem cell therapy and coordination dynamics therapy to improve spinal cord injury.

During competition a motocross athlete suffered a clinically complete spinal cord injury (SCI) at the Thoracic 11/12 levels according to MRIs (magnetic resonance imaging). Six weeks after the accident the subject began intensive Coordination Dynamics Therapy (CDT) at an up-to-date therapy centre. After 6 months of therapy, when further improvements were only marginal, the patient opted for haematopoietic stem cell therapy in addition to ongoing CDT. During two years of stem cell therapy, including 4 sessions of stem cell application, and ongoing coordination dynamics therapy, improvement remained marginal--no more than what would have been achieved with continuing only CDT. It is concluded that this haematopoietic stem cell therapy did not have any beneficial effect on the repair of the spinal cord in this patient. Differences in the regeneration capacity between commonly used laboratory animals and human are addressed. On the basis of a frog model for regeneration, cell communication, and neural control, it is discussed why complete SCI in human are difficult to improve and why for stem cell therapies more proper human knowledge is needed to induce structural repair and direct it to the injured sites of the neuronal networks. Further research is needed to improve and justify the clinical application of stem cell therapy. A thoughtful combination of stem cell therapy and CDT may have a chance of structural repair even in complete SCI. However, objective measures are needed to quantify improvement in MRI (anatomic measure), EMG (measuring of motor programs by sEMG, electrophysiologic measure), and measurements of coordination dynamics (kinesiologic measure).

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.

Surface EMG- and coordination dynamics measurements-assisted cerebellar diagnosis in a patient with cerebellar injury.

Cerebellar diagnostic was performed in a patient who had suffered severe cerebellar injury, using kinesiologic (coordination dynamics) and electrophysiologic (surface EMG (sEMG)) means. Since the right cerebellum had been completely destroyed, significant coordination problems (especially on the right side) were expected to be found in addition to balance problems. As compared to a healthy person, coordination between arms and legs was 80% up to 300% worse. Unexpectedly, no pronounced impairment of coordination of the right arm and right leg was found (with respect to the remaining limbs) as a result of the lost right cerebellum. The values of coordination dynamics measured for the right arm and the right leg for exercising in the forward and backward direction were as good as or even better than those obtained for the left side. However, sEMG disclosed a strong impairment of antagonistic muscle activation (spinocerebellum) between the tibialis anterior and the gastrocnemius muscles on the right side upon exercising the legs only on the special coordination dynamics therapy device (similar to a stationary bicycle). The muscles of the right-sided leg worked worse than those of the left-sided leg. But upon exercising both legs and arms on the special device (more integratively), the antagonistic muscle activation improved in the poor right leg by 36% in the short-term memory but not in the good left leg (symmetry improvement). These kinesiological and electrophysiological measurements show that there was no clear ipsilateral correlation between the cerebellum and the laterality of body functions. For different kinds of supported walking sEMG motor programs worsened with the reduction of the support. Probably the damaged vestibulocerebellum could not sufficiently coordinate balance any more with walking When swinging and jumping on the springboard, sEMG motor programs were best for jumping in anti-phase, where maybe more inhibition is activated. It is concluded that coordination measurements and sEMG are powerful tools to evaluate the outcome of cerebellar injury and to provide a diagnostic tool to quantify improvements in the CNS functioning as a result of the coordination dynamics therapy.

Symmetry diagnosis and treatment in coordination dynamics therapy.

Forward-backward movement symmetry of the human CNS was investigated through pattern change during exercising on a special coordination dynamics therapy and recording device in the forward and backward direction. A mirror-image symmetry shift was found in a patient with cerebellar injury for the attractor patterns (movement patterns with the highest temporal stability) for exercising on the special coordination dynamics therapy device in forward and backward direction, with respect to pace and trot gait coordinations. Symmetry diagnosis and symmetry treatment are of importance in CNS repair because of the learning transfer to the movement symmetry counterpart: training of backward walking improves forward walking The theoretical and practical basis of Schalow Coordination Dynamics Therapy is given in the Method section including symmetry considerations with respect to CNS self-organization.

Improvement after cerebellar injury achieved by coordination dynamics therapy.

Coordination dynamics therapy of changing intensity was administered at home for nearly 8 years (at the beginning at low intensity) to a patient who had suffered a severe injury of the cerebellum (and of the cerebrum). Motor functions improved markedly during the first year of rather intensive therapy (by 42%), but there was but little improvement in the 5 following years (by 27%). An intensive 3-week coordination dynamics therapy was administered after 4 years of quantified therapy at an up-to-date therapy place under optimal conditions. The motor functions improved strongly (by 29% in 13 days). Therapy under professional conditions was shown to be much more efficient (by the factor of 150 as quantified by low-load coordination dynamics values) than that at home. A comparable patient with a brain (cerebral) injury improved slightly more under optimal conditions (by the factor of 390). In the patient with the injury of the cerebellum, the largest improvement concerned speech and higher mental functions. The strong improvement during the 3-weeks of optimal therapy may have partly been due to the enhanced training of CNS symmetries. It thus seems that not only phase and frequency coordination between neuron firings has to be improved by the therapy, but also symmetries in CNS organization.

Functional development of the CNS in pupils aged 7 to 19 years.

In pupils aged 7 to 19 years, the functioning of the central nervous system (CNS) improved by a factor of 3 during their development. The CNS functioning was quantified in the framework of the dynamical system theory of pattern formation by the value of coordination dynamics. A transient increase in the optimal rate of arm and leg movements was observed in the pupils within 8 and 14 years of age. This high-speed moving is interpreted as a mean how the immature CNS tries to improve its functioning with respect to coordination and symmetry. Moreover, in very young pupils a lack of continuous drive of the CNS was observed; in other words, the concentration upon a certain task was not continuous. Some pupils were able to concentrate for only approximately 10 s. It was difficult for young pupils to simultaneously concentrate on two different tasks like moving and speaking or moving and thinking. It is concluded that concentration problems observed in young pupils are due to their immature CNS.

Hypoxic brain injury improvement induced by coordination dynamics therapy; a comparison with normal CNS development.

A 13-year-old girl suffered a rather severe hypoxic CNS injury and was given up by the school medicine. Adequate therapy was rejected for the patient by a university clinic with the argument that there were only simple reflexes left. The patient underwent coordination dynamics therapy and could significantly improved; she now can sit, walk, eat, drink, count and speak a few words. During a 3-month intensive therapy, a 70% improvement in CNS functioning could be achieved, as quantified by the coordination dynamics, i.e. a similar improvement as could be achieved in patients after stroke and traumatic brain injury, and in cerebral palsy. The improvements in CNS functioning achieved were compared with changes occurring during development in pupils aged between 7 and 19 years. Similarities could be observed with respect to high-frequency exercising for improving CNS functioning, missing continuous concentration on a certain task, and the strong improvement of the coordination dynamics. In the Method section, the theory is presented of the Schalow coordination dynamics therapy.

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.

Tapering of human nerve fibres.

To determine the tapering of human nerve fibres, rostral and caudal root pieces of cauda equina nerve roots were removed and nerve fibre diameter distributions were constructed for 4 myelin sheath thickness ranges for the two sites, and compared with each other. The reduction of the group diameter in the different alpha-motoneuron groups was 0.2 % per 13 cm. Accounting for systematic errors, there may be even less tapering. An identified single nerve fibre showed no tapering. Further, there is indication that gamma-motoneurons, preganglionic sympathetic and parasympathetic fibres and skin afferents also reduce their fibre diameter by 0.2 % per 13 cm or less. Consequently, a nerve fibre with a diameter of 10 microm would be reduced to approximately 9.8 microm at 1m from the cell soma. Preganglionic parasympathetic fibres were found to be represented in roots S1 to S5. At similar distances from the spinal cord, the mean diameter of ventral root alpha1-motoneuron (FF) axons increased from the thoracic towards the lumbo-sacral region before decreasing again in the lower sacral region. Usually no alpha1-motoneuron axons were found in S5 roots. The diameter distribution of unmyelinated nerve fibres of a ventral S5 root showed three peaks at 0.25, 0.95 and 1.2 microm. The unmyelinated fibres with diameters around 0.25 microm may represent parasympathetic fibres. In six selected areas of the ventral S5 root, 6.6 times more unmyelinated nerve fibres than myelinated fibres were found on the average.

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.

Improvement in Parkinson's disease patients achieved by coordination dynamics therapy.

Eight patients in whom Parkinson's disease had set on 5 to 10 years earlier underwent low intensity coordination dynamics therapy with on average 4 hours per week for 2.5 months. The ongoing pharmaco-therapy and the conventional fitness training for 1 to 2 hours per week were not changed. With the coordination dynamics therapy the functioning of the central nervous system (CNS) of the Parkinson's disease patients improved by 35%, as quantified by coordination dynamics measurements. Following 3 months of no coordination dynamics therapy, but further ongoing pharmaco-therapy and fitness training the CNS functioning worsened again by 21%. It is concluded that pharmaco-therapy and conventional fitness training alone cannot prevent the worsening of the CNS functioning in progressing Parkinson's disease, but additional coordination dynamics therapy can.

High-load coordination dynamics in athletes, physiotherapists, gymnasts, musicians and patients with CNS injury.

High-load coordination dynamics were measured in athletes, physiotherapists, gymnasts, musicians, patients with spinal cord injury and a patient with multiple sclerosis during exercise on a special coordination dynamic therapy device to quantify improvement in the central nervous system (CNS) organization due to therapy in patients and to quantify differences in the CNS organization between healthy subjects and patients with CNS injury. The values of high-load coordination dynamics for the group of athletes were two times better than those of physiotherapists, gymnasts and musicians, but still two times poorer than the best value achieved so far in a patient with a spinal cord injury after 10 months of continuous intensive coordination dynamics therapy. Especially the physiotherapists, gymnasts and musicians had poor coordination between arms and legs for the difficult intermediate coordinations between pace and trot gait for high load. Exhaustion of the CNS and improvement of CNS functioning in the short-term memory could be made visible using hysteresis-like curves for load increase and decrease. When not receiving therapy, patients with CNS injury could not turn at high loads, and showed poor coordination at lower loads only. After exercising 7,000 coordinated arm and leg movements per month, the CNS organization for high load improved in 3 healthy subjects by 36%. In patients with CNS injury, such improvements of high-load coordination dynamics took several months of intensive coordination dynamics therapy including 350,000 coordinated movements per months. The rate of learning may differ in healthy subjects and patients very approximately by a factor of 50 depending on the severity of the injury. On the other hand however, the high-load coordination between arms and legs, necessary for walking could be improved during therapy even in patients with multiple sclerosis, with the consequence that they could manage better in every day life.