Cervical spinal cord injury of an 18-year old man approximately 8 hours after a motor cycle accident (A) and one year later (B).

The arching of the back is impaired in the patient Nefeli (A). In the four-year-old brother the arch of the back is physiologic (B).

Free walking on treadmill in the forward and backward direction of a patient with a SCI. Note the pathologic inward rotation of the left knee and the not straight upper body because of the scoliosis.

The 11-year-old Nefeli with an incomplete spinal cord injury (SCI) during exercising coordinated arm, leg and trunk movements to improve the coordinated firing of neurons and sub-neural networks. This special CDT device for measuring and therapy (int.pat.) is produced by the firm: Giger Engineering, Martin Giger dipl.Ing.ETH/SIA, Herrenweg 1, 4500 Solothurn, Switzerland, www.g-medicals.ch.

Layout of the recording of single-nerve fiber action potentials to measure the self-organization of neuronal networks of the human CNS under physiologic and pathophysiologic conditions. By recording with two pairs of wire electrodes (B) from sacral nerve roots (cauda equina, C), containing between 200 and 500 myelinated nerve fibers, records were obtained in which single-nerve fiber action potentials (APs) were identified from motoneuron axons (main action potential (AP) phase downwards) and afferents (main AP phase upwards).

Schematic splitting of the activity of several nerve fibres into simultaneous impulse patterns of single fibres by comparing waveforms, conduction velocities and reoccurring characteristic impulse patterns (rhythmic firing of sphincteric motoneurons). The different conduction times and waveforms were recognized on an expanded time scale. Stretch receptor and secondary muscle spindle afferents contribute to the drive of sphincteric motoneurons and form, together with other afferents, regulation units.

Nefeli during dancing at school. Disappointing is that 16 of the 18 pupils had over-weight.

Improvement of free walking on treadmill of the 10-year-old patient Nefeli with a SCI. At the beginning a walking speed of 2.5km/h was only possible, later on a speed of 4km/h became possible. The patient walked without shoes to have a better sensory input and in this way a higher stability, which was the limiting factor of continuous walking.

Development of a classification scheme for human peripheral nerve fibers. Conduction velocities (V) and nerve fiber diameters (Ø) of afferent and efferent nerve fiber groups in normal humans and in patients with a traumatic spinal cord injury for 0.5 to 6 years.

Foot arches during supported walking. Note the right foot has in the stance phase (A, arrow) no foot arch.

Improvement of urinary bladder functioning quantified by the time from the urge/desire to void until micturition.

The six-year-old Nefeli (sitting), who acquired a spinal cord injury, following 8-months-therapy in a rehabilitation center in Affoltern in Switzerland (one day costs approximately 2000 US Dollar). Note, Nefeli had problems to manage at school in the first class.

The girl Nefeli, who acquired a spinal cord injury at the levels Th10/11 during walking with sticks and free walking. Note the pathologic walking pattern in B.

Classification scheme for human peripheral nerve fibers. Conduction velocities (V) and nerve fiber diameters (Ø) of afferent and efferent nerve fiber groups in normal humans and in patients with a traumatic spinal cord lesion for 0.5 to 6 years. The splitting of the a1-motoneurons into the 3 subgroups, a11, a12, a13, has not yet been confirmed. This is the only existing classification scheme for human nerve fibers!

Therapy-induced spasticity reduction in the short-term memory. The position of the ball represents the state of the system and the potential well, the attractor. The ball is attracted to the stable position in the deepness of the hole, called attractor state. The attractor layout, consisting of two attractive states of different stability, is changing upon exercising very coordinated rhythmic movements. Black ball = stable state, open ball = very unstable state, hatched ball = spasticity and movement co-exist. Variability of phase and frequency coordination not indicated.

Severe scoliosis of the SCI patient Nefeli caused by the spinal cord injury and the cancer removal. With the removal of the neuroblastoma at least one intercostal was removed.

MD, PhD, Untere Kirchmatte 6, CH-6207 Nottwil, Switzerland

Epigenetic regulation for repair by movement-based learning. CDT-induced stimulation of the pathways that regulate neural network repair is a proven therapeutic and preventive tool. Epigenetic mechanisms, stimulated by physiologic network activation, are likely key players within signaling networks, as DNA methylation, chromatin remodeling and small non-coding RNAs superfamily are required for the fine-tuning and coordination of gene expression during neural network repair by learning. Since the nervous system is involved in nearly all body functions, CDT will improve health.

Development of a classification scheme for human peripheral nerve fibers. Conduction velocities (V) and nerve fiber diameters (Ø) of afferent and efferent nerve fiber groups in normal humans and in patients with a traumatic spinal cord injury for 0.5 to 6 years.

Touch (and pain)-stimulated afferent activity. Touch and pain activity, stimulated by pin-prick (A) and touch (Ea) of S5 or Co dermatomes and recorded extracellularly from a dorsal coccygeal root (brain-dead human HT6). T1, T2, T3, T4, P = mark action potentials (APs) from single touch and pain fibers. Subscripts 1, 2, 3 mark single fibers.

Zones of Head and referred pain.

Up and down movements of the trunk to arch the patient’s back and to activate neurogenesis at the SCI level Th10. The impaired arch is marked with SCI Th10.

MD, PhD, Untere Kirchmatte 6, CH-6207 Nottwil, Switzerland

Ten-year-old Nefeli can move again the big toe separately four years after the accident and following 10.5 months of coordination dynamics therapy. In A she does not activate foot muscles and is relaxed. In B,C she concentrates and visualizes the task to activate the dorsal flexion of the big toe, which indicates that the spinal cord repair has reached with the activation of the halluces longus the spinal cord segment L5.

MD, PhD, Untere Kirchmatte 6, CH-6207 Nottwil, Switzerland

The 10-year-old SCI patient Nefeli during training with the hula hoop to improve trunk mobility/stability and balance.

Arachnoid cysts are central nervous system lesions that infrequently occur in childhood. They can be mobile and produce partial or complete obstruction in the Cerebrospinal Fluid (CSF) circulation. They are usually present at birth and are asymptomatic, although sometimes the symptoms appear in adolescence or adulthood due to the growth acceleration [1,2].

The leiomyomatosis peritonealis dissiminata (LPD) a histologically benign condition, but it can residivere and be metastatic. Since the macroscopically picture imitates diffuse peritoneal carsinosis, the risk of unnecessary drastic precautions are nearby.

Spinal cord cross section with indicated approximate injury (cross-hatched) and loss of interneuron (dotted area) of the patient Nefeli. Synapses of descending motor tracts onto anterior horn neurons are shown.

Primary motor areas (homunculus of the brain). Note that the toes are close to urinary bladder and rectum areas.

A-C. Volitional abduction and adduction of the toes becomes possible again in the SCI patient Nefeli. With the activation of the Mm. interrossei dorsales and plantares (C), the regeneration of the spinal cord has reached the S1 to S3 spinal cord segments.

Correlation of muscle fiber types, motor nerve fiber types, and oscillatory firing spinal neuronal networks, based on histochemical, morphological and physiological properties. This figure provides a simplified correlation between muscle fiber, motoneuron and sacral oscillator types. No additional subtypes have been included. a = motoneuron, ?1, ?2 = dynamic and static fusimotors, parasympathetic = parasympathetic preganglionic motoneuron. S1, ST, S2 = stretch, tension and flow receptor afferents.

Nefeli is watching the coordinated moving of the fins of fishes. ...

Improvement of running and walking times when moving along a floor. The patient is using the arms also for keeping the balance.

Activation of the halluces longus muscle (C) when dorsal flexing the big toes separately (B). Spinal cord regeneration reached the L5 level.

MRI of the 10-year-old patient Nefeli with a spinal cord injury at the levels around Th10. Because of scoliosis, the spinal cord is not fully in the plane. The injury of the spinal cord is mainly from the dorsal site.

Sclerotomes (B) and Dermatomes (A).

The spinal cord injury patient Nefeli during performing hula hoop and playing at the same time with the sister/Author with a balloon. B. Nefeli during hula hoop with two rings. C. With three rings, which was possible only for a few seconds. D,F,G. Nefeli during hula hoop and swinging additionally rings with the hands.

Running to improve pelvis positioning in a patient with a SCI at the level of Th10/11. A. During walking on knees, the pelvis is too much backwards mainly because of spasticity. B-E. During running the patient is able to bring the pelvis forward, especially in E. F. After running 10 times the distance of 6m the patient was exhausted but happy. Note that the patient is strongly using her arms to increase the running speed. A high-speed camera would have been needed to improve the quality of the pictures.

Salamander-crawling (C, D) in similarity salamander-walking (A, B) of the 10-year-old Nefeli with a spinal cord injury (Th10). In D the bending is disturbed because of the scoliosis and spasticity.

A, B. Possible rotational body movement of Tiktaalik, caused by alternately using one front limb for forward locomotion. C, D. This front limb movement is simulated by a patient with a spinal cord injury (Nefeli) by using alternately the right and left arm. Tiktaalik roseae is a lobe-finned fish from the late Devonian period, about 375 million years ago, having may be features akin to those of four-legged animals (tetrapods). Tiktaalik has a possibility of being a representative of the evolutionary transition from fish to amphibians.

Improved running performance (A) of the SCI patient because of being able to flex and lift more the knees instead of swinging the leg outwards during walking (B) and running (C).

Coordination dynamics values over time of the SCI patient Nefeli.

Ten-year-old patient with an incomplete spinal cord injury at the Th10 level during creeping. Note, because of the severe scoliosis, the creeping is not symmetrical. The rotation to the left is limited because of the scoliosis. C. Training of right-left symmetry via the corpus callosum (D) when exercising on the special CDT device with crossed arms.

Jumping on springboard of the 11-year-old SCI patient Nefeli after 2.5 years of CDT. Jumping in anti-phase (A-C), in rotation (D,E) and in abduction-adduction (F,G).

The 5.5-year-old Nefeli after suffering an incomplete spinal cord injury Th10 by medical malpractice. B. Nefeli after eight months of conventional children rehabilitation in Switzerland (Affoltern). Sticks and orthosis were needed. C,D. Ten-year-old patient Nefeli after six months of coordination dynamics therapy. At school she can walk again and can write at the white board.

Direct comparison of secondary muscle spindle afferent activity and motoneuron activity between the brain-dead human HT6 with a synergy of the bladder (A) and the paraplegic 9 with a dyssynergia of the bladder (B).

Comparison between changes in secondary muscle spindle afferent activity and detrusor pressure (measured before the surgery; for the implantation of a sacral anterior root stimulator). Paraplegic 9. A. Activity changes of the afferent fiber SP2(1) following bladder catheter pulling (Figure 37Ba). Approx. mean activity level is represented by a dashed line at 7.5 IIs/0.8s ((APs -1)/0.8s). The activity above the mean is cross-hatched and is proposed to be due to parasympathetic activation. Root vS4.

Improvement of the low load coordination dynamics best values with therapy.

Natural standing of the SCI patient at school following 12 months of therapy (A). After 18 months of CDT she stands straighter during working in the kitchen (B). The patient prefers to be bare foot (B) or to wear socks to have more input from the soles of the feet for better balance because of the damage of the fasciculus gracilis.

Patient with SCI during exercising on the special CDT device different movement patterns to improve phase and frequency coordination of neuron firing. In A and B also trunk rotation is trained. When turning in the standing position (F), the performance of the right foot is pathologic (plantar flexed).

Improvement of the straightness of the trunk during hula hoop. The treatment time is 12 months in A, 18 in C and 22 months in D. The improvement of straightness may not be characteristic for the improvement of her scoliosis.

Two ways to get up from the floor after falling. In A through D mainly the arms are used for getting up and in E through H the legs.

MD, PhD, Untere Kirchmatte 6, CH-6207 Nottwil, Switzerland

MD, PhD, Untere Kirchmatte 6, CH-6207 Nottwil, Switzerland

Schematic diagram of the sympathetic and parasympathetic nervous system. Yellow = sympathetic, blue = parasympathetic. The recording from a sacral root shows single action potentials of preganglionic neurons (par) and a skin afferent fiber.

MD, PhD, Untere Kirchmatte 6, CH-6207 Nottwil, Switzerland

Improvement of the straightness of the trunk during hula hoop. The treatment time is 12 months in A, 18 in C and 22 months in D. The improvement of straightness may not be characteristic for the improvement of her scoliosis.

Improvement of longest hula hoop exercising times in dependence on therapy. Note that the individual times varied much.

Human spinal cord with dorsal (A) and ventral side (B,C). Intumescentia cervicalis and lumbosacralis are visible. The caudal ventral roots are thinner than the dorsal roots. The passage of the artery spinalis magna (Artery of Adamkiewicz) and the anterior spinal artery are indicated. The C5 and Th10 roots and the intercostal nerve Th12 are indicated. Dissection of the Author.

Caudal part of the human spinal cord from the dorsal side. Lig. dent. = denticulate ligament. Dissection of the Author.

Volitional dorsal flexion of the feet in a patient with 70% SCI. In ‘A’ plantar flexed and in ‘B’ dorsal flexed. To improve foot power, the hand grip is co-activated (clench her fists).

A. Spinal cord segments and their relation to the vertebral bodies. Note the Ascensus of the spinal cord, giving rise to the long cauda equina nerve roots. B. Approximate segmental innervation of the skin. C. Below the spinal cord injury level there is loss of sensitivity and loss of connectivity to muscle and other functions.

Spinal cord (A) and dermatome segments (B-D). The segmental innervation of the skin in B is according to Hansen-Schliack and in C after Keegan and Garret. The overlap of dermatomes (D) is according to Foerster. Note the different location of the T1 dermatome in B and C. There is variation of the segmental skin innervation especially in the lower sacral range.

Phase and frequency coordination between oscillatory firing motor units (FF-type) during the generation of a motor program during exercise on the special coordination dynamics therapy device at loads increasing from 100 to 200N. Oscillation periods (T) and oscillation frequencies (f [Hz]) of oscillatory firing motor unit 1 are partly indicated. ‘A,B,D,E’ same recording situation as in Figure 23; ‘C,F’ soleus electrodes shifted to gluteus muscles to check early re-innervation upon therapy. The waveforms of the 3 identified FF-type motor unit potentials ‘1’, ‘2’, and ‘3’ are the same as in Figure 23; motor units ‘2’ and ‘3’ are partly marked. In ‘F’, some coordination’s between motor unit ‘3’ and ‘1’ are marked.

Motor program bursts in patients who suffered a spinal cord injury, structured with clonus activation and rhythmic firing of FF-type motor units A. EMG recording of a clonus (f = 5.3Hz) in the right tibialis anterior muscle of a patient who suffered a complete spinal cord injury sub Th5/7; the patient was not exercising. B, C. Motor programs of a patient who suffered an incomplete spinal cord injury sub Th4 upon exercising on the special coordination dynamics therapy device at 50 and 100N (medium to high load). In B, motor program bursts are structured by rhythmicity; frequencies of 5 and 7.3Hz are suggested. No motor program in the right tibialis anterior muscle; some motor program structure in the right gastrocnemius muscle. In C (faster sweep), there is no motor program in the right tibialis anterior muscle. Mainly clonus activity at a frequency of 4.5Hz can be seen in the right gastrocnemius muscle. Two physiologic motor program bursts can be seen in the left tibialis anterior muscle (not structured by rhythmicity). In the left gastrocnemius muscle a motor program burst can be seen which is structured by 5Hz rhythmicity (clonus frequency, see clonus in the right gastrocnemius muscle) and higher frequency rhythmicity (26 and 40Hz).

Trot gate crawling of a cerebral palsy girl in interpersonal coordination with the therapist. The crawling performance of the therapist is not optimal. The right arm is leading with respect to the left knee. The crawling performance of the patient is also not optimal; the knees are too much apart.

The potential, V(f), of the coordination dynamics for jumping on springboard (D, Nefeli) of a healthy (A) and injured CNS (B,C). The region around each local minimum acts like a well that weakly traps the system into a coordinated state. Behavioral changes are represented by the over-damped movement of a rolling ball in the potential “landscape”. High fluctuations (indicated by long arrows attached to the ball (network state)) in the stable state, due to high variability of phase and frequency coordination (in the injured case), will have a greater probability of “kicking” the system out of the basins of attraction (B,C) than for low fluctuations (short arrows) (A), due to small variability of phase and frequency coordination (in A). In B, only the in-phase jumping is stable, even though the fluctuation is high. In C there is only an attractor basin for the in-phase jumping, but the fluctuation is so high that there is a high probability that the system is kicked out of the basin of attraction. The patient can no longer jump in anti-phase and has difficulty with jumping in-phase. The stability of jumping depends on the motor program (deepness of basin of attraction) and the fluctuation of the pattern state (moving of the ball) caused by the increased variability of phase and frequency coordination due to the injury.

Endomyocardial fi brosis is a rare cause of restrictive cardiomyopathy which predominates in lowincome population living in tropical areas. It´s characterized by endomyocardial fi brous tissue deposition causing restrictive physiology with poor prognosis without proper management. We present a 40-yearold woman with right ventricular endomyocardial fi brosis complicated by pericardial effusion and a giant atrial thrombus. The use of multimodal imaging is very important for the diagnosis of this extremely rare pathology in our country.

The girl looks at you in the hope that you will help to cure spinal cord injury (and other diseases) in children. The picture was taken from the fairy tale film “Till Eulenspiegel”. In the film she (Jule Hermann) is hoping that her father wants her.

Poster of the Author Schalow G (Number 38) at the international conference IPBIS2018 in Belfast 2018: Pediatric acquired brain injury repair. The poster is not especially good because of lack of money. But the repair progress of the nervous system in children can clearly be seen It is also shown that human anatomy and physiology is needed for repair.

The SCI patient Nefeli during exercising only with the legs while playing/working with the iPhone (A) or singing and moving (B). While playing a bit crazy during CDT (B) is beneficial for repair because it keeps the patient in a good mood in spite of the SCI. Being addicted to the iPhone (A) is mostly not beneficial for repair.

Automatic stepping in a newborn infant. A. The 5-day-old infant, Juliane, performing primary automatic stepping; slight backward posture. The heel of the right foot touched the ground first. B. Infant Juliane, 8-day-old, performing automatic stepping.

In spite of all the struggles the Author had with the patient Nefeli when pushing her to the limits of exercising, she wrote into the control book that she likes the Author.

Supported jumping in anti-phase of the 9.5-year-old Nefeli with SCI in comparison to other girls. Note, with the right small finger the therapist (Author) is trying to keep the right foot of Nefeli in a physiologic position. The progress in jumping is quantified by the increase of jumps per series. y = age in years.

Objective: The main goal of this research is the assessment of sexual dysfunction in a group of OCD patients in Iran. Method: The participants were 36 women and 20 men (between 18 to 50 years old) who suffered from OCD based on both psychiatric interview and DSM-IV questionnaire (SCID). They were referred to Roozbeh Psychiatric Hospital and 3 private clinics in Tehran from 2011 to 2013. The following questionnaires were filled in this descriptive cross-sectional study: FSFI, IIEF, MOCI, OCI-R and a demographic questionnaire.

Exercising on the special CDT device with coordinated support by the Author. The Author recognized with the left hand when Nefeli started to sweat in the leg first time after the SCI, which means that the sympathetic nervous system re-innervated the body below the injury level Th10.

The spinal cord injury patient Nefeli just after learning to ride a normal bicycle at an age of 12.5 years (A). She manages also to ride curves (slalom) (B). She still has problems to keep the feet on the pedals, but when she slips from pedals, she has no problems to keep the balance (C). Note that she has to concentrate very much to keep the feet on the pedals (A), seven years after the SCI injury.

Relearning to ride a bicycle (A-G) instead of riding wheel instruments in the lying position (H) of patients with spinal cord injury. In B the feet are fixed. In C Nefeli is demonstrating the improvement of trunk stability. In D through G the feet are not fixed. E. With support of the father, Nefeli can manage a bit to ride a normal bicycle.

A. Posterior funiculus, containing the posterior columns fasciculus gracilis (medial, afferent fibers from the leg) and fasciculus cuneatus (lateral, afferent fibers from the arm). Afferent fibers sub-serving different sensory modalities traverse the root entry zone and enter the posterior horn (B). The type of myelin changes from peripheral to central, and the myelinating cells are no longer Schwann cells, but rather oligodendrocytes. The spinal cord injury at the level of Th10 is indicated. The afferent fibers from the arm join the cord at cervical levels and lie more laterally and dorsally to the spinal cord injury. The action potentials derived from receptors in muscles, tendons, fasciae, joint capsules and skin are conveyed in the distal processes of pseudo-unipolar neurons in the spinal ganglia. The central processes of the cells, in turn, ascend in the spinal cord and terminate in the nucleus gracilis of the medulla oblongata. The impulses derived from receptors in the leg are conveyed similarly to the caudal spinal cord. But in the spinal cord the central processes are mainly destroyed at the injury site and the action potentials cannot reach the second neurons in the nucleus gracilis of the medulla oblongata (dotted lines) (B). B. Central continuation of posterior column pathways. The posterior column nuclei contain the second neurons of the afferent pathway, which project their axons to the thalamus. Due to the spinal cord injury the second neurons in the nucleus cuneatus are partly de-afferented (dotted line). C. Pictured spinal cord injury site. Soled lines are functional, dotted lines not. To understand the regeneration of the human spinal cord, induced by coordination dynamics therapy, more knowledge of the regeneration in human is needed.

Neuron operating as a coincidence or coordination detector. A. Afferent input is reaching rather uncoordinated the cell soma. Only sometimes an action potential is generated, because the threshold of action potential generation is mostly not achieved. B. The action potentials in fibers 1 through 4 are reaching time-coordinated the dendrites or the cell soma. The postsynaptic potentials add up and the threshold is achieved at approximately –30mV, and action potentials are generated time-coordinated at the axon hillock. In the real CNS mostly, many more smaller postsynaptic potentials will contribute to the generation of an action potential and passive conduction from the dendrites to the cell soma has to be taken into account. Coordinated afferent input may thus induce or enhance (coordinated) communication between neuronal network parts following CNS injury.

Segment-indicating muscles of the L4, L5, S1, S2/S3 and S4/S5 spinal cord segments for measuring the level of spinal cord regeneration. A. Relation between spinal cord and vertebra segments. B. The spinal cord segment L4 indicating muscle is for example the quadriceps. The extensor halluces longus is characteristic for the L5 segment. C. The plantar muscles of the foot represent S1 to S3 spinal cord segments. D. The vesical and anal sphincters are activated from the S4/S5 spinal cord segments. The skeletal muscles of the leg are innervated by a1, a2 and a3-motoneurons, but the external bladder and anal sphincters are innervated only by a2-motoneurons.

Evolution of the attractor layout of bladder functioning induced by learning transfer from movements to bladder functions upon CDT. The region around each local minimum of the potential landscape acts like a well that weekly traps the system into a coordinated state. Black balls correspond to stable minima of the potential. With learning, the pattern ‘spasticity of the external bladder sphincter’ vanishes and the patterns for bladder functioning (‘synergy’ and dyssynergia’) appear anew and gain their physiologic stability (physiologic deepness of each basin of attraction). The corresponding attractor layout for physiologic bladder functioning is given. Fluctuation of pattern state (the black ball) (C), and their decrease (F), due to the impairment of phase and frequency coordination of neuron firing, is pictured in ‘C’ and ‘F’ by long and short arrows. Dotted and dashed lines indicate the re-occurrence of bladder sensation. Note that more than two years of optimal continuous CDT were needed for bladder repair.

Self-organization of premotor spinal *2-oscillator O1, which innervates the external urinary bladder sphincter (skeletal muscle). Brain-dead human HT6; recording from a dorsal S4 nerve root. A. Recordings from *2-motoneurons O1 and O2, firing in the oscillatory mode with impulse trains of 2 (upper recording) and 3 (lower recording) action potentials (APs). The durations of the oscillation periods were 110 (O1) and 164ms (O2). The interspike intervals of the impulse trains were 5.9ms (O1) and 4.6 and 7.4ms (O2). Motoneuron O1 conducted at 36 m/s; its recurrent fiber conducted at 21 m/s. The measurement layout is shown schematically. The inserts show the oscillatory firing modes; they have not been drawn to scale.

Clinical urinary bladder function test (Urodynamics). Improvement of the urinary bladder functions, quantified by urodynamics in a 30-year-old female patient. A. 3 months after the accident resulting paraplegia sub Th12 following spinal cord lesion. B. 12 months after the accident (lesion level lowered to sub L3). In A, the detrusor pressure (Pdet) is generated by the contracture of the bladder wall, as the pressure difference between abdominal pressure (Pabd, measured in the rectum) and the bladder pressure (Pves, measured in the bladder). Electromyographic recording obtained with surface electrodes from the sphincters and the pelvic floor (EMG) is shown; the external sphincters and the functionally correlated pelvic floor muscles show similar sEMG activity (the rhythmic pressure peaks in A do not originate in the bladder). In A, the detrusor shows nearly no activity with retrograde bladder filling at 25 ml/min; in B, the detrusor shows first activity at 360 ml bladder filling. A detrusor-sphincteric-dyssynergia occurs, because the detrusor pressure peaks occur at the same time as the sphincter EMG activity peaks (B) (bladder and sphincter contract at the same time, so that fluid can only emerge from the bladder at high bladder pressure; there is a danger of reflux through the ureter into the kidneys). The EMG peaks are a bit irregular, probably because the fluid, leaving the bladder, shunts transiently the EMG electrodes. Exact functional description of B: 2x coughing (B below) increases the EMG activity and passively the pressure in the abdomen and in the bladder (marked by the small arrows, physiologic). The bulbocavernosus reflex (induced by pressure applied to the clitoris) increased the EMG activity of the sphincters (physiologic). Conclusion: The reflex arch is in order; sacral nerve roots and nerves have not been damaged in the accident. I (bottom right): The patient feels an increase of unvolitional detrusor pressure (first feeling of bladder pressure at 360 ml). She tries to contract the sphincters to stop the bladder emptying. Shortly after the desire to empty the bladder, as the detrusor pressure decreases, fluid is leaving the bladder. II: Due to tapping onto the bladder, the bladder reflex is activated (detrusor activated, nearly no abdominal pressure); fluid is leaving the bladder. III: Due to the abdominal muscular pressure the pressure in the abdomen increases as does passively the pressure in the bladder (the detrusor is not activated); fluid left the bladder. With a delay, the detrusor was activated by the bladder reflex. - The urinary bladder of the patient is partly functioning. It has to be further improved by therapy induced reorganization of the CNS: (1) An earlier feeling of bladder filling, (2) an increase of the time difference between the feeling of the first bladder filling and the un-volitionally emptying of the bladder (for the time being, approx. 10 min, in dependence on whether the patient is physically active (such as walking) or not, (3) further learning how to activate the detrusor on volition, and (4) the physiologic coordination between the bladder and the external sphincter functioning (to stop the detrusor-sphincter-dyssynergia).

Relation of coordination dynamics values to therapy duration for a load of 20N and for exercising in the forward (lines and dots) and backward directions (20Nb; dashed line and crosses) in a patient with a SCI sub C5/6 (Kadri). Note that with no therapy the coordination dynamics values got worse (increased) and upon therapy they improved again. Upon metal removal the coordination dynamics values increased strongly. The transient coordination dynamics value increases (peaks) ‘1’ through ‘9’ fall together with the re-appearance of certain muscle functions or specific improvements of motor and autonomic functions and indicate therefore most likely small bits of regeneration. After the large peak ‘6’ of transient coordination dynamics value increase, urinary bladder functioning was re-learned.

Comparison between the development of an infant and repair of a cervical spinal cord injury upon CDT. Left penal, positioning upon 0.5 years of therapy and right penal after 5 years of therapy.

Comparison between development and the repair of an almost complete cervical spinal cord injury upon one year (A,C,G) (therapy started at an age of 15.5 years) and 5 years of coordination dynamics therapy (B,E,H) (CDT started with 17 years). The MRI of the SCI of the patient of the left panel is shown in ‘I’ and those one of the right panel in ‘K’. Trunk rotation (A,B,C), un-sustained sitting (D,E,F), and four-point kneeling (G,H,I) is compared between one year and 5 years of CDT and with the positioning of an infant.

Improvement of times for running 60 and 400m (A,B) and increase of jumps with a skipping-rope per single session (C) in relation to on-going therapy sessions. Therapy period = second half of 2006 (Next PDF No 160).

The outcome of a SCI repair depends strongly on the severance of the injury. A-D. MRI’s of approximately 99, 95 and 50% injury. C shows the 50% injury with titan fixation and B without. The severance of an injury can also be estimated with a fixation in place. G,H. In 50% injury, the patient can relearn walking, running and jumping. E,F. In 95% (and 99%) the patient cannot re-learn free walking and jumping.

Layout for measuring coordination dynamics (arrhythmicity of exercising) between arm and leg movements, displayed on the laptop; for the intermediate coordination’s between pace and trot gait, the fluctuation of the network states is larger. The recording of sEMG activity (displayed on the oscilloscope) from the tibialis anterior and other muscles is also shown. The inset shows single motor unit action potentials on the lowest trace. The recordings are taken from a patient (Kadri) with a motoric complete cervical spinal cord injury C5/6 (95% injury).

Relation of coordination dynamics values to therapy length for increasing load between 20 and 150N. The loads for forward exercising (dots, 20N, 100N, 150N) are marked at the curves (20Nb = backward exercising (crosses) at 20N). Note that with no therapy the coordination dynamics values got worse and upon administering therapy again the values improved again even 2 years after the accident. After stopping therapy, the coordination dynamics values for 100 and 150N increased again (23.3.2008). When the patient (Sten) trained himself intensively (including running and jumping), he further improved his high-load CD values (8.9. and 23.9.2010).

Relation of coordination dynamics values to therapy length for increasing load between 20 and 150N. The loads for forward exercising (dots, 20N, 100N, 150N) are marked at the curves (20Nb = backward exercising (crosses) at 20N). Note that with no therapy the coordination dynamics values got worse and upon administering therapy again the values improved again even 2 years after the accident. After stopping therapy, the coordination dynamics values for 100 and 150N increased again (23.3.2008). When the patient (Sten) trained himself intensively (including running and jumping), he further improved his high-load CD values (8.9. and 23.9.2010).

A. Improvement of high-load coordination dynamics (CD) values in a patient with severe brain injury upon coordination dynamics therapy for several years. The high-load CD values were obtained by summing up the single CD values for forward and backward exercising, ? (high-load CD value) = ?20N + ?50N + 100N + ?150N + 200N + ?150N + ?100N + ?100N + ?50N + ?20N + ?20N). B, C. For comparing the rate of repair, the improvement curves of the high-load coordination dynamics values of an athlete (C) and a healthy pupil (B) are inserted. Note that the brain-injured patient needed much more time to achieve similar good CD values. D. Continuation of therapy. The substantial improvement of the high-load CD values (lower values), in the middle of 2018, motivated the patient Sotiris to continue his therapy at the limit.