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The 17 year
old young man Fovios suffered from a motor cycle accident, a very severe brain
injury. The neck hit a street border stone. Brain and brain stem were injured
and he was unconscious following the accident. It was intended to use his
organs for transplantation. He was a potential organ donor. The parents denied
that their son was used for organ donation. Unexpectedly, the patient Fovios
recovered from coma 7 months after the accident spontaneously. When 16 years
later coordination dynamics therapy (CDT) was administered to him, his CNS
functions improved by approximately 20% through three sessions of CDT. He could
exercise faster with improved coordination and the will power for walking and running needed movement
patterns pace and trot gait were improved first. It seems therefore not a myth
that if somebody agrees to donate organs, the hospital staff and neurorehabilitation
will not work as hard to save the life of that person in very severe brain
injury.
Keywords: Potential organ donor, Coordination dynamics
therapy, Brain repair
INTRODUCTION
Most organ donation for organ transplantation
is done in the setting of brain death. Brain death may result in legal death,
but still with the heart beating and with mechanical ventilation, keeping all
other vital organs alive and functional for a certain period of time. Given
long enough, patients who do not fully die in the complete biological sense,
but who are declared brain dead, will usually start to build up toxins and
wastes in the body. In this way, the organs can eventually dysfunction due to
coagulopathy, fluid or electrolyte and nutrient imbalances or even fail. Thus,
the organs will usually only be sustainable and viable for acceptable use up
until a certain length of time. This may depend on factors such as how well the
patient is maintained, any comorbidities, the skill of the healthcare teams and
the quality their facilities.
The decision of brain death is now a days safe.
The author worked on brain-dead humans and recorded with the single-nerve fiber
action potential recording method from brain-dead humans and patients the
organization and reorganization of the human central nervous system (CNS) (Figures 1 and 2) [1,2]. With these
recordings, he was able to develop the coordination dynamics therapy (CDT) to
partly repair the human CNS [3-5]. When the brain death is diagnosed, mostly
soon later the still remaining functional parts of the CNS, mainly spinal cord
and lower brain stem, also die and before the failure of the organs.
The problem with organ donation occurs before
the brain death, namely due to inefficient repair treatment administered to the
patient with a severely damaged brain. With inefficient treatment, the
pathologic processes win slowly against the innate physiologic processes and
the patient becomes brain dead. Through efficient and intensive CDT, the
damaged brain can be repaired and the patient may not suffer brain death on the
long term. In previous publications it was shown that the patient Manolis, who
lost half of the brain in a car accident and drifted with conventional therapy
in direction of brain death and recovered when intensive CDT was administered.
Manolis recovered fully after 5 years from coma and re-learnt to speak through
6 years of intensive CDT with 20 h therapy per week [6].
In this paper it is reported about a young man,
who suffered a very severe brain injury in a motor cycle accident and it was
intended to use his organs for transplantation. He was a potential organ donor.
The parents denied that their son was used for organ donation. Unexpectedly, the
patient Fovios recovered from coma 7 months after the accident spontaneously. When
16 years later CDT was administered to him, his CNS functioning improved
substantially through three sessions of CDT. It seems therefore not a myth that
if somebody agrees to donate organs, the hospital staff and neurorehabilitation
will not work as hard to save the life of that person in severe brain/brain stem
injury.
The author himself suffered a ‘squamous cell
carcinoma (epithelioma - a malign tumor) in the maxilla. The tumor (stage
between 1 and 2) was removed and a neck dissection performed. Two lymph nodes
with formation of metastases were removed and two stages of further lymph nodes
and lymph vessels were removed for safety reasons. Radiation and chemotherapy
were administered to the tumor area to reduce the risk of tumor recurrence from
30% to 15%. After one year, autograft transplantation from the leg to the
maxilla (fibularis transplant) was successfully performed for the
reconstruction of the maxilla. The author is now a 10 year cancer survivor and
benefitted from transplantation [7]. Still the author has the opinion that one
first has to fight for the survival of the patient with the severely damaged
brain by all means. For the time being it is not sufficiently tried to save the
life of the severely brain injured patients. Rehabilitation and universities
are 30 years out-of-date with respect to human neurophysiology and human repair
physiology [2,3]. Human neurophysiology and especially electrophysiology, and
human repair physiology are not red at universities worldwide. The main
difference between a rat and a human is the functioning of the brain and its
repair strategies. In rat the nerve fiber growing strategy is used for repair
and in humans the learning strategy. CDT is a movement-based learning treatment
to repair the human CNS.
In the Materials and Methods section, the
scientific basis for CDT will be shortly introduced. In the Results, the repair
of the very severely brain injured patient Fovios is measured by the
coordination dynamics of the human CNS. In the Discussions, the
brain/brain-stem repair of Fovios will be compared with those of another severely
brain injured patient [6] and mainly brain stem injured patient [8].
MATERIALS AND
METHODS
Coordination dynamics therapy mainly rests on
human neurophysiology and human repair physiology [2,3]. Based on the new
recording method of the human CNS, the single nerve fiber action potential
recording method [1] (Figures 1 and 2),
a classification scheme of human peripheral nerve fibers could be constructed [9].
In Figures 3 and 4, a peripheral
nerve fiber is characterized by the conduction velocity and the nerve fiber
diameter. Neural network organization at the single neuron level can now be
recorded under physiologic and pathologic conditions and changes due to injury,
malformation and degeneration measured. With every injury, malformation or
degeneration, the phase and frequency coordination among neuron firings becomes
impaired and has to be repaired, which can efficiently be achieved when
exercising on the special CDT device.
With the new recording method, the
“single-nerve fiber action potential recording”, the phase and frequency
coordination could be measured invasively and with the single-motor unit
“surface electromyography” (sEMG) non-invasively. With both
electrophysiological recording methods progress in CNS functioning and repair
was achieved. The oscillatory firing of motoneurons/motor units for example
could be measured (Figure 5). With
the sEMG, even the phase and frequency coordination among motor unit firing (Figure 6) could be recorded during the
development of motor programs [3].
For CNS repair, the phase and frequency
coordination has to be repaired, which can efficiently be achieved when
exercising on the special CDT device, where the different patterns between pace
and trot gait are imposed by the device. Pace and trot gait are innate
automatisms and humans use them for crawling, walking and running. But the
device imposed intermediate coordination between pace and trot gait are very
difficult for the CNS to generate and the whole complexity of neural network
organization is needed to generate them. When the patient becomes able to
generate these patterns and exercise rather smoothly on the device, his CNS has
improved in its functioning and repair has been started. Animals like rats are
most likely unable to generate this intermediate coordination between pace and
trot gate because of the missing complexity of CNS neural networks. Exercising
on a special CDT device is nearly always the first physiologic movement a
severely brain-injured patient can perform. Important for repair through
movement-based learning is the learning transfer to vegetative and higher
mental functions [10]. In very severely brain-injured patients the improvement
of the cognitive functions is very important to reach a meaningful life.
For repair through movement-based learning it
is important to measure objectively the progress of repair. The quantification
of CNS functioning can also be achieved when exercising on a certain special
CDT device. The arrhythmicity of turning, the so-called coordination dynamics
value, quantifies by one value the quality of integrative CNS functioning.
Therefore, when exercising on a special CDT device, CNS functioning is improved
and measured at the same time.
The theoretical background for measuring CNS
functioning through movements is coming from the “System Theory of Patterns
Formation” [11]. Through movement pattern change, the CNS functioning can be
measured. The pattern change is achieved when the patient is exercising on the
special CDT device and the coordination dynamics value is obtained from the arrhythmicity
of exercising during the pattern change. The device is imposing the patterns to
which the patient has to adapt to and to turn as smoothly as possible. When the
CNS is functioning well, the patient can turn rather smoothly and the
coordination dynamics value is small (good). When the patients CNS functions
poorly, the patient can turn only with high arrhythmicity and the coordination
dynamics value is high (bad) or the patient is not able to turn at all. In this
case, the patients CNS can just not generate the different movement patterns.
In the patient of this case report, first the patient could not exercise at
all. With the help of the author, he learnt unexpectedly quickly to exercise by
himself. Then it became possible in the first therapy session to improve CNS
functioning and to measure the progress with movement-based learning. It will
be shown in the Results that the very severely brain-injured patient learnt
first the important automatic patterns of human which are needed for walking
and running and then also the complicated intermediate coordination between
pace and trot gait started to improve. It is actually astonishing how quickly
the patients CNS learned to functioning better, even though he was selected to
be a potential organ donor!
RESULTS
Case report
General case
The 17 year old Fovios suffered in a motor
cycle accident a very severe brain injury. The neck hit a street border stone.
Brain and brain stem were injured and he was unconscious following the
accident. Most likely he was ventilated. The parents were asked whether they
agree that Fovois could be used as a potential organ donor. They refused.
Unexpectedly the young man recovered from coma after 7 months spontaneously. The
patient was continent. The remained continence was also unexpected, because in
very severe brain injury also the continence is lost. But in a rather complete
spinal cord injury also sometimes the continence is retained. Conventional
physiotherapy was administered with little progress. A leg operation was
performed 4 years after the accident. Fovios became able to move slowly in the
upright position without support.
16 years later, at an age of 33, the father
came with his son three times for consultation and treatment to the author. The
patient needed for upright moving support
(Figure 7A). Together with the author a highest speed of 3 m per 35 s was
achieved (which is an extremely slow speed) when the author was holding both
hands for support and balance (Figure
7B).
The right hand and arm were spastic (Figure 7A) like in stroke patients.
When the author was holding both hands the spasticity in the right hand reduced
(Figure 7B). Through exercising on a
special CDT device for 30min to 60 min, the right-hand spasticity reduced
strongly in the short-term memory as in stroke patients.
When the right hand was fixed to the handle
of the special CDT device, the patient learned unexpectedly quickly to exercise
by himself. First the author supported the turning (Figure 8). Then the author included during the support coordinated
instructive training by counting in coordination with the handle position
“one-two-three” (Figure 9). After
approximately 30 min of exercising the CNS functioning had improved that much
so that the patient became able to turn by himself. It became thus possible, besides
the training for repair, to measure the improvement of CNS organization via the
coordination dynamics in the three therapy sessions two to three days apart (Figure 10). The improvement of CNS
functioning will now is analyzed.
Increase of the
turning frequency as the first sign of CNS functioning improvement
In Figure
11, the improvement of CNS functioning is shown from the beginning of the
first to the third therapy session. When the patient became able in the first
therapy session to turn by himself, he could turn only slowly (Figure 11A, 0.339 Hz). Then he became
able to turn faster (Figure 11B,
0.464 Hz). During the second therapy session he could turn further faster (Figure 11C, 0.529 Hz) and during the
third session still faster (Figure 11D,
0.679Hz). The increase of the turning frequency is one indication of improvement
of CNS functioning. It increased by 50%. The inner frequency of turning of the
author is in the range of 1.5 Hz.
Reduction of
coordination dynamics values as the second sign of CNS functioning improvement
The coordination dynamics values also
improved (reduced). They reduced from 57.845 (Figure 11A) to 57.530 (Figure
11B) in the first therapy session and further to 50.131 (Figure 11C) to 46.110 (Figure 12D) during the second and
third therapy sessions. The improvement of CNS functioning, quantified by the
coordination dynamics value, was by 20%. The decrease of the coordination
dynamics values is a second measure for the improvement of CNS functioning. For
comparison, the healthy and trained author has a coordination dynamics value of
2 in comparison to 46 which the patient reached. The authors CNS functioned at
that time 23 times better.
The first selective
enhancement of the pace and trot gait automatisms are a third sign of the CNS
improvement
Interesting is further, how the different
coordination patterns during exercising improved, which can be judged here by
the frequency of turning. At the beginning of CNS repair, there was nearly no
preference to a certain exercise pattern (Figure
11A). The patient got often nearly stuck. Then slowly the trot gait pattern
(K) improved (Figure 11B), because
he could turn continuously with higher frequency around the trot gait pattern.
During the second session, pace (P) and trot gait (K) movement patterns
improved strongly. During the third therapy session, a rather continuous
exercising became possible. The patient only seldom got stuck for certain
exercise patterns. The frequency did not reduce transiently to zero (Figure 11). On the coordination
dynamics trace of the healthy and trained author no priority of certain
patterns can be seen. His CNS manages with all movement patterns well.
In conclusion, during the repair through CDT,
the CNS gave first priority to the repair of the automatism patterns pace and
trot gait which humans need for crawling, walking and running. That means that
during the repair of the CNS, the most important patterns for life are repaired
first. The repair of the automatism patterns pace and trot gait is a third
measure for the improvement of CNS functioning.
Necessity for an
improvement of the breathing center functioning
During the third therapy session, Fovios got
problems with the breathing. He could not sufficiently inhale to get sufficient
oxygen supply for exercising and neural network repair. For sure he was not
fit. Probably he had not trained fitness for years. During repair, power is
needed for muscle activation and for neural network repair. The CNS neural
networks have ‘stress’ to generate the especially complicated patterns between
pace and trot gait. During exercising for repair, the patients with severe
brain injuries sweat because of muscle power generation and neural network
repair. The CNS has difficulties to generate in the deep complexity of CNS
organization the complicated patterns between pace and trot gait.
For repairing efficiently his CNS, priority
has to be given first to the repair of the breathing center in the formation
reticularis in the brain stem. For turning faster and longer may be oxygen has
to be administered during the therapy sessions.
PROGNOSIS
Because of insufficient
breathing, his speech was quietly. An improvement of the breathing center will
improve his speech. Even though his higher mental functions are probably only
little impaired, an urgent therapy is necessary, because he attempted already
once to suicide. With an intensive efficient therapy like CDT, Fovios has a
good prognosis to get rather fully back to life, because his CNS improved
quickly in functioning.
DISCUSSION
To keep the level of CNS functioning
With several
inefficient treatments Fovios could not keep during 16 years the level of CNS
functioning. First, he managed to move without a stick. Now at an age of 33 he
needs a stick to slowly move. To keep the level of CNS functioning, he may have
to train every day for 1 h.
Comparison to very severe
brain injury
In comparison to a severe brain injury as in
the patient Manolis, Fovios with probably mainly a brain stem injury (a new MRI
not available) is well up, because his higher mental functions are probably
only little impaired and his brain stem injury can be repaired through CDT.
Since the breathing is an automatism, the genetics will help for efficient
repair as found out in animal experimentation. When the breathing center was
damaged in a dog, it recovered spontaneously with 2 h [12,13].
Comparison to brain
stem injury
When
jumping on a trampoline, the eight-year-old Rafaela fell on the back and hit
probably with the neck the metal support surrounding [5] in similarity to
Fovios. As can be seen from her MRI, Rafaela had suffered an incomplete injury
of the spinal cord extending from the thoracic segments Th1/2 rostral till to
the medulla oblongata (Figure 12B).
All the cervical spinal cord segments were damaged probably by pressure, caused
by the edema and/or lack of blood supply caused by the pressure.
It
seems that the injury included also a damage of the caudal part of the reticular
formation and the nuclei of the vagus (X) and accessory nerve (XI). The caudal
reticular formation is the nuclear area for inspiration and expiration. This
conclusion is supported by the clinics. Rafaela, being in the coma, had
problems with breathing and was connected to a respirator. Five years later,
Rafaela was operated because she had stones in the kidneys and a big stone in
the bladder, indicating that, most likely; also the vagus nerve/nucleus was
damaged, because the vagus nerve regulates the secretion of the kidneys. From (Figure 13A) it can be seen that the
shoulders of Rafaela are too much curved forwardly.
With intensive CDT for three months her
breathing and her movement functions improved (Figure 13) [5]. She could stand up by herself from the sofa with a few trials (Figure 13B and 13C) and exercise on
the sky-walker (Figure 13C).
When
the coma regressed in Rafaela 10 days after the accident, she had no motor
functions below the injury level. The physicians told the mother that Rafaela
will stay like this for the rest of her life, but Rafaela recovered quite well.
She is good at a normal school.
The
injury of Fovios was much more severe because Rafaela was 10 days in the coma
and Fovios 7 months, which seems to be the limit that a patient following
severe brain injury can recover from coma spontaneously. The severely
brain-injured patient Manolis recovered from permanent coma through 4 to 5
years of aggressive CDT. Interesting is that when the author studied medicine,
after engineering and theoretical physics, he had the impression that after 4
to 5 years of learning medical facts the learning improved including memory.
PROGNOSIS
Even though the
patient did not get better over 16 years, but got worse, he could be improved
in three sessions with up to 1 h duration. An intensive CDT with 20 h therapy
per week would improve most likely the right-hand function, improve breathing
and would make him walk again. The problem is that after 16 years and trying
out many inefficient and ‘hocus-pocus’ treatments the patient and the relations
do not believe in anything anymore and are worn out to fight again.
ORGAN DONATION
The demand for
organs significantly surpasses the number of donors everywhere in the world.
There are more potential recipients on organ donation waiting lists than organ
donors. There is therefore strong interest to get more organ donors. Since
further with a long-lasting movement-based learning therapy no money can be
earned, but money can be earned with organ transplantation, there exists the
possibility that not much efforts are taken to keep patients alive in cases of
very severe brain injuries. Further, basic human neurophysiology and repair is
not red at universities to inform medical students about new possibilities of
brain repair. Physiotherapy of brain injuries is inefficient and at least 30
years out-of-date. When in Switzerland the physiotherapy education was upgraded
from school to academy, only the names were upgraded, not the knowledge. During
the change from school to academy there was no interest to integrate the
knowledge of the author. That a potential organ donator even recovered after 7
months from coma spontaneously is something like a horror scenario.
PRESS
The German
parliament (Bundestag) decided at the 16.1.2020 for the "opt in"
(only those who have given explicit consent are donors) and against the
"opt out" (anyone who has not refused consent to donate is a donor
(German: Widerspruchslösung)) probably on ethical grounds, but not on the basis
of medical research at the edge. German TV at the same day showed a patient who
benefited from a kidney transplantation; they did not show a patient who
suffered a severe brain injury and was chosen for a potential organ donor.
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