Urinary bladder dysfunction and incontinence are a big problem in spinal cord injury and brain injury. With the development of the discipline human repair-neurophysiology in general and a new recording technique, the single-nerve fiber action potential recording method, the functioning of the sacral micturition center can be analyzed under physiologic and pathologic conditions and a movement-based learning therapy developed to repair urinary bladder functions. In all of the 8 patients with a central nervous system injury, to which coordination dynamics therapy was administered, impaired bladder functions were repaired.

Human repair-neurophysiology is a new discipline with which the human nervous system can be repaired. Since the nervous system is involved in nearly all body functions, the general health can be improved. Especially urinary bladder functions of the sacral micturition center can be analyzed in detail by using the newly developed single-nerve fiber action potential recording method and recording from the thin and long lower sacral nerve roots (Figure 1) [1]. By combining human neurophysiology with the System Theory of Pattern Formation, there is a theoretical basis that through movement-based learning vegetative and cognitive functions can also be repaired by learning transfer [2]. Bladder continence is achieved via the repair of the vegetative (inner bladder sphincter) and the somatic nervous system (external bladder sphincter) and their coordination. Bladder dyssynergia can be repaired.
Because of the ascensus of the human spinal cord, the lower sacral nerve roots are thin and long (Figure 1A) and afferents and efferents are mixed in lower sacral nerve roots. They are ideal to record simultaneously with two pairs of wire electrodes the impulse traffic running in and out of the sacral micturition center. To identify the nerve fibers in which the impulse traffic is conducted, a classification scheme for human peripheral nerve fibers was developed, the only existing one for human. The nerve fibers are classified by a group conduction velocity and a group nerve fiber diameter (Figure 1B). It was found that the neural networks organize themself by phase and frequency coordination among neurons and neural sub networks. With every injury, degeneration or malformation, this phase and frequency coordination becomes impaired and has to be repaired. This can be achieved when patients exercise on a special coordination dynamics therapy device (Figure 2C, D). The nervous system learns from the device to function more physiologically, including the sacral and the pontine micturition centers (Figure 1A). With the repair of the phase and frequency coordination, some patterns including continence patterns re-appear. In severe central nervous system injury, other parts of the nervous system have to take function over by plasticity. Therefore also other arm, leg and trunk movements have to be trained.
The patients train exactly coordinated arm and leg movements on the special device (Figure 2C, D) and the automatisms creeping, crawling, walking (Figure 2A), running and jumping (2B) with or without support. For bladder repair the exercising on the special device and the jumping on springboard are most important. The jumping on springboard activates the pelvic floor muscles rhythmically, of which the external bladder and anal sphincters are a part. When exercising on a special device, the neural networks of the central nervous system are activated and repaired in the deep complexity of neural network organization. This is achieved because arm and leg movements change their coordination between the pace and trot gait patterns. Through this pattern change, according to the system theory of pattern formation, the quality of central nervous system functioning can be measured through pattern change by a single value.
The movement-based learning process is optimal by training 20 hours per week.

In all treated 8 patients with incontinence, the bladder functions were repaired. The repair time depended on the severity of the brain or spinal cord injury. In the cerebral palsy patients, the repair time was approximately 3 months. In a 50% cervical spinal cord injury, the repair time was approximately also 3 months. In a rather complete cervical spinal cord injury (95% injury), the repair time was 2.5 years [3]. Obviously, in severe spinal cord injury, the bladder repair is very difficult. The nervous system has to use all available repair mechanisms. The urinary bladder repair is the biggest problem in spinal cord injury. Ongoing urinary bladder infections may ruin kidney function. Further, through coordination dynamics therapy also movement patterns are simultaneously repaired. With the improvement of cardio-vascular performance pressure ulcers do not occur any more.
In a cervical spinal cord injury patient (Figure 2), the repair mechanisms during therapy are explained. After spinal cord injury in a car accident, the 16-year-old Kadri was in the spinal shock phase for 1 month. After the shock phase she showed a spastic external bladder sphincter. Six weeks after the accident coordination dynamics therapy was started. Seven months after the accident, the external sphincter was no more spastic. A small storage phase developed, but she was incontinent. After 10 months, vegetative symptoms appeared with bladder fullness. After 20 months, a reflex bladder, bladder fullness feeling and the desire to void developed. After 24 months, the patient became continent, but synergia and dyssynergia of the bladder occurred. After 26 months, the stability of bladder synergia increased. After 26 months of coordination dynamics therapy, approximately 27 months after the spinal cord injury, the now 19-year-old female patient had achieved a healthy functioning bladder through therapy. The tetraplegic patient learned to sit freely (trunk stability) on a chair and some finger functions re-appeared through a bit of spinal cord regeneration, induced by training specifically also finger functions (Figure 2D). With the gained finger functions, the patient Kadri could work with a laptop, but would not be able to perform intermittent catheterization for bladder emptying. With the fully repaired bladder, she did not need the catheterization anymore and she had her intima’s sphere back. She did not go to school for 3 years and trained all the time. The father, an athlete himself, carried her about during training and helped her not to get depressed. As Kadri said by herself, her intelligence increased with coordination dynamics therapy, so that she managed the high school after the three-years-break and studied international connection and law afterword. The three years therapy did not ruin her carrier. She would have liked to study medicine, but because of the limited regained finger functions, she did not.

Coordination dynamics therapy is a causal therapy. It repairs urinary bladder and other functions through repairing/improving nervous system functions and in turn different body functions including urinary bladder functions.
The main problem is that patients have to train for a long time at limits. Aother problem is that basic human medical research is not organized.

Proper basic human repair-neurophysiology [3] has to start with the anatomy. The nerve fiber compositions of for example the pelvic and vagus nerves and tract fibers in the spinal cord have to be measured like in Figure 1. What action potential patterns are conducted in certain identified nerve fibers in and out of the sacral micturition center? Can an urologist, after working hard with the patients the whole day round, start with morphometry and electrophysiology in the evening even if he would have the knowledge and infrastructure? Human repair-neurophysiology is more than statistics.

Schalow G and Lang G (1987) Recording of Single Unit Potentials in Human Spinal Nerve Roots: a New Diagnostic Tool. Acta Neurochir. 86: 25-29.
Schalow G (2015) Repair of the Human Brain and Spinal Cord. Nova Science Publishers, Inc., Hauppauge NY, USA, 525 pp.
Schalow G (2022) Human Repair-Neurophysiology, Book Publisher International, 229 pp.