All these years like attack pains, about once in a 15 minutes, tortured him. According to his words, the feeling was appeared that all muscles in legs are in a strongest spasm with pain. But muscles tone do not change at this.
At first inspection the legs were very cold. Subjectively, as boiled macaroni, that were extracted from refrigerator. The muscles are greatly miniaturized in a volume (for instance, sural ones have about 4 cm in diameter), fully slack. But they there are. This means, that that peripheral nerves that are stretching from spinal cord to muscles basically are intact. Otherwise the trophic atrophy of muscles (shrinkage) will be, because by nerves the substances are feed that take part in metabolism in muscles tissues. Proper this fact was a stimulus to try a recovering.

He cannot lie on a stomach. Even at urgent request to turn over on a stomach (with the help) he refuses, since it gives rise to very intense pains.

The first course was at the beginning of May. The total duration was 3-5 minute in a day.
The second course was from 1 June to 12 June, totally 9 days (off and on).

1st course
After first complex of procedures he felt the heat in the thighs area, the feeling in muscles, that they were contracted. On the next day the legs were warmer then usually, he slept normally and more slackly, but usual pang was kept. On the 2-5 days the legs temperature became in principle normal.
After third training an apprehensibility in thighs appeared approximately 15 cm below the line, that were the boundary of perceptibility.
During forth train he for the first time stired a foots - arcuated in knees legs he could pull approximately on 10 cm.
At the fifth day the effect became stronger. He practically completely bent the legs in knees. The perceptibility appeared spottily on the both legs. But what was characteristic. At pressing for instance on the calf of right leg he with closed eyes point on the thigh of the left leg, where he localized a feeling. At pressing on the right thigh or leg he pointed approximately to the same. The pressing on the calf of left leg he felt in middle of the thigh of the same leg, etc.
Somewhere it coincides, somewhere discrepancy was on a parts of the leg or even on different legs. These means that sensor nerves after trauma and regeneration are entangle and enough badly. At closed eyes if he gave the command to the legs to be bend he don't felt if this moving was realized or not even if the moving there was. This tell us that the system of proprioception practically do not work.

Second course
Before the beginning of the second course the perceptibility was in a less volume than immediately after the first course. For instance, there was not a perceptibility on foots (it there was), the perceptibility was restored only in one calf.

He couldn't move by the legs. (To my regret I never understood, on which day after procedures the possibility to move was disappeared.)

20 September. The capability to move by legs is kept, but in a less extent. For instance, he cannot in a sitting position to bring-separate knees, although after second course he could fulfill the moving within 1-3 cm. Pains were kept as before. The sensitivity was kept.

Shelving the possibility of nerve fibers growing (it is clear, that for such short time as 1-2 hours of training or 1-7 days of a course during which stepwise changes occur, this is impossible) one can suppose, that on this stage at the least (as a minimum) two necessary processes realize. Thanks to intensification of circulation of the blood, the normal electrochemical environment in muscle tissues as well as in their innervating nerves is restored. In complex with normalization of a temperature (for electrolytic way of currents carrying it is important) this ensures the possibility to conduct nerves pulses. Further the temperature is supported by tonic contraction of muscle fibers. (The heat is produced both at contraction and at weakening of muscle fibers).
It is possible, that appeared during first course muscle tone could ensure the necessary extent of the blood circulation and a temperature on the boundary level. But after small recession week signal were not enough to ensure passing of necessary commands.
A second process is informational. The brain, by a great or small jumps, but just during of training influence fulfill an identification of receiving signals and changes correspondingly the nervous functional bonds. And though such conclusion conflicts with existing ideas about possibility of changing of functional bonds, nevertheless the most logical conclusion is that it is just so.

All these years F. didn't leaves the attempts to restore of legs work and is assured, that sooner or later he begins to walk. He tried all that he could. This means that the problem of moving restoring is a dominant for his brain. Maybe this factor greatly increases a receptivity of information flows at training.

14.06.02. I had meeting with Fransois. Tempereture of a legs, sensations and movement was the same as after 2-nd course. But if before there was pain attack each 10-15 minutes this time during near the one hour of our conversation he has only two attack of a pain.

..............................................................................

PS

24.09.02, excerp from Christopher Reeve Recovery
http://www.christopherreeve.org/News/News.cfm?ID=328&c=30

1) What can Mr. Reeve do now that he could not do before?

At the time his accident, Mr. Reeve had no sensation or motor function from the neck down. He was classified as C2 ASIA A (see question #9). He remained at this level for approximately five years. However, at this time he has been reclassified as C3 ASIA C because he has regained some sensation below the level of the injury and the ability to move some joints. This means he has more neck function, intact sacral (lowest spinal cord levels) motor and sensory function, and that more than half of the key muscles below his injury are graded 3 or less on a 5 point scale. He has continued to have slow incremental improvements over the past two years.

Today, Mr. Reeve can feel pinpricks and the light touch of a cotton swab over most of his body (sensations of light touch indicate the ability to feel, while pinprick sensations indicate the ability to discriminate the location and intensity of the touch). The ability to feel allows him to know when he has pain or when he is uncomfortable.

He can also move some of his joints without assistance, particularly when the effects of gravity are reduced as they are, for example, under water. Mr. Reeve has regained the ability to move his right wrist, the fingers of his left hand, and his feet. When gravity is reduced, for example in a pool or lying in bed, he is able to straighten his arms and legs against resistance but he has no balance control for sitting, standing, or walking.

2) How have these changes affected Mr. Reeve's life?

Mr. Reeve still cannot walk and he has not regained bowel, bladder, or sexual function, nor can he breathe without a ventilator, but his recovery seven years after his injury defies many scientific and medical expectations and it has had a dramatic effect on his daily life. The most important differences in his life are that he can sit in his wheelchair for longer periods of time (up to 16 hours) and he has more balance while sitting. He also has more physical endurance and can speak better and for longer periods of time. He has fewer medical complications, like recurrent bladder and lung infections. For example, before 1999, Mr. Reeve frequently required hospitalization - there were a total of nine life-threatening complications and he required almost 600 days of antibiotic treatment. Since 1999, he has not been hospitalized, has had only one serious medical complication, and has needed only 60 days of antibiotic treatment. Overall, these improvements in his health have boosted Mr. Reeve's emotional well-being, and have enabled him to commit to a variety of work projects with confidence that he will be able to give them his uninterrupted attention.

It is again important to emphasize that the biological basis of Mr. Reeve's recovery is unclear.
In his book, Nothing is Impossible, Mr. Reeve states that he can move his arms in a flying motion and walk in a pool. To be precise, he can only move his arms while lying flat or while floating on the water in a pool because both positions reduce the effects of gravity. He cannot raise his arms while sitting in his wheelchair because that position has full gravity resistance. Mr. Reeve can initiative a step by moving his leg forward and shifting his weight, but to do this requires the assistance of many individuals to hold him in a standing position and maintain his balance.

3) What has Mr. Reeve been doing that might have contributed to his unexpected recovery?

Mr. Reeve began to exercise following his spinal cord injury in 1995. Since 1999, his regimen has involved intensive rehabilitative exercise incorporating functional electrical stimulation (FES) on a bicycle, aqua therapy, and bone density treatment. He has visited with his Washington University physicians four times between 1999 and May 2002 for follow-up and assessment.

a) Functional Electrical Stimulation (FES): Mr. Reeve does one hour of exercise at least three times a week on an FES bicycle. Using FES, a computer sends electrical messages to the legs to compensate for the loss of signals from the brain. Mr. Reeve's physicians hope that simulating normal biking will encourage spinal cord cells that are still intact to "remember" what it's like to be involved in leg movements. The exercise provides basic physical benefits, including building muscle mass and bone density, reducing spasticity, and cardiovascular workout.

b) Aqua therapy: Aqua therapy is physical therapy done in water. The effects of gravity are greatly reduced under water so that in a pool, small body movements can be more easily detected and health-care professionals can determine a patient's maximum ability to move without the full resistance of gravity. Also, when patients are beginning to recover movement, water makes practice easier. Mr. Reeve does aqua therapy approximately once a week for approximately two hours.

c) Bone density treatment: Since people with spinal cord injuries don't typically put weight or pressure on their bones, they tend to lose bone density and often develop osteoporosis. With drugs and exercise on the FES bicycle, Mr. Reeve's osteoporosis has been reversed and he now has normal bone density.

4) How will we discover whether Mr. Reeve's recovery is in fact due to the activity-based therapy?

Mr. Reeve's participation in long-term exercise was motivated primarily by the well-established general benefits of activity on health and well-being (on cardiovascular function, bone density, etc). If the recovery of function was due to the exercise, it was a wonderful side effect. Now, scientists need to carry out detailed studies involving large numbers of patients to see whether others experience similar benefits. These human experiments will be an expensive proposition, and it will be years before the final answer is in. Even if this particular approach turns out to be beneficial, there is the possibility that there are other interventions that will also improve function, perhaps even more rapidly and with even better results.

The good thing is that there are few, if any, negative side effects of exercise, and so even if people don't experience recovery in the way that Mr. Reeve did, it is likely that their general health will be improved.

5) How does Christopher Reeve's recovery relate to the body of scientific work in spinal cord injury?

The scientific literature on human recovery from spinal cord injury dictates that most recovery occurs in the first six months and that it is generally complete by two years after the injury. Although later continued recovery can occur, it is small in magnitude and typically confined to individuals who demonstrated early recovery. There are no reports of anyone recovering more than one ASIA grade beyond two years post-injury and particularly when no initial recovery was observed in the first two years.

The current study demonstrating late recovery is consistent with the ongoing work in the field suggesting that the injured nervous system is capable of recovery when conditions are optimized. A growing body of work suggests that patterned neural activity is one important factor to optimize. Research by the groups lead by V. Reggie Edgerton, Ph.D. and Susan Harkema, Ph.D. (University of California Los Angeles), Anton Wernig, Ph.D (University of Bonn), Volker Dietz, M.D. (University Hospital Balgrist), Hughes Barbeau, Ph.D. (McGill University), and Serge Rossignol, M.D., Ph.D. (University of Montreal) suggests that locomotor (gait) training (see question #10) is important for recovery of walking. Work in other fields such as stroke suggest that repetitive overuse of a limb affected by stroke can enhance recovery. A great deal of research into normal development of the nervous system provides the strongest support that neural activity is an important regulator of the processes of nervous system development, and that these are the same processes that are required for regeneration. Research by Dr. Fred Gage (The Salk Institute) and colleagues provides impressive evidence that patterned neural activity may be important for new cell birth and survival. Dr. Martin Schwab's (University of Zurich) research demonstrates that factors that limit regeneration do exist, including molecules that block axonal regrowth.

6) What is the scientific significance of Mr. Reeve's recovery?

Mr. Reeve's chronic recovery of some sensation and movement demonstrates that changes in function can occur years after a spinal cord injury. This is an extremely important message because today, most people who have been spinal cord injured are told not to expect improvement after the first few weeks or months. As a consequence, patients become resigned to their situations and don't take the steps that might promote and enhance continued improvement.

Christopher Reeve has championed the view that people who are spinal cord injured should not simply accept their situations but should continue to work toward recovery, however frustrating this may be. His experience is an example of what can happen when one refuses to accept the "get used to it" dogma. Although it is not clear what has caused his recovery, the improvements in function provide a source of hope and inspiration for others.

7) Will Mr. Reeve continue to recover?

We don't know how much more recovery will occur. Mr. Reeve is optimistic that he will continue to regain sensory and motor function, but the pace of recovery has been very slow.

8) What is functional and what is not?

Christopher Reeve's recovery, however limited, raises an important point. Oftentimes, what able-bodied people consider functional may be very different from what a spinal cord injured person considers functional or life-improving. Physicians, therapists, and insurance companies are encouraged to rethink how they define "functional improvement." Although substantial time and money may be required to affect small changes in sensation and movement, those changes are likely to have an enormous beneficial impact on individuals with severe injuries, both psychologically and in their ability to be more independent. For example, improved circulation and bone density reduces skin breakdowns, infections, bone fractures and hospitalizations. As a consequence, health care costs are reduced and the patient benefits emotionally and physically.

9) What is the ASIA scale?

The ASIA scale is the most widely used method for classifying the severity of a spinal cord injury. It enables health care providers to have a consistent way of measuring the status and/or change in individuals with a spinal cord injury.

The spinal cord has four sections, or levels, relating to bone structure: (1) cervical (around the neck); (2) thoracic (the chest region); (3) lumbar (the small of the back); and (4) sacral (the pelvic region). Cervical levels are numbered C1-7, thoracic levels are T1-12, lumbar levels are L1-5, and sacral levels are S1-5.

There are five ASIA categories of spinal cord injury:

ASIA A-complete: No motor or sensory function in levels S4-S5.

ASIA B-Incomplete: Sensory but not motor function is preserved below the injury and includes the sacral segments S4-S5.

ASIA C-Incomplete: Motor function is preserved below the injury, and more than half of key muscles below the point of injury have a grade less than 3.

ASIA D-Incomplete: Motor function is preserved below the injury, and at least half of key muscles below that point have a grade of 3 or more.

ASIA E-Normal: motor and sensory function is normal.

The terms "complete" and "incomplete" are oftentimes used in discussions of spinal cord injury. They do not refer to anatomy, i.e., whether the spinal cord has been severed. Rather, they are part of the ASIA classification system and refer only to whether there are sensory or motor function responses.

:::::::::::::::::::.. Our commentary
Compared this excerp with a condishion of Fransois we can conclude that during the first course he "jump" from level ASIA A-complete to ASIA C-incomplete (2 grade on scale ASIA) and 2-nd course fix it on a more higher level.

to page THEORY