MD, Director of PR&M Dept General Hospital of ELEFSINA “THRIASIO”
This study aims to describe a conceptual framework that explains the state of post-CNS paralysis, with loss of voluntary self-initiated movement and/or muscle strength. We readdress correctly the problem space concerning the “where” and “how” of CNS paralysis—away from current research focus in the “broken” neural networks responsible for motor commands.
Clinical experience reveals that paralysis involves more than centrally disrupted transmission. CNS Paralysis cannot be explained by the damaged neural circuits alone. Quoting Alain Berthoz (2021): “…an important question is whether pathological sub-movements that emerge after CNS lesion have a central or peripheral origin. Possible deficits could be deficits in motion planning, in muscle activation, or in blending between consecutive units of action at both the kinematic and muscle activation..."
Scientific literature refers to spontaneous recovery, yet, its neurophysiology remains unclear. Current evidence-based guidelines for stroke rehabilitation recommend task-specific, repetitive, and goal-oriented training, with an emphasis on highly intensive repetition. However, in the case of paralysis, where, by definition, voluntary movement initiation is absent, voluntary goal-directed behaviour technically cannot be applied, while all interventions so far proved ineffective, with very low level evidence (below I).
Looking behind the name, the ancient Greek word for stroke event was ‘καταπληξία’ (kataplexy), and meant the acute circulatory event, distinct from the state of paralysis ‘παράλυσις’, which meant to untie or loosen from the side, or to detach, remove something from something else, and by extension to cause relaxation or weakening of the sides (as it is still said today).
This is a 15-year translational, qualitative, clinical experimental study with a descriptive foundation. It is based on the practice of continuous bracketing to ensure that the phenomena described remain free from pre-existing theories, beliefs, and opinions, and eliminate the detrimental implications imposed by the traditional mind–body dichotomy.
The study includes individuals with CNS paralysis after stroke or brain injury. Absolute prerequisites for participation: average level of cognitive and attentional ability, positive attitude toward sustained physical and mental effort, and informed consent for the use of photographs and video recordings. (When lying in a supine position, our head, neck, and shoulders remain outside our visual field. Moreover, during walking, our attentional monitoring of body parts through gaze is almost nonexistent, without disrupting the ongoing walking pattern).
We conceptualise paralysis as disconnection of the limb from the body’s overall sequential motor ordering system, caused from a phase transition within the states of motor activity space—from the 3D geographic to the 2D geometric, or the more primordial topologic state. We propose that paralysis arises from a distortion within the motor-perceptual system through which the living body both constitutes itself in space and simultaneously generates that space. Based on this framework, we establish the scientific principles for developing an effective therapeutic approach that enables patients to reconstruct a lived and actable spatial field.
The therapeutic procedure does not involve any physical exercise. Instead, cognitive instructions are provided to the patient while utilising the neurobiomechanical substrates of the human motor system in order to readjust the perturbed core-body posture, enhance orderly muscle recruitment and force exertion, and re-establish the coupling of rhythm, timing, and effort—always within a whole-body framework. We also take serious consideration of the delayed movement initiation in post stroke patients, evidenced by Mark Latash.
Patients usually regain one particular targeted sequence of self-movement activity state during each 1-hour clinical session, usually once a week, with a medium average of 5 or more overall sessions needed to complete the therapeutic process. Even they regain their average functional status, they experience subjectively “differently” the affected limb. Previous core body physical condition seems to be a critical facilitating factor, as well as the degree of physical discipline.
We approach paralysis, as an epiphenomenon of brain lesion caused by a defective switch, a “phase transition” within the motor activity states towards most primitive linear topological or geometric space, when the patient, after the acute CNS shock stage, fails to exert successful self-movement initiation with the affected limb; immobilisation renders body unable to produce itself in space and also to produce that space, co-organised by environmental and kinaesthetic elements, encompassing limb’s structure, function and interactions in context and time.
Quoting Jaques Paillard, (1991), “The capability of spatially orienting the body with respect to a solid supporting surface, to the flow of air or water, to the gravitational field, or to the visual environment and external space is important, not only for the
maintenance of basic postural attitude, but also for the performance of locomotor, manipulatory and orientational movements.”
Henry Poincaré (1905), made the important distinction between motor activity states as motor attitudes (principle of all of nothing, emergence) and motor actions as motor events (skill aquitition with rehttps://wordcounter.net/petitions).
He describes 2 kinds of MOTOR ACTIVITY STATES: Inanimate movement states, (perception of Geometric Space or the more primitive Topologic Space), allows a linear mode of motor action events, like changes of position, or displacements, and Animate movements states, (perception of Representative or Geographic Space), in its triple integration mode – visual, tactile, and motor, plus distance for 3D perception, for reach, grasp, pull, push, & yield.
In conclusion with this study:
We discriminate the concept of motor activity states (modes of motor attitudes), in contrast to actions (motor events) and describe paralysis as a phase transition within the body’s activity states, caused by the neuromechanical motor substrates underlying our implicit hierarchical sequential motor ordering. We present the fundamental principles for developing an innovative, effective and systematically structured therapeutic approach that can be further refined and validated through clinical practice and research.
The persistent and narrowly focused research on defining and understanding the neurophysiology of paralysis—limited to lesioned neural networks—may stem from the detrimental mind-body duality, and false attribution of superiority of the mind over the body. We continue to think in terms of the duality between thought and motion/rest, despite well knowing that we are both mind and body, inseparably united. Meanwhile, lesion-specific long-term deficits, at motor, cognitive, and psychological level, remain concealed beneath the static hemiplegic pattern—frequently undiagnosed and undertreated.
