antiquity
11-03-2002, 04:32 PM
November 2002 IssueDr. John McDonald on Making FES Affordable
TG: Christopher Reeve has been very fortunate with the kind of support he's had--three different insurance companies, a large team of nurses and aides, the use of equipment that others in the SCI community do not have. What can be done to provide functional electric stimulation therapy to the average person with SCI?
JM: What needs to be developed are home applications. And if it's cost-effective, then you have a winning approach. The FES bicycle is--or could be--made in an affordable manner that would allow most everyone to have it.
TG: But aren't insurance companies more likely to agree to place a unit or two in each rehab center, and then have people come in as outpatients?
JM: Not only will that exclude individuals, but it's going to cost more in the end, with individuals traveling back and forth, and the cost to them of having to take off work three times a week to do this.
TG: And there's the cost of the rehab visits and the facilities.
JM: Yes, it would add up very quickly. If you did it three times a week, 50 weeks out of the year, that's 150 times a charge of $120 ($18,000 per year).
TG: Christopher Reeve feels that a grassroots demand for this kind of equipment is needed. How does that happen? He gets the attention of the press, but what can others do to bring pressure to bear? Is it a legislative thing?
JM: It's turning into a legislative thing because the Christopher Reeve Paralysis Foundation is making it that. They have active legislation ongoing now (The Christopher Reeve Paralysis Act) to get support for this for everyone. And that's a critical piece. And now this occurring with Chris, this late recovery, is one of the most critical things in saying, "Hey, this thing now will pass," where it wouldn't have two weeks ago [interview occurred Sept. 13].
TG: And his being a "worst-case scenario" is also important?
JM: Exactly. If I ever told one of my colleagues a month ago that--"Oh, I've been working with Christopher Reeve and he's recovered two ASIA [American Spinal Injury Association] grades, he can feel and move most of his joints, albeit just a little, but he's still in the same wheelchair, he's not walking"--they'd all have laughed. It's impossible. Now it isn't. TG: But since he's not your typical patient in terms of the kind of support he's had, is it fair to say that this is all that unusual? We're comparing him to the typical SCI population, a population that hasn't really had the benefit of this kind of therapy.
JM: Right, true. Perhaps other people in the SCI population would have a better response--or a worse response.
TG: So we need more clinical trials.
JM: Absolutely. It requires funding, it requires resources. What needs to be done is the big clinical human trial.
TG: Hundreds of people at different rehab centers?
JM: Exactly. This is the perfect opportunity for the National Institutes of Health to really push something forward. The fact that someone can move a finger is not necessarily important. But if it changes their life in any way, that is. The average person doesn't realize that a cure is not what everyone's asking for--everyone would love to get a little back. In steps. And that's the way it's going to happen.
TG: Reeve says FES machines are available for around $15,000. If the cost stays at $15,000, would it be cost-effective for an insurance company to put a machine in someone's home?
JM: I think if the retrospective studies demonstrate that it reduces one major long-term complication, the answer is overwhelmingly yes. Either no skin breakdowns, or no pathologic bone fractures, or if you get a major reduction--like Chris saw--with just general infections. One of those alone would be overwhelming. Or individuals who because of spasticity require implantation of pumps. ... But I strongly believe it could be done for way less than $15,000. The original bikes were built in the late 1970s and they're still that technology--customized, and they don't need to be. People with SCI are sitting in the best seat they have, a wheelchair, and they can use attachments that real bikers would use for the feet, and use modern electronics where you can have biofeedback.
TG: A system like this could be widely adapted to people in their chairs.
JM: Yes, because that chair is designed for them. Those are the things that need to be done to make this affordable, and I think that in short order we'll be able to add to the literature in demonstrating that there are physical benefits in the categories sufficient to make this cost-effective in a short period of time.
http://newmobility.com/review_article.cfm?id=617&action=browse
TG: Christopher Reeve has been very fortunate with the kind of support he's had--three different insurance companies, a large team of nurses and aides, the use of equipment that others in the SCI community do not have. What can be done to provide functional electric stimulation therapy to the average person with SCI?
JM: What needs to be developed are home applications. And if it's cost-effective, then you have a winning approach. The FES bicycle is--or could be--made in an affordable manner that would allow most everyone to have it.
TG: But aren't insurance companies more likely to agree to place a unit or two in each rehab center, and then have people come in as outpatients?
JM: Not only will that exclude individuals, but it's going to cost more in the end, with individuals traveling back and forth, and the cost to them of having to take off work three times a week to do this.
TG: And there's the cost of the rehab visits and the facilities.
JM: Yes, it would add up very quickly. If you did it three times a week, 50 weeks out of the year, that's 150 times a charge of $120 ($18,000 per year).
TG: Christopher Reeve feels that a grassroots demand for this kind of equipment is needed. How does that happen? He gets the attention of the press, but what can others do to bring pressure to bear? Is it a legislative thing?
JM: It's turning into a legislative thing because the Christopher Reeve Paralysis Foundation is making it that. They have active legislation ongoing now (The Christopher Reeve Paralysis Act) to get support for this for everyone. And that's a critical piece. And now this occurring with Chris, this late recovery, is one of the most critical things in saying, "Hey, this thing now will pass," where it wouldn't have two weeks ago [interview occurred Sept. 13].
TG: And his being a "worst-case scenario" is also important?
JM: Exactly. If I ever told one of my colleagues a month ago that--"Oh, I've been working with Christopher Reeve and he's recovered two ASIA [American Spinal Injury Association] grades, he can feel and move most of his joints, albeit just a little, but he's still in the same wheelchair, he's not walking"--they'd all have laughed. It's impossible. Now it isn't. TG: But since he's not your typical patient in terms of the kind of support he's had, is it fair to say that this is all that unusual? We're comparing him to the typical SCI population, a population that hasn't really had the benefit of this kind of therapy.
JM: Right, true. Perhaps other people in the SCI population would have a better response--or a worse response.
TG: So we need more clinical trials.
JM: Absolutely. It requires funding, it requires resources. What needs to be done is the big clinical human trial.
TG: Hundreds of people at different rehab centers?
JM: Exactly. This is the perfect opportunity for the National Institutes of Health to really push something forward. The fact that someone can move a finger is not necessarily important. But if it changes their life in any way, that is. The average person doesn't realize that a cure is not what everyone's asking for--everyone would love to get a little back. In steps. And that's the way it's going to happen.
TG: Reeve says FES machines are available for around $15,000. If the cost stays at $15,000, would it be cost-effective for an insurance company to put a machine in someone's home?
JM: I think if the retrospective studies demonstrate that it reduces one major long-term complication, the answer is overwhelmingly yes. Either no skin breakdowns, or no pathologic bone fractures, or if you get a major reduction--like Chris saw--with just general infections. One of those alone would be overwhelming. Or individuals who because of spasticity require implantation of pumps. ... But I strongly believe it could be done for way less than $15,000. The original bikes were built in the late 1970s and they're still that technology--customized, and they don't need to be. People with SCI are sitting in the best seat they have, a wheelchair, and they can use attachments that real bikers would use for the feet, and use modern electronics where you can have biofeedback.
TG: A system like this could be widely adapted to people in their chairs.
JM: Yes, because that chair is designed for them. Those are the things that need to be done to make this affordable, and I think that in short order we'll be able to add to the literature in demonstrating that there are physical benefits in the categories sufficient to make this cost-effective in a short period of time.
http://newmobility.com/review_article.cfm?id=617&action=browse