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Thread: The Case for Late Recovery (NM article re: Chris Reeve)

  1. #1

    The Case for Late Recovery (NM article re: Chris Reeve)

    November 2002 Issueテつ*テつ*The Case for Late Recovery

    The subject of the single-case study--"Late Recovery Following Spinal Cord Injury"--published in the September 2002 issue of Journal of Neurosurgery: Spine, was Christopher Reeve.

    John W. McDonald, M.D., Ph.D., and colleagues from The Restorative Treatment and Research Program and Center for the Study of Nervous System Injury at Washington University's School of Medicine in St. Louis conducted the research.

    TABLE 1
    Description of ASIA International Standards for Classifying SCI

    Grade Description

    A テつ*テつ* complete: no sensory or motor function preserved in S4-5
    B テつ*テつ* incomplete: sensory but no motor function preserved below the neurological level and extending through S4-5
    C テつ*テつ* incomplete: motor function preserved below the neurological level; majority of key muscles have a grade
    D テつ*テつ* incomplete: motor function preserved below the neurological level; majority of key muscles have a grade >3
    E テつ*テつ* normal motor & sensory function

    According to the study, "progressive and considerable motor and sensory recovery was evident" over a 2.5-year period from late 1999 until mid-2002, as measured by ASIA standards [see Table 1]. But a September 15 article in a British publication, The Independent--"Is Superman Kidding Himself"--quotes Reeve saying in a 48 Hours (CBS-TV) interview in May 1997 that he had feeling all the way down to his spine at that time, and that he could also feel his son's hand on his. The author, Jeremy Laurance, also questions the extent of Reeve's recovery.
    "Saying that I've gone from wiggling my fingers to wiggling my toes, and that [this] hardly qualifies as recovery, is extremely inaccurate," responds Reeve. "I'm able to move the fingers of my left hand and move my right wrist, I'm able to fully extend both legs, sit in a pool and kick my legs while I have 5-lb. ankle weights on. I'm able to put a leg on somebody's shoulder and as they lean against me, offering resistance, I can push and completely straighten out the leg. ... Also when I'm in the pool or lying in bed I'm able to open my arms, like a snow angel, from by my side to all the way open, then back again. I'm also able to put my feet against the wall of the pool ... and I'm able to push back and fully extend my legs against considerable resistance." Reeve says his progess has been documented by both EMG and functional MRI and that his major gains--motor function up to 20 percent of normal and sensory awareness up to 70 percent of normal--have been made since working with John McDonald. He says he has also recovered voluntary exterior sphincter control, and that the touch of his son's hand that he felt in 1997 was pressure sensation, while what he feels now is delicate surface sensation.

    "Regeneration and recovery probably begin the instant after the injury," says McDonald. "Certainly Chris had some recovery just to get to the point of getting out of the hospital. ... We never state that his recovery is due to this activity recovery program [but it is a hypothesis]. The issue here is that his major recovery definitely occurred post-1999. ... The real message here is that a late recovery is possible."

    Reeve exercised on a computer-controlled, customized recumbent bike system throughout the study. Functional electric stimulation (FES) surface electrodes were placed over gluteal, hamstring and quadriceps muscle groups. This was supplemented with surface electrical stimulation to paraspinals, abdominals, wrist extensors, wrist flexors, deltoids, biceps and triceps. Once-a-week aquatherapy began after muscle recovery first became evident.

    At first Reeve's leg muscles fatigued rapidly, but after 20 sessions, his exercise time had increased to one hour. Even at the trial's beginning, Reeve was no stranger to FES therapy. He had purchased FES equipment after returning home from rehab in late 1995. Other equipment was donated. But it was not until a couple of months into the trial--according to the study--that Reeve regularly pedaled at a rate of 50 rpm for an entire hour.

    TABLE 2

    Yearly Incidence of infection
    and requirement for antibiotic treatment*

    テつ* Total No.テつ* Type of Infectionテつ*テつ*テつ* Total Days テつ*
    Year Eventsテつ* テつ*Urinaryテつ* テつ*Pulmonaryテつ* テつ*Bowelテつ*テつ* テつ*Skinテつ*テつ* テつ*Treatment テつ*
    1996 23 10 9 3 1 169 テつ*
    1997 13 4 4 0 4 190 テつ*
    1998 13 5 6 0 2 168 テつ*
    1999 8 1 4 0 3 99 テつ*
    2000 5 3 2 0 0 36 テつ*
    2001 3 3 0 0 0 18 テつ*
    2002 1 1 0 0 0 10 テつ*

    * Events were recorded from detailed personal records and include total number of infectious events requiring antibiotic treatment, types of infections and total days of antibiotic treatment required.

    The first sign of recovery occurred in November of 2000, when Reeve's wife, Dana, noticed a twitching in his left index finger. Reeve learned to control this movement, then gradually made further progress: "[T]he patient's condition improved from ASIA Grade A to ASIA Grade C. ... Motor scores improved from 0/100 to 20/100, and sensory scores rose from 5-7/112 to 58-77/112." In addition, osteoporosis was reversed, muscle mass increased, spasticity decreased, and medical complications and antibiotic use fell dramatically [see Table 2].

    According to McDonald, the theory behind Reeve's recovery--regeneration through patterned neural activity--has been well documented by other researchers.
    Responding to a "life impact" question in the study, Reeve says: "The recovery has given me the security of knowing that I run minimal risk of infection ... [and] hospitalization. At the moment, recovery is important in terms of any incremental improvement on the way to the ultimate goal. I have been able to stay out of the hospital for more than 3.5 years. Before I had blood clots, pneumonia, a collapsed lung, very serious decubitus ulcers, and an infected ankle, which threatened amputation of my leg. I was always very tentative about my life because I never knew what would go wrong next. Over the last couple of years, I have become very confident with my health. I have been able to stay off antibiotics. ... I can stay up in the chair for as much as a 15 or 16 hours. ...

    Given the fact that I am a ventilator dependent C2, I would say that I am probably in the best possible condition. I am able to work and travel in a way that is very satisfying. The next incremental goal will be to get off the ventilator. I feel I am making progress in that direction. ... I hope I will be able to get incremental recovery ... so I can be in a different wheelchair ... have more freedom, [and] be less dependent on others than I am now."

    Washington University in St. Louis, where Reeve's rehabilitation is based, has created a Web site and hotline (314/454-8633) to handle questions.

  2. #2
    Seneca, thanks for posting this. It's helping me to build my case for a similar recovery facility.

    Onward and Upward!

  3. #3

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