Teresa Vietti, M.D.,
medicine always comes first for pediatrician
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Teresa Vietti, M.D., medicine always comes first for pediatrician |
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Reeve's
results signify super progress
By Gila Z. Reckess
Christopher Reeve has regained the ability to feel pinpricks and the light touch of a cotton swab over most of his body and to move some of his joints without any assistance. He also reports improvements in overall health and quality of life. These slow but progressive results began in 2000. At that point Reeve started undergoing a series of evaluations by School of Medicine researchers. Based on these evaluations, Reeve's therapy was adjusted to promote recovery. The study, which appears in the September issue of the Journal of Neurosurgery: Spine, marks the first documented case of partial recovery more than two years after traumatic spinal cord injury. The American Spinal Injury Association (ASIA) scale is the standard method for assessing spinal cord damage. After three years of treatment, Reeve's ASIA classification has been upgraded from A to C on a scale that ranges from A to E. This study is the first documentation of a person improving two ASIA ratings more than two years after being injured. "In light of science's perception of spinal cord injuries, it's remarkable to recover any sensation or movement whatsoever long after the injury has occurred, particularly in those most injured," said the study's lead author, John W. McDonald, M.D., Ph.D., assistant professor of neurology and neurological surgery and director of the Spinal Cord Injury Program at the medical school. "(Reeve) feels so much better, both physically and emotionally, and his confidence and outlook on life have dramatically improved," added McDonald, who also is a staff physician at Barnes-Jewish Hospital, the Rehabilitation Institute of St. Louis and St. Louis Children's Hospital. "However, this study only involved one person, and further research is needed to see if such therapies also are effective for others with spinal cord injury." The research was a collaborative effort between the Department of Neurology, the Division of Bone and Mineral Diseases and the Mallinckrodt Institute of Radiology. Reeve fractured his neck in an equestrian accident in 1995 when he was 42. His spinal cord injury was classified as the most severe type of injury with complete quadriplegia, also known as tetraplegia, which is paralysis of all four limbs. Even optimistic specialists believe that recovery is possible only within the first six months to two years after injury. But unlike most patients with this condition, Reeve began an aggressive exercise program while he was still in rehabilitation in 1995. Reeve began a series of evaluations at the medical school in the fall of 2000. The medical school's approach to spinal cord rehabilitation has three main goals: first, to help paralyzed individuals exercise and thereby receive the strength and cardiovascular benefits of physical activity; second, to help any undamaged nerve cells function as best they can; and third, to encourage new cells to grow. To achieve those goals, the team combines several therapies, including functional electrical stimulation (FES), bone density treatments and aquatherapy. "Our goal is to make recovery from spinal cord injuries a feasible option for most individuals," McDonald said. "I believe rehabilitation is going to shift to being a home-based, lifelong process that almost anyone with determination and proper medical supervision can achieve." Reeve continued to use a specially designed FES exercise bicycle for one hour at least twice a week, which was part of his previous regimen. A computer sends electrical messages to his muscles, similar to what the brain does normally. This electrical stimulation causes the leg muscles to contract and pedal the bike. FES also was applied to Reeve's other muscles, including his arms and abdominals. The research team theorizes that simulating normal motions will encourage spinal cord cells that still are intact to "remember" what it's like to be involved in movement. Regular exercise also provides basic, physical benefits, including building muscle mass and bone density. By combining FES-assisted exercise with osteoporosis drug treatment, Reeve successfully reversed his previously severe osteoporosis and now has normal bone density. Once Reeve could make small movements, he began aquatherapy at the Gaylord Rehabilitation Center in Connecticut. Since gravity's effects are drastically reduced under water, movements are enhanced and it is easier to practice any recovered abilities. In 1999, Reeve still had no sensation or movement below his injury. But now he can feel light touch and pinpricks on about 65 percent of his body and has regained about 20 percent of motor function. That means that he can move the majority of his joints when gravity is reduced and can move some joints against resistance, the best of which are his right wrist, left fingers and legs. His motor improvement is about four times better than results in patients who receive the drug methylprednisolone within eight hours of injury, which is the only documented way to intervene in these patients. Reeve's ability to feel touch has had the greatest impact on his daily life. For instance, he now can tell when he should shift his weight and can sit in a wheelchair for up to 16 hours. The study also reports that Reeve's general health and quality of life have improved dramatically. Before 1999, he experienced nine life-threatening complications and required about 600 days of antibiotic treatment. But in the past three years, he has not been hospitalized and has required only about 60 days of antibiotic treatment. As a result, his ability to commit to work projects and to participate in life have improved. While it is impossible to determine the biological cause of physical improvements in a single case study, researchers at the medical school are conducting laboratory studies to determine whether regeneration and repair of nervous system cells may be responsible for these clinical results. They also are planning a prospective, randomized clinical trial to examine the impact of physical and functional benefits of the therapy. |
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