Christopher Reeve's improvement makes medical history
They believe intensive physical therapy is key to the modest, though important, changes that Reeve has experienced since his injury in 1995. However, they cannot predict whether improvement will continue or if the same approach would help others with long-term paralysis.
"We are talking about an unprecedented amount of recovery. There is just no basis to talk about how much more to expect," said neuroscientist Naomi Kleitman, head of spinal-cord injury research at the National Institute of Neurological Disorders and Stroke.
The first clear sign of change occurred one early November day almost two years ago, when Reeve twitched his left index finger. He had been immobile from the neck down for more than five years, unable to feel or move anything. But the movement was the start of a slow rebirth of sensation and control that he says has changed his life for the better.
Reeve, 49, still needs a wheelchair. He uses a ventilator to breathe for all but one hour a day, but he can feel touch, pain and move his fingers, wrists and legs.
"His was the worst-case scenario," said Dr. John McDonald, who oversaw his treatment at Washington University School of Medicine in St. Louis. "Nobody in the world would have predicted he could recover."
Reeve was thrown from a horse seven years ago and landed on his helmet, breaking his neck and damaging the thumb-size bundle of nerves that carries messages between the brain and the rest of the body. At least three-quarters of the nerve fibers were severed, and what remained did not work.
His muscles withered, his bones thinned and he suffered repeated bouts of infection and life-threatening complications.
After years of exercise efforts, the actor in April 1999 began an approach called activity-based recovery, which involves repeated electrical stimulation of the muscles. The idea is that constant motion could re-educate remaining nerves in the spine to carry signals and perhaps sprout new branches to connect to healthy fibers above and below the injury.
For one hour three times a week, Reeve sat on an exercise bicycle while electrical stimulation made his legs pump the pedals. Similar stimulation was done to other muscle groups. He then began weekly aquatherapy, working his muscles in a pool for two hours at a time.
McDonald described the results in the September issue of the Journal of Neurosurgery: Spine.
"The idea is not new," McDonald said of Reeve's exercise program. What's new was that he was able to do it so late after his accident.
Reeve now can tell hot from cold and feel about two-thirds of the normal sensation of being touched and half of the usual intensity of pinpricks. This ability to feel lets him know when he should shift his weight, so he can sit in a wheelchair up to 16 hours a day without developing pressure sores.
In the water, he can make flying motions with his arms and walk. Out of it, he can't raise his arms or walk without being held up.
Reeve told McDonald that knowing he can breathe on his own has relieved his terror of a ventilator failure, and life with his family is much more normal.
"They know I am healthier, stronger, and that on any day I might have a surprising recovery." Gaining sensation also has been important.
"It makes a huge difference if someone touches you on the hand, and you can feel it."
Some experts say they were most impressed by the claim that Reeve is healthier. He had been plagued by infections, was hospitalized frequently and was taking antibiotics constantly, McDonald said. Quadriplegics often suffer from skin breakdown, lack of blood flow, joint and muscle problems, bedsores, lung and bladder infections and side effects of antibiotics.
Doctors usually tell paralyzed patients most improvement is in the first six months, with no hope of recovery beyond two years.
"Given this report," said Dr. Kevin O'Connor, head of spinal-cord injury recovery at Boston's Spaulding Rehabilitation Hospital, "it's really unfair to patients to say there is a time limit."
Information from Knight Ridder Newspapers is included in this report.