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For years, doctors and therapists believed there was only a brief window for recovery after a spinal cord injury.
Actor Christopher Reeve, who was paralyzed in a 1995 horseback riding accident, altered that view.
Seven years after his top two vertebra were shattered, Reeve was able to feel light touches and pinpricks on most of his body, said Dr. John McDonald, who directs the International Center for Spinal Cord Injury and Paralysis at Kennedy Krieger Institute and the Johns Hopkins University School of Medicine in Baltimore.
Until Reeve's improvements were documented, no one believed that someone with such a severe spinal cord injury could recover feeling and movement.
Before his death in 2004, Reeve was able to move his fingers, wrists and legs. During aqua therapy, he could move his arms and was able to stand in the water.
"He was beginning to bike on his own," McDonald said. "That's the level of control he was regaining."
Some of the techniques that worked for Reeve are now being studied around the country to help others with spinal cord injuries.
Activity-based restoration therapies use functional electrical stimulation to help patients with paralysis exercise their muscles and stir damaged cells to work as they did before the injury.
"Every time the person takes a step, it produces electrical stimulation up the spinal cord," McDonald said.
Bicycling also improves cardiovascular health, prevents skin breakdown and reduces the incidence of osteoporosis.
There's also the Lokomat, which Dallas resident David Cunniff relied on. The Swiss-made robot moves a person's legs in a natural gait while he is held up by a harness.
The repetitive training helps patients get stronger, said George Hornby, research assistant professor at the Rehabilitation Institute of Chicago.
"There's nothing magical about the robot," he said. "What it comes down to is it's all about practice and allowing the patient to practice walking when they cannot walk or stand on their own."
Doctors recognize the importance of activity after a spinal cord injury.
"It's not OK to tell a person who is paralyzed not to exercise because they can't move," McDonald said.
To maximize the benefits of activity-based therapy, equipment such as a functional electrical stimulation bicycle should be in the home, McDonald said.
Researchers are also looking at combining several therapies for maximum improvement.
"Maybe it takes all three - drugs, training and electrical stimulation," said Dr. Keith Tansey, director for the spinal cord injury program at the University of Texas Southwestern Medical Center at Dallas. "We're just really at the forefront."
Using animal models, researchers at UT Southwestern are studying whether drugs can speed the body's response to stimulation and hasten recovery.
"The drugs go directly into the spinal cord itself," Tansey said. "And the next thing you know, the limbs are stepping."
The spinal cord is capable of producing function, he said.
"These people have spasms, but they have inappropriate motor output," Tansey said. "The question is how to switch from inappropriate output to appropriate."
No one approach is sufficient, McDonald said.
"There won't ever be a single cure," he said. "It's going to be a combo, taking the most effective and efficient therapies and putting them in the home for the individual's use long term."
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(c) 2005, Fort Worth Star-Telegram. Distributed by Knight Ridder/Tribune News Service.
