September 30, 2002
By DAVE PARKS
The next steps in Christopher Reeve's battle against paralysis are expected to be robotic ones, courtesy of a new physical therapy device developed by HealthSouth Corp.
A new robotic machine that lets paralyzed people walk on a treadmill is now being built for Reeve, officials say. It is called an AutoAmbulator, and it is heading for full production in January.
HealthSouth officials say the AutoAmbulator will give the "Superman" actor and other paralysis victims a fighting chance at recovery from strokes, multiple sclerosis and spinal injuries.
"He's at the right stage to benefit from this type of therapy," said Dr. John W. McDonald, Reeve's physician and a neurologist at the Rehabilitation Institute of St. Louis. The institute is a joint venture of Barnes-Jewish Hospital, Washington University and HealthSouth, and Reeve has received much of his therapy there.
McDonald said HealthSouth offered Reeve one of the AutoAmbulators, and it will be delivered to a clinical facility in Reeve's New Jersey home.
"It's a perfect opportunity," McDonald said.
Reeve was paralyzed by a spinal cord injury suffered in a 1995 equestrian accident, and he has stunned the nation with his unexpected improvement. He has regained the ability to move his right wrist, the fingers of his left hand and his feet. He can feel a pin prick on most of his body and is able to move some joints voluntarily.
But he has little or no balance required for sitting, standing or walking, according to the Christopher Reeve Paralysis Foundation. Rehabilitation experts hope Reeve will improve further with exercises that develop balance and walking motion, which is what the AutoAmbulator does.
The AutoAmbulator operates with computerized, robotic braces that move the legs in a natural stride. Patients are supported by a harness, and the machine monitors vital signs. It takes one physical therapist to run the AutoAmbulator, which provides smooth, consistent exercise on a treadmill.
The AutoAmbulator is the latest of a new generation of physical therapy machines based on a breakthrough theory of rehabilitation.
For decades, it was thought that brain and spinal injury patients were pretty much stuck with the impairment that remained after a short, initial recovery. But researchers have found these nerve systems can be forced to rewire themselves, and movement of limbs can be restored. The key is intense, patterned, repetitive exercises.
Dr. Swaid Swaid, a neurosurgeon at Birmingham's HealthSouth Medical Center, said creation of the AutoAmbulator was inspired by Reeve shortly after the actor was paralyzed.
Swaid and Richard Scrushy, HealthSouth's chairman and former CEO, watched Reeve exercising in a harness suspended over a treadmill at the University of California Los Angeles.
The device required several physical therapists to move Reeve's legs and operate machinery. It was cumbersome, labor intensive and inconsistent. But Swaid and Scrushy realized the concept had possibilities.
Reeve moved on to a different system - a recumbent bicycle with a device that stimulated his muscles with electrical current. After a year on the bike, he began regaining sensation and motion in his lower body.
Meanwhile, HealthSouth developed the AutoAmbulator. It rolled out the first prototype in Birmingham last year and introduced a more compact model in March, after the device was approved by the Food and Drug Administration.
"It's going to revolutionize rehabilitation," Swaid said.
So far, only two AutoAmbulators exist. Engineers are working on one. The other is at HealthSouth's Sports Medicine and Rehabilitation Center on Birmingham's Southside. It is being used to conduct pilot studies involving about 30 patients.
"That's what we're excited about," Swaid said. "Wow!"
Still, it's too early to draw conclusions from these small studies, and larger studies are needed, Swaid said.
Peggy Furio of Hoover, a 67-year-old stroke patient, doesn't need results of a study to know the AutoAmbulator helped her. Physical therapists have been strapping her to the prototype two or three times a week for 30-minute sessions in the robotic legs and 15-minute sessions walking on the treadmill without the robotics.
"You just have to let the machine do the work," she said.
When she started in January, she was wobbly and walked with a four-pronged cane. She now uses a regular cane and can walk some without it. Her balance has steadied, and that has lessened the threat of falls and improved her everyday life.
"I really don't think I'd be where I am at all without this machine," she said. "I feel really blessed to be in therapy this long."
Furio is able to continue therapy because she is part of a study. If she were relying upon insurance or Medicare, she likely would have no coverage for the AutoAmbulator or, for that matter, most long-term physical therapy.
Beth Pierpoint, director of therapy and an AutoAmbulator clinical specialist at HealthSouth, said insurance reimbursement issues are critical. Insurers will have to be convinced that the AutoAmbulator is cost-effective, and HealthSouth is working on that issue, she said.
Clearly, it makes financial sense to exercise paralyzed people, she said. It saves treatment costs by preventing skin breakdown, cardiovascular disease, pneumonia, blood clots, spasticity and rigidity.
An estimated 200,000 people in the United States have spinal cord injuries, according to the Spinal Cord Injury Network at the University of Alabama at Birmingham. The National Multiple Sclerosis Society estimates about 300,000 Americans have MS. And an estimated 4 million Americans live with disabilities caused by stroke, according to the National Stroke Association.
Production of the AutoAmbulator is expected to begin in January at Control Systems Engineering in Memphis. The devices will cost between $80,000 and $100,000 each, and HealthSouth hopes to have all inpatient centers equipped by August.
Information from: The Birmingham News, Birmingham Post-Herald
Copyright © 2002 The Tuscaloosa News