Christopher Reeve’s recovery

Christopher Reeve demonstrated to the world that he had recovered some movement and sensation. While he could not walk, did not regain bowel, bladder, or sexual function, nor could he breathe without a ventilator, his limited recovery was significant.

The scientific literature on spinal cord injury predicts that most recovery will occur in the first six months after injury and that it is generally complete within two years. Christopher's recovery, coming five to seven years after his injury, defies these medical expectations and had a dramatic effect on his daily life.

Why did Christopher Reeve get better so long after his injury? He believed his improved function was the result of vigorous physical activity.

Christopher began exercising the year he was injured. Five years later, when he first noticed that he could voluntarily move an index finger, Christopher began an intense exercise program under the supervision of Dr. John McDonald at Washington University in St. Louis.

Christopher included several activities in his program. He used daily electrical stimulation to build mass in his arms, quadriceps, hamstrings and other muscle groups. He rode a Functional Electrical Stimulation (FES) bicycle, did breathing training and also participated in aquatherapy.

In 1998 and 1999, Christopher underwent treadmill training to encourage functional stepping. His experience with treadmill training was the foundation of the Reeve Foundation's NeuroRecovery Network®.

Christopher and Dr. McDonald believed that these activities may have awakened dormant nerve pathways.

Dr. McDonald and other researchers and clinicians caution not to over-interpret Christopher's results. Clearly, not all people with paralysis would benefit from a similar program and you should always consult your physician before starting or changing a fitness regime.

A fitness program built for Superman

It is true for any of us: exercise is related to better health. There are few, if any, negative side effects of exercise. Even people who don’t experience recovery in the way that Christopher Reeve did are likely to enhance their well-being.

Christopher’s participation in exercise was motivated by the well-known benefits on cardiovascular function, muscle tone, bone density, etc. Indeed, he had fewer medical complications such as bladder and lung infections.

Before 1999, Christopher frequently required hospitalization – he had a total of nine life-threatening complications and required almost 600 days of antibiotic treatment.

After 1999, he was rarely hospitalized, had only one serious medical complication, and needed only 60 days of antibiotic treatment.

These improvements in his health boosted Christopher’s emotional well-being and enabled him to commit to a variety of work projects knowing he could give them his uninterrupted attention.

Now, scientists are working to develop cutting-edge therapies to afford the same benefits to other people living with paralysis.

Christopher Reeve’s experience is an example of what can happen when one refuses to accept the “get used to it” dogma. Although it is not clear what caused his recovery, his improvements in function provide a source of hope and inspiration for others.

He was a strong advocate for making new technology and therapies more widely available.

I have the staff and the equipment. But what I really hope comes out of my experience is a paradigm shift in the way insurance companies do business. If insurance companies would pay for proactive therapy and equipment they would save money keeping people like me out of the hospital. People with lower level injuries would get up and get out of their chairs. It’s a win-win proposition.

– Christopher Reeve

Below is a rundown on the various activities that were in Reeve’s exercise program:

Note: before considering participation in advanced rehabilitation therapies, such as FES or treadmill training, it is important to consult your physician to ensure that the therapies are appropriate and safe.

Functional Electrical Stimulation (FES)

Christopher Reeve did one hour of exercise at least three times a week on an FES bicycle.

This technology allows persons with little or no voluntary leg movement to pedal a stationary leg-cycle called an ergometer. Computer generated, low-level electrical pulses are transmitted through surface electrodes to the leg muscles. This causes coordinated contractions and the pedaling motion.

FES bikes are not new and have been on the market for over 20 years. Moreover, FES systems have been deployed in research centers throughout the world for the last several years.

Here in the U.S., there are a couple of companies currently producing the bikes. Therapeutic Alliances, Inc., one of the oldest manufacturers, makes the Ergys 2. Restorative Therapies, Inc. offers the RT300-S which is operated straight from the wheelchair eliminating the need for transfer.

FES bikes are also not cheap – they are in the range of $15,000. Some insurance companies have reimbursed for units. There are bikes available in some community settings, at health clubs and rehab clinics.

The first step is to choose a bike that is mechanically sound. All the electronics are upgradeable from the manufacturers. Each bike has a program cartridge set up for the specific needs of each rider, including run times, resistance, etc. A prescription is needed to get the cartridge. For safety reasons, it’s not recommended that FES bike riders use another’s cartridge.

Abundant medical literature documents the effectiveness of FES to increase muscle mass and improve cardiopulmonary function. There are studies that also link FES to a reduced frequency of pressure sores, improved bowel and bladder function and decreased incidence of urinary tract infections.

According to Dr. McDonald, the FES bike can be more useful than for just building muscle mass. “We propose to use them for a totally different reason – to promote regeneration and recovery of function. We now have data demonstrating that [FES] activity can enhance regeneration in animals and is associated with recovery of function in humans.”

Treadmill or Locomotor Training

Locomotor Training is a rehabilitation approach that has been emerging over the last decade. It involves a kind of activity-triggered learning whereby practicing a series of specific movements (in this case, stepping) triggers the sensory information that somehow reminds the spinal cord how to initiate stepping.

Locomotor Training uses repetitive motion to teach the legs how to walk again. A paralyzed person is suspended in a harness above a treadmill, reducing the weight the legs will have to bear. As the treadmill begins to move, therapists manually move the person’s legs in a walking pattern.

The ultimate goal of Locomotor Training is to retrain the spinal cord to ‘remember’ the pattern of walking.

The theory behind locomotor training is that the injured nervous system may be “plastic,” and capable of recovery when patterned neural activity, like stepping, is optimized.

Research from the University of California at Los Angeles and in Germany, Switzerland and Canada, notes that the spinal cord itself appears to act like a small brain and is thus capable of controlling stepping. The spinal cord makes many routine decisions about the correct way to walk. When an individual living with paralysis is retrained to walk, both the brain and spinal cord figure out new ways to do it.

Many people with paralysis, regardless of time elapsed since onset, have improved their walking after receiving Locomotor Training. The level of recovery is different for each person, although almost all those with incomplete injuries showed gains.

It is important to understand that Locomotor Training is an evolving therapy and may not help everyone to walk better. People have seen other benefits beyond walking like improved health and well-being.

As treadmill units filter out into the community, it is important for people to recognize that a Locomotor Training program must include highly trained therapists to work with patients. Maximizing a patient’s ability to step after injury depends to a very large extent on the skill and precision with which the therapists deliver locomotor training.

Locomotor Training is the principle therapy offered by the Reeve Foundation’s NeuroRecovery Network® (NRN), which is a network of cutting-edge clinical rehabilitation centers and Community Fitness and Wellness Facilities that make up two branches of care for people living with spinal cord injury and other physical disabilities.

Aquatherapy

Aquatherapy

Christopher Reeve demonstrated the ability to move his legs and arms in a pool. The effects of gravity are greatly reduced in water so that small body movements can be more easily detected and therapists can determine a person’s maximum ability to move without the full resistance of gravity.

Also, when people are beginning to recover movement, water makes practice easier. When time permitted, Christopher did aquatherapy once a week for approximately two hours.

Bone density treatment

Since people with paralysis don’t typically put weight or pressure on their bones, they tend to lose bone density and often develop osteoporosis.

With drugs and exercise on the FES bicycle, Reeve’s osteoporosis was reversed to normal bone density.

Resources

If you are looking for more information on exercise or have a specific question, our information specialists are available business weekdays, Monday through Friday, toll-free at 800-539-7309 from 9am to 5pm ET.

Additionally, the Reeve Foundation maintains a fact sheet on fitness and exercise with additional resources from trusted Reeve Foundation sources. Check out our repository of fact sheets on hundreds of topics ranging from state resources to secondary complications of paralysis.

We encourage you to reach out to other organizations specializing in activity-based therapies, including:

This project was supported, in part by grant number 90PR3002, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.