He Never Gave Up

What Actor and Activist Christopher Reeve Taught Scientists About the Treatment of Spinal Cord Injury

Magazine article

By: Jeffrey Klugar

Date: 2004

Source: Jeffrey Klugar. "He Never Gave Up: What Actor and Activist Christopher Reeve Taught Scientists About the Treatment of Spinal-Cord Injury." Time, (Obituary). October 10, 2004.

About the Author: Jeffrey Klugar (sometimes spelled Kluger) is a senior writer for Time, for which he has written several cover stories. He has also authored two books on space and space travel, Apollo 13, and Journey Beyond Selene. He has received several honors and awards for his journalism. Prior to joining the staff of Time, he wrote for several other periodicals.

INTRODUCTION

Christopher Reeve, an actor well-known for his portrayal of the title character in the Superman movies, was also an accomplished athlete with a passion for horseback riding. On May 27, 1995, Reeve was involved in a gymkhana equestrian event when his horse balked at a jump, throwing his rider over his head. Reeve's hands became tangled in the reins, and he landed on his head, fracturing his top cervical vertebrae and causing a spinal cord injury (SCI). The immediate outcome of this injury was a total loss of function below the level of the fracture; because the damage to his spinal cord was severe, Reeve lost immediate movement from the neck down, as well as the ability to breathe voluntarily. The severity of his injuries was extreme, immediate, complete, and permanent.

In a complete injury, there is total loss of function below the level of the SCI, resulting in absolute loss of voluntary movement and sensation. In an incomplete injury, there is some functional ability remaining; there may be some voluntary movement or sensation remaining below the level of the SCI. In a complete injury, both sides of the body are affected to the same degree; that is not necessarily the case for individuals with incomplete injuries. In an incomplete injury, the voluntary movement and level of sensation need not be equivalent; that is, there may be feeling in areas that have no movement, as well as the reverse. One side or area of the body may be affected differently than the other.

When the spinal cord injury affecting the uppermost cervical vertebrae occurs, as was the case for Christopher Reeve, there is loss of ability to breathe voluntarily, necessitating supported respiration by mechanical means, such as a ventilator or respirator.

There are three key components that determine degree of recovery and rehabilitation from SCI at present. They are: location of injury and degree of compression of the spinal cord, time until aggressive medical treatment occurs, and type of rehabilitation facility or nature of rehabilitation undertaken. The closer to the top of the spinal column the injury occurs, the greater the area of the body affected, In addition, the degree of compression of the spinal cord determines the severity of the SCI: the more compression of the cord, the more likely the damage will be permanent and complete. In the past, the first course of treatment in a spinal cord injury involved stabilization of the site, and complete bed rest until the spinal swelling diminished enough to enable medical professionals to determine the extent of the injuries. Current research suggests that prompt and aggressive medical and, when necessary, surgical intervention can decrease swelling intensity and duration, and may ameliorate some of the secondary damage, possibly even preventing axonal death. A corticosteroid called Prednisolone has been shown to have the ability to reverse some damage, and to have some protective ability for the spinal cord, if it is administered within eight hours of the occurrence of the injury.

When making decisions about rehabilitation facilities, it is crucial to choose one that has significant experience with spinal cord injuries, one in which SCI patients are housed near one another for comfort and support, and one in which the techniques employed are state of the art. It is imperative that non-physical aspects of the SCI are dealt with as well: spinal cord injuries are sudden, cataclysmic, and life-altering. The injured person often has to redefine him/herself in terms of abilities and level of independence.

PRIMARY SOURCE

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SIGNIFICANCE

Christopher Reeve was an activist for political freedoms and human rights long before the 1995 accident that left him paralyzed. He was a liberal Democrat who devoted considerable time and attention during the pre-accident phase of his life to political activism concerned with the environment, the concerns of children, funding for the arts, and first amendment rights; after the incident that left him quadriplegic, his advocacy was directed at medical research concerning spinal cord injury. He and his wife, Dana, founded the Christopher Reeve Paralysis Foundation (CRPF), the CRPF Research Consortium, and the Christopher and Dana Reeve Paralysis Resource Center, devoted to education, advocacy, and the advancement of research aimed at curing spinal cord injuries. After making a difficult decision to continue his life after the horseback riding accident, Reeve became determined to use his celebrity and recognizable name to advocate for broader and deeper research into the treatment and cure of paralysis. He attended Senate and Congressional hearings, lobbied, and personally met with law- and policy-makers, in an effort to give a face to spinal cord injuries.

Until recently, it was assumed that a damaged spinal cord could not either rebuild itself or be repaired. Current research is aimed at understanding the cellular mechanisms underlying the original growth and development of axons and neurons in the central nervous system, with the goal of creating means in which they can be re-grown subsequent to SCI. Ethical and responsible stem cell research has great promise in this area; embryonic stem cells have been used with some success in regeneration research involving lower animals.

When the spinal cord is injured, two types of cellular destruction occur: primary damage occurs at the time of the event, and secondary damage is caused by the swelling of the spinal cord and the buildup of fluid around the site of the injury, cutting off the blood supply to the spinal neurons and axons, and causing cellular death. Current research is aimed both at minimizing primary damage and at preventing secondary damage.

Another very large area of research focus concerns efforts at encouraging regeneration of axons. One way in which this is studied is by long-term observation of the development of immature nervous systems in young, developing animals. A variety of mechanisms are being studied at present, with one central goal being the development of a way to overcome a paradoxical physiological process in adult humans: axons and neurons in the central nervous system do possess the capacity to regenerate and re-grow after injury, but are prevented from doing so by a number of inhibitory processes. It appears that the inhibitory factors are present in order to prevent CNS damage by cellular overgrowth—but this protective mechanism effectively prevents re-growth when there is a need for it to occur. Research scientists have documented the presence of at least three proteins that inhibit or prevent growth in the CNS; they are studying them in order to map out their exact mechanisms of action. When they have discerned exactly what makes them function as they do, they may have uncovered the keys to either reversing their action or to turning them off. Axonal regeneration is a highly specific process: the axons must grow only in certain directions, and to specific lengths, and they must make exactly the correct neuronal and biochemical connections in order to function properly.

Burgeoning technology and advancing computer sophistication has led to another avenue of rehabilitation, involving the development of adaptive and prosthetic devices. Computers are being used to create a connection between physiology and physical therapy technology. One result of this research is called FES, or functional electrical stimulation. This technology was used by Chris Reeve in the form of a stationary bicycle: electrodes were placed on the muscles of his legs and attached to a computer, which he or his assistant could control. He was placed on a specially adapted stationery bicycle, and the muscles were stimulated in such a way that his legs would move and he could turn the pedals of the bike—keeping his large muscles from deteriorating, and providing a degree of aerobic conditioning that would otherwise be extremely difficult for a person with limb paralysis to obtain.

Christopher Reeve was able to use the power of his famous name to both encourage and to fund research in all of the developing areas of spinal cord injury treatment. He was absolute in his belief that a cure for paralysis was on the horizon; as a result, he was able to advance the knowledge and technology with which spinal cord injury research progressed by enormous amounts during the nine years after his accident.

FURTHER RESOURCES

Web sites

AAPM&R: American Academy of Physical Medicine and Rehabilitation. "Advances Made in Treatment of Spinal Cord Injuries." 〈http://www.aapmr.org/condtreat/injuries/sciadvance.htm〉 (accessed December 23, 2005).

Christopher Reeve Homepage. "Without Pity: A Film About Abilities." 〈http://www.nlm.nih.gov/hmd/about/collectionhistory.html〉 (accessed December 23, 2005).

MayoClinic.com. "Spinal Cord Injury." 〈httphttp://www.mayoclinic.com/health/spinal-cord-injury/DS00460/DSECTION=8〉 (accessed December 23, 2005).

The National Academies. "The Promise of Stem Cells: From Research to Medical Therapies." 〈http://www.christopherreeve.org/atf/cf/{219882E9-DFFF-4CC0-95EE-3A62423C40EC}/stem%20cell%208-pager%20final%20rev%207-3.pdf〉 (accessed December 23, 2005).

National Institute of Neurological Disorders and Stroke. "Spinal Cord Injury: Hope Through Research." 〈http://www.ninds.nih.gov/disorders/sci/detail_sci.htm〉 (accessed December 23, 2005).