Fwd:RP=OT ??- CYCLE TRIGGERS RECOVERY

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Mc: High-tech bike helps paralyzed in recovery

Wash U. neurologist out to prove activity can stimulate new cell growth

Margie Manning

http://www.bizjournals.com/stlouis/stories/2002/07/15/focus4.html

Research by neurologist Dr. Mc III could help spinal cord injury

patients recover some of their lost functions by riding a specially designed

exercise bicycle in their own homes.

Mc, 38, assistant professor of neurology at Washington University and

director of the spinal cord injury unit at -Jewish Hospital, is

beginning clinical trials on the Functional Electrical Stimulation (FES)

Bicycle. The bicycle, built to hold a paralyzed person, includes a computer

that stimulates nerves in key muscle groups, allowing patients to ride the

bicycle under their own muscle power.

Mc said early data from his clinical work indicates patients who use

the bicycle for one hour at a time, three times a week, can avoid many of

the physical complications associated with spinal cord injuries, while

animal research in the lab shows the activity can stimulate new cell growth

and activity.

"What we've found so far is compelling evidence that this program can

enhance recovery of function," Mc said.

He has just completed research in a "worst-case scenario" -- a patient who

was injured more than five years ago.

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Until now, it's been accepted wisdom that if patients haven't recovered

within two years of the injury, they won't recover. But Mc's work

could change that thinking.

"In this case we took someone five years out from their injury, with the

highest level and worst injury possible, and we showed that we can reverse

that person to the point where they are 60 percent to 70 percent of normal,"

he said.

He's about to begin a broader clinical trial with 120 patients. They will

take part using FES bicycles at Mc's lab, but he hopes to increase

participation by getting some of the bicycles into patients' homes.

Until now, that's been cost prohibitive. The bicycle was originally designed

in the late 1970s for acutely injured people who might be able to recover in

the first couple of months, but was not intended for people who have had

their injuries for a long period of time. Only about 700 of the bicycles

have been produced in the past 25 years, and they cost about $14,000 to

$16,000 each, Mc said.

Mc is working with a manufacturing group whom he declined to identify

to redesign the bicycle and reduce the cost by as much as 50 percent.

"The goal is to demonstrate to insurance companies that this is a

cost-effective approach, so they will pay for it," Mc said.

Currently, insurance companies will pay for rehabilitation on the bicycle in

only about half of Mc's cases.

But Rummerfield, director of performance assessment for the spinal

cord injury program at Washington University School of Medicine, said

there's a huge potential cost savings for insurance companies because of the

physical benefits of FES bicycle therapy. Those physical benefits include

building muscle mass and preventing skin breakdown, decreasing spasms that

are typically treated with medication, building bone density to prevent

osteoporosis and bone fractures, and enhancing bloodflow and cardiovascular

activity.

"One bone fracture costs $70,000 for hospital treatment. Skin breakdown can

cost $60,000. A bladder infection can run in the tens of thousands of

dollars," Rummerfield said. "If you can get the cost down, hopefully the

insurance companies will realize this is saving them a lot of money."

Rummerfield also said the benefits to the patient are "unbelievable." He

should know. Rummerfield, injured in a car crash in 1974, is the first

quadriplegic to regain full use of his body. Since recovering, he's

completed a triathlon and holds the land speed record for an electric car.

Rummerfield, who incorporated exercise into his recovery but did not use an

FES bicycle, said Mc's work "is light years ahead of anything that's

ever been produced."

Funding for Mc's work has come primarily from private donations so

far. He's just begun to apply for federal grants and for grants from the

Reeve Paralysis Foundation to pay for the research project,

which he said will cost about $750,000 a year.

Researchers who work with Mc include Dr. Becker and Charlie Li,

who have worked on demonstrating the role of physical activity in cell

regeneration; Dr. Sadowsky, a specialist in spinal cord injuries;

Schultz, clinical nurse specialist; and Edrington, who is

coordinating the clinical trials.

More information about the trials is available at the spinal cord injury

program's Web site, http://www.neuro . wustl.edu/sci.

mmanning@...