November 2002

News

Christopher Reeve

REEVE’S THERAPY LEADS TO PARTIAL RECOVERY

When actor Christopher Reeve was paralyzed from the neck down in a 1995 horse-riding accident, doctors gave him little hope of recovery from the devastating spinal cord injury (SCI) he suffered.

But recently, as has been widely reported, Reeve has begun experiencing slight movement in his fingers and toes. “We have all been surprised at these developments,” says Reeve’s physician, John McDonald, MD, PhD, a neurologist at Washington University School of Medicine and director of the spinal cord program at the Rehabilitation Institute of St Louis. “Normally, there is little recovery after the first 18 months of an injury, which makes this all the more unusual. He has really broken a new barrier here.”

McDonald has led Reeve’s home SCI rehabilitation program since 1999. Since that time, Reeve’s regimen has included functional electrical stimulation, aqua therapy, and bone density treatment. “The program’s goals are to use exercise and therapy for strength and cardiovascular improvement, to help undamaged nerve cells function as well as possible, and to encourage new cells to grow,” says McDonald. “What we’ve discovered with Mr Reeve is that the adult nervous system does have the capacity to regenerate.”

In the fall of 2000, Reeve began to move his left index finger, according to McDonald. Since that time, he has developed the ability to feel a pin prick on his body and move most of his joints. His strongest joints are his right wrist, left fingers, and knees, where he has the strength to oppose resistance.

Reeve was originally classified by the American Spinal Injury Association (ASIA) as a C2 ASIA A, which meant that he had no sensory or motor function below his shoulders. But McDonald reports that, in the past 3 years, Reeve has improved to C3 ASIA C, which means that he now has more neck function and has intact motor and sensory function in his lowest spinal cord level, and that more than half of the key muscles below the injury are graded 3 or less on a 5-point scale.

In the functional electrical stimulation exercises, Reeve simulates biking movements and a computer sends electrical messages to his legs to encourage spinal cord cells that are still intact to remember leg movements. In aqua therapy, which Reeve does in 2-hour installments once each week, he has been able to slowly walk under water with the aid of his assistants. He initiates a step by moving his leg forward and shifting his weight while assistants hold him in a standing position and maintain his balance. Because gravity is reduced in the pool environment, he is able to move more freely than in his wheelchair; he can also reportedly move his arms in a flying motion under water.

His bone density treatment, coupled with drugs and other exercise, has reversed the actor’s previously severe osteoporosis to the point where he now has normal bone density.

Partially due to the success of Reeve, Washington University researchers are conducting more clinical research to further investigate whether activity-based therapies lead to functional recovery in individuals with SCI. “We want to demonstrate that this type of recovery is possible in more people,” says McDonald. “And we want to see if we can build on this breakthrough.” He says that Reeve’s progress is consistent with recent spinal cord injury studies that suggest that the nervous system might be capable of recovering from injury under certain conditions. Specifically, McDonald says the studies show that encouraging patients to use their injured body parts does help them recover lost function. For example, he says that several groups have discovered that patients with less severe spinal cord injuries who can still move their legs appear to benefit from gait training, where patients practice walking with the help of therapists, harnesses, and other supportive equipment.

In addition, studies with stroke patients suggest that encouraging them to use semi-paralyzed limbs helps the limbs recover lost function. “This is effective, because forced movements stimulate damaged nerve cells to relearn their tasks,” says McDonald.

REPORT SAYS PTS AND OTS GET HIGHEST RATES FROM NURSING HOMES

According to three recently published reports by Hospital and Healthcare Compensation Service (HCS), nursing homes pay the highest hourly rates to occupational and physical therapists.

The national average hourly rate for OTs in nursing homes is $25.96, compared with $25.35 in a continuing care retirement community (CCRC) and $23.54 in hospitals. Meanwhile, PTs receive $27.54 per hour on average in nursing homes, compared with $27.25 in CCRCs and $25.95 in hospitals.

The Hospital Salary and Benefits Report includes data from 346 hospitals and provides compensation data on 180,500 employees nationwide. It covers 145 hospital positions, including management, nursing, rehabilitation, dietary, radiology, and technical positions.

The CCRC Salary and Benefits Report includes data from 537 CCRCs and provides compensation data on 78,800 employees. Data was reported according to total units, revenue size, and geographic region. The Nursing Home Salary and Benefits Report includes data from 2,319 homes and provides compensation data on 267,300 employees. Data was reported according to bedsize, and for-profit and non-profit status. Both of these reports cover 39 management and 40 nonmanagement positions.

“Once again, the reports show that salaries for therapists really have not increased much,” says Rosanne Cioffe, director of reports for HCS. “Mostly due to funding problems, this has been the trend for the past few years.” Cioffe says the information was gathered through questionnaires sent to nursing home, CCRC, and hospital staffs, with data effective as of May 2002 for all three reports.

HCS is a subsidiary of John R. Zabka Associates Inc, Oakland, NJ, and provides high-level professional consulting services to the health care industry. In addition, the company conducts its extensive program of research on compensation and benefits in the industry, with the findings published annually.

THERAPISTS URGE CONGRESS TO ACT ON CAP

Thanks to fears that the $1,500 Medicare cap on outpatient therapy services may go back into effect on January 1 if Congress fails to act to repeal it, therapy associations are working hard to try to convince legislators to continue the moratorium on the cap for another 2 years.

The American Occupational Therapy Association, the American Physical Therapy Association, and the American Speech-Language-Hearing Association are all working to get their members to call, write, and email representatives.

Though the House has passed a bill that would continue the moratorium, the Senate has yet to act on its version of the bill. In general, Congress has avoided acting on health care issues because of uncertainties in the upcoming election. Since both parties are optimistic about their chances to win the House and Senate, they have reportedly been hesitant to pass any laws.

CARE MANAGERS PART OF A GROWING TREND

More and more people are hiring geriatric care managers (GCMs) to care for elderly parents living in cities other than their own, according to a recent article in the Wall Street Journal.

GCMs, typically trained in gerontology, social work, nursing, or counseling, help arrange for and supervise the caregivers who provide assistance with day-to-day needs such as bathing, dressing, and eating. Among other tasks, GCMs assess the patient’s needs, select doctors and coordinate medical care, find housing, address financial concerns, and regularly give status updates to families.

Whether they work for agencies or as independent consultants, GCMs usually charge hourly fees, ranging from $40 to $95. However, Medicare, Medicaid, and private health insurance do not cover costs.

There are no licensing requirements for GCMs, and qualifications and skill levels vary.

SURGERY A VIABLE OPTION FOR CARPAL TUNNEL SYNDROME SUFFERERS

A recent study published in the Journal of the American Medical Association suggests that surgery may be a better option for patients with carpal tunnel syndrome than many health care providers had thought.

Researchers in the Netherlands studied 167 patients who either had surgery or wore wrist splints for 6 weeks. After 3 months, 80% of patients with surgery showed significant improvement, compared with 54% of splint patients. And the patients with surgery continued to do significantly better after 18 months.

While the findings suggest that surgery should be the first rather than the last option for patients, the researchers noted that the study probably will not change treatment strategies immediately. Patients studied had moderate cases of carpal tunnel syndrome, and the researchers noted that they did not study patients with either mild or severe cases, which they believe suggests that more research is needed before a major change in treatment plans is adopted by providers.

SIERRA GROUP CEO SPEAKS TO CONGRESS

Janet Fiore, CEO of the Sierra Group, King of Prussia, Pa, recently testified before the US Congress, House Committee on Small Business, on the role that small businesses are playing in helping individuals with disabilities lead productive lives through employment.

During her speech, Fiore demonstrated how a partnership between a small business, center for independent living, and state government has led to a training program for people with disabilities that provides educational and business skills required for entry level employment.

She also described how this system supports employers by providing access to IT and HR technical assistance, hardware and software grants, tax incentives, and other assistance.

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