Reeve Pushes Ahead

Actor Christopher Reeve is shown in this Sept. 27, 2002 photo. Doctors have Christopher Reeve smiles as he speaks about some of the successes he has had in the eight years since his spinal cord injury Thursday, March 13, 2003 at University Hospital in Cleveland.
AP
On Feb. 28, actor Christopher Reeve, who's been paralyzed and on a respirator since breaking his neck in a riding accident eight years ago, had electrodes implanted in his diaphragm in an effort to restore his ability to breathe naturally.

Dr. Raymond Onders, a surgeon at the University Hospitals Of Cleveland, who performed the operation two weeks ago, said on The Early Show Reeve is doing well and is already in therapy.

"He came back in for training this week. So our plan is actually, we had to give him a week rest from the surgery; then we did an extensive training. Chris does everything aggressively. We did about four weeks of training in four days. So he's now back at home, continuing the conditioning process at home," Dr. Onders said.

Reeve is the third person to undergo the procedure. In the treatment, tiny wires are threaded through small incisions directly into the diaphragm. Surgeons use a tube-like instrument that causes very little tissue damage, and patients go home the same day.

"We've developed a technique where we laparoscopically through his belly button, use a device to stimulate his diaphragm to get it to breathe on its own. We map his diaphragm. And once we find the right spot I then implant wires into his diaphragm," Dr. Onders explained showing the long, thin implant instrument with a little needle at one end.

"So out of this tiny little needle here we put an electrode in Chris' diaphragm. We put two on each side and then we run these wires out into his chest. So the wires will actually come out of his chest, and all Chris has is a really a little bandaid on his chest," he explained noting the band-aid will not be even visible underneath his shirt.

Now doctors threaded tiny electrodes into Reeve's diaphragm connecting them to a battery-powered pacemaker.

Then when training time comes, the threaded tiny electrodes are connected to a battery-powered pacemaker. "He plugs it in, and actually turns on our stimulator and turns off his ventilator," he explained.

Every few seconds, an electrical pulse contracts his diaphragm which inflates his lungs. "It will take him about 12 to 16 weeks to actually increase his diaphragm," he added.

As his diaphragm muscles get stronger, Reeve is expected to be able to do away with the respirator entirely.

"As you know, he actually has not used his entire diaphragm in nearly eight years. So his muscles obviously are going to be a little weak and it's going to require some training on his part to strengthen those muscles so hopefully we can get him breathing 24 hours a day. Right now, just 15 minutes an hour," Dr. Onders said.

Reeve was a candidate for the treatment because the phrenic nerves that control breathing, which run from the spinal cord to the diaphragm, were not injured by his fall, Dr. Onders said. But the nerves meet the spinal cord below the site of Reeve's injury, so they could no longer receive signals from the brain stem, where breathing is initiated. As a result, they stopped functioning.

Years ago, doctors realized that if these nerves could be activated artificially, more natural breathing might be restored.

While breathing on his own, Reeve is regaining the ability to talk normally. It has not risen above a whisper, Dr. Onders said, but it will soon come back.

Now that he is breathing more normally - not through the ventilator's hole in his throat - he can smell odors for the first time since his accident, his doctor says. He can smell scents placed under his nose - oranges, peppermint and coffee.

If the federal agency approves the operation, it is expected to cost about $10,000. It is now financed by the agency, the Department of Veterans Affairs and other donors for use in five patients. Hospital officials say $2 million to $3 million more will be needed to complete the trial.

The new technique involves running wires from a control box worn outside the body to electrodes on the diaphragm. When the electrodes are stimulated by currents, the diaphragm contracts and air is sucked into the lungs. When the nerve is unstimulated, the diaphragm relaxes and air moves out of the lungs. About 75 percent of natural breathing is carried out by this process, with the rest under the control of other muscles. The control box sends a signal to the electrodes on the diaphragm 12 times a minute, a normal breathing rate.

About 200 to 300 spinal cord patients a year might be eligible for the operation, Dr. Onders says. It could also benefit many patients who need to be on respirators for long periods but whose nerves are free of disease.