Monday, December 11, 2000

Teen battles back from paralysis


He hopes he'll walk again

By By Tom O'Neill
The Cincinnati Enquirer

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Steven Hacker takes steps with help from therapist Leah Darling and his father Steve.
(Ernest Coleman photo)
| ZOOM |
        ANDERSON TOWNSHIP — The right leg shakes as it bends, rises and plants unsteadily on the brown carpet.

        Watchful eyes in the rehab unit at Mercy Hospital Anderson see this kind of thing all the time, but not from Steven Hacker. Not until a few weeks ago, when his physical therapist said “humor me” and everything changed.

        One small step.

        The Amelia teen-ager lets out a breath and his left leg rises. With his father and therapist holding his belt, Mr. Hacker curls his fingers tightly around the arm-brace crutches on which he balances himself — and his future.

        On July 22, 1999, Mr. Hacker, 19, shattered the sixth vertebra in his neck in a bicycling accident. The next day, doctors at University Hospital emerged from surgery and told Steve Hacker and Sherry Conley their son was paralyzed from the shoulders down.

        Based on statistical probability, there was no clear reason to hope he would ever walk again.

        Steve Hacker began “walking” three weeks ago.

INFOGRAPHIC
Surgical procedure
SPINAL-CORD INJURIES
  • An estimated 8,000 to 10,000 spinal-cord injuries occur annually in the United States.
  • People between ages 16 and 30 account for 58 percent of those injuries — more than all other age-groups combined.
  • More than 80 percent of people injured are male.
  • The most common age at time of injury is 19.
  • Most common causes: motor vehicle crashes, 44 percent; falls, 18 percent; acts of violence, 17 percent; sports, 13 percent.
  • Two-thirds of all sports-related injuries involve diving.
  • Leading causes of death among sufferers: pneumonia/influenza, non-ischemic heart disease, septicemia and pulmonary circulation diseases.
  Sources: The Miami Project to Cure Paralysis; National Spinal Cord Injury Association
        “I feel a lot more coordinated, more fluid,” he says during a break in a recent therapy session. “That stopping and going, though, that ain't no good.”

        As he settles back into his wheelchair, the muscles in his left leg begin to spasm uncontrollably, slowly at first. It reminds him how far he has to go, but also how far he's come.

        “That first day he walked, the whole department was all choked up,” his physical therapist, Leah Darling, says. “It was pretty emotional. We all were amazed.”
       

Celebrity brings hope
               Mr. Hacker's story isn't unique. Fueled by actor Christopher Reeve's success in increasing research funding, advancements in cellregeneration, electric muscle stimulation and immediate-care steroid injections have brought new hope.

        Mr. Reeve was paralyzed in a fall from a horse in 1995.

        Some say that, like cancer, a “cure” won't likely be a magic pill, but a combination of promising approaches.

        “I will walk again,” Mr. Hacker says as he adjusts a New York Yankees cap he's wearing backward on his head. “Definitely.”

        Dr. Nancy McDonough, medical director at Good Samaritan Hospital's rehabilitation department, treated Mr. Hacker for several months. His injury was termed “incomplete” because his spinal cord was not severed, allowing for hope. She attributes his success to the large-dose steroids he received during initial treatment at Clermont Mercy Hospital.

        Anti-inflammatory steroids suppress the immune system, buying time for cells that otherwise would die in the first hours after injury. Inflammation causes congregating blood cells to produce potentially harmful substances.

        The risk of the treatment is infection, but experts are increasingly convinced the benefits far away the perils.

        “I was really shocked when he came back to see me,” Dr. McDonough says. “He's still coming up with miraculous progress. I was excited, and you could see the excitement in his mother's face.”

Out of the woods
               His mother's face was ashen a year and a half ago when neurosurgeons took a piece of bone from her son's hip, replaced the shattered sixth vertebra, and fused the new bone with the fifth and seventh vertebrae.

        “I literally felt my legs go out from under me,” Mrs. Conley says. “And you know your life is changed.”

        For her son, life changed one afternoon in the woods behind his Clermont County house. There, he and a friend set up a ramp from which they could launch themselves airborne on their bikes.

        In midair, Steven Hacker saw the sky fly past his eyes. Then the trees. He knew he was in trouble. He didn't realize how much until the split-second he landed on his head. He also broke his left wrist and left thumb. He wasn't wearing a helmet.

        “Obviously you give them a hope that something will come back,” Dr. McDonough says of parents. “But I never anticipated, if you would have pinned me down that day, I would have thought he'd get nothing back below the level of his injury.”

        But, she adds, “This year alone, I've had three or four patients I think the steroids have really helped.”

        A still-experimental advancement occurred in October 1999, when interleukin-10, a substance produced by immune-system cells, showed promise in minimizing nerve damage in rats. Like steroids, it slows inflammation.

        “They're not exactly sure why (steroids) work,” said Researcher Naomi Kleitman, a Ph.D. in neurological research and director of education at the University of Miami School of Medicine. “But it's one of the things that's led to this change. ... Cells die, but by looking at the immune system in first few hours, it stops the runaway train in terms of immune reaction that's reacting to a very serious injury. ... The jury is out because overall stats on how much improvement are iffy. But I think it opened a whole world of ideas of what works.”

        Mr. Hacker's mother just knows what she sees.

        In the first few weeks, few shards of hope were extended. Steven, then a student at Live Oaks Career Development Campus in Miami Township, couldn't feel any sensation below his upper chest. It slowly returned, eventually reaching his toes.

        On June 26, he took his first step with a walker, though he needed assistance standing up and lowering himself back to his wheelchair.

        Ms. Darling, his therapist, is realistic about Mr. Hacker's condition. But she sees signs for hope. “I've had to eat my words a couple of times. But that's OK. I don't mind.”

        After several months of Mr. Hacker using a walker, Ms. Darling floated an idea.
       

Into the future
               It all started with, not coincidentally, humor.

        “I told him, why don't you try these,” Ms. Darling says of arm-brace crutches. “He said "I don't think so' and I said "humor me.'”

        He did.

        “He's amazed a lot of people here,” his father says.

        His therapy session next brought him to a bench-press type machine he positions his wheelchair in front of. Called “down-presses,” the exercise strengthens his upper body, primarily the arm muscles used to get in and out of his wheelchair.

        That day, he did three sets of 15 repetitions of 62.5 pounds. “Feels more like 262,” he says with a smile.

        Asked what weight he started at, Ms. Darling rifles through a file. “I've never really had a file this thick,” she says before finding the answer: 40 pounds, one set of 10 reps.

        “There's no such thing as false hope,” says Mrs. Conley, a former member of Amelia council. “As long as you have it, it's real. But the strength of the spirit is something you can't measure.”
       

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