Shoemaker to Begin Rehabilitation Today : Medical: His competitiveness increases his chances of making progress, doctor says.

Bill Shoemaker will start rehabilitation today, two weeks after suffering a broken neck in a single-car accident on the Foothill Freeway in San Dimas that left him paralyzed from the upper chest down.

Doctors not directly involved with his care said it is too early to say whether Shoemaker, 59, will regain use of his arms and legs or be able to breathe on his own. But the likelihood for some improvement is great, they said.

Shoemaker, who was transferred to the Craig Rehabilitation Hospital in Englewood, Colo., Monday, suffered damage to his spine at the fourth cervical vertebra, and breathes with the aid of ventilator.

He was taken by ambulance from the Centinela Hospital Medical Center in Inglewood Monday morning and flown by Lear jet to Denver. Accompanying him on the two-hour flight were members of the Craig Hospital staff and Marje Everett, former chief executive officer of Hollywood Park.

Shoemaker, who slept most of the flight, was strapped to a stretcher and stabilized with the help of a Halo Fixation, a device attached to the skull that keeps the neck from moving.

Patients with injuries similar to Shoemaker’s spend about 150 days in rehabilitation, doctors said. However, each individual reacts differently to therapy.

Shoemaker was considered one of the world’s greatest jockeys when he retired last year to start a career as a trainer. At 4-feet-11, about 100 pounds, he guided thundering, 1,000-pound thoroughbreds down the homestretch with sure hands.

He rode more for than 40 years and won more races--8,833--than any other jockey.

Now, he will learn to negotiate a wheelchair equipped with space-age technology in an effort to assume control of his care.

Because of his competitive background, Shoemaker’s chances of responding to therapy are encouraging, said Kenneth Parsons, medical director of Long Beach Memorial Rehabilitation Hospital.

“This man’s a fighter,” Parsons said. “Certainly, the life of the jockey is one of great discipline. Those same traits of being a competitor and a winner will come up again, I think. If not right now, as time passes he will become more of his old self.”

Other doctors agreed to discuss such cases in general but not Shoemaker’s specifically because they do not have enough information to analyze his case.

“With the kind of medical care and rehabilitative care (available), chances are he will have a normal or close to normal life span,” said Julie Madorsky, medical director of spinal cord injuries at Casa Colina Rehabilitative Hospital in Pomona.

How much Shoemaker will be able to do depends largely on his ability to breathe and talk. Robert G. Watkins, a back specialist with the Kerlan-Jobe Orthopaedic Clinic, said in a statement last week that the injury is “a complete C4 level.”

Parsons said that description does not indicate whether the fourth cervical nerve is working or not. Such knowledge is important in understanding Shoemaker’s chances of breathing on his own. Doctors performed a tracheotomy, an operation in which a hole is cut in the windpipe to accommodate a tube from a respirator.

Madorsky said Shoemaker might be a candidate for a special pacemaker that would stimulate his diaphragm to contract. If effective, he could eventually breathe on his own.

Shoemaker is unable to speak, so people read his lips to understand him.

Therapists also will help Shoemaker to increase the strength of his remaining muscles, primarily in his neck and shoulders. His arms and legs will be exercised by therapists. He also will be started on a bowel and bladder training program.

Because Shoemaker has lost the ability to move and feel, he is susceptible to pressure sores, doctors said. Pressure sores are areas of gangrene on the skin. Patients are turned and moved at least once every two hours in an effort to avoid the sores, Madorsky said.

Eventually, Shoemaker will be put in a wheelchair. It most likely will be equipped with sophisticated controls that Shoemaker can manipulate with his restricted movement.

“(There will be) a little black ball attached to a control box which will be attached to the chair,” Madorsky said. “The control box will be put somewhere where he can control it. Either right under his chin or to one side of his face. He will be able to operate an electric wheelchair by means of moving his chin or his head (against the ball).”

Another mechanism to control the chair is called the sip-and-puff system.

“It’s like a straw,” Madorsky said. “You sip on it to make it go and puff on it to make it stop.”

These techniques will be applied to an environmental control system, a hand-held remote-control device that operates numerous household appliances. The system can be connected to any electrical gadget. It can be used to turn on the television set and change channels or to open and close electrical doors.

“He would have some type of joystick that he would push,” Madorsky said. “A stick that he would hold between his teeth. He could do a lot of things. Some people write or type with mouth sticks. Some people get very adept with it and draw and paint. You can also push buttons with it for telephone or computer games or TV controls.”

The primary goal of rehabilitation is to teach Shoemaker to use what he has. Marlene Casini of Craig Hospital said 91% of their patients eventually return home.

One element that sets Shoemaker apart from the more than 250,000 patients with spinal cord injuries in the United States is his celebrity status. Doctors said that rehabilitation should be done in the privacy of family, friends and therapists.

“It is a great deal of physical, mental and emotional work to get through four or five months of rehab care,” Parsons said. “I would hope that people would just let him work at it, let his family work at it. Then five or six months down the road see how he is.”

One group that hopes to visit Shoemaker at an appropriate time is the North American Riding for the Handicapped Assn., which is based in Denver. Horseback riding, called hippotherapy, is used by some physically impaired patients, said Bill Sceppi, the organization’s executive director. Shoemaker supported the group when he was a jockey.

Madorsky said all sorts of adoptive devices such as special reins, boots and stirrups make riding possible. Patients often are mounted on the horses with the help of hydraulic lifts.

Still, it will be Shoemaker’s decision whether to include riding as part of his therapy. He has many other choices, doctors said.

“He certainly can train (horses),” Madorsky said. “He can continue to teach others andtrain.”