79–006 

111TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 1st Session 111–45 

CHRISTOPHER AND DANA REEVE PARALYSIS ACT 

MARCH 23, 2009.—Committed to the Committee of the Whole House on the State 

of the Union and ordered to be printed 

Mr. WAXMAN, from the Committee on Energy and Commerce, 

submitted the following 

R E P O R T 

[To accompany H.R. 307] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 307) to enhance and further research into paralysis 

and to improve rehabilitation and the quality of life for persons living with paralysis and other physical disabilities, and for other 

purposes, having considered the same, report favorably thereon 

without amendment and recommend that the bill do pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 1 

Background and Need for Legislation .................................................................... 2 

Hearings ................................................................................................................... 2 

Committee Consideration ........................................................................................ 2 

Committee Votes ...................................................................................................... 3 

Committee Oversight Findings ............................................................................... 3 

Statement of General Performance Goals and Objectives .................................... 3 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 3 

Earmarks and Tax and Tariff Benefits .................................................................. 3 

Committee Cost Estimate ....................................................................................... 4 

Congressional Budget Office Estimate ................................................................... 4 

Federal Mandates Statement ................................................................................. 5 

Advisory Committee Statement .............................................................................. 5 

Constitutional Authority Statement ...................................................................... 6 

Applicability to Legislative Branch ........................................................................ 6 

Section-by-Section Analysis of the Legislation ...................................................... 6 

PURPOSE AND SUMMARY

The purpose of H.R. 307, the ‘‘Christopher and Dana Reeve Paralysis Act’’, is to enhance and further research into paralysis and 

to improve rehabilitation and the quality of life for persons living 


jbell on PROD1PC69 with REPORTS
2 

with paralysis and other physical disabilities, among other purposes. The bill authorizes the appropriation of $25 million for each 

of the fiscal years 2010 through 2013 for the Secretary of Health 

and Human Services to carry out projects and interventions to improve the quality of life and long-term health status of persons 

with paralysis and other physical disabilities. In addition, the bill 

authorizes the Director of the National Institutes of Health to develop mechanisms to coordinate research on paralysis and to support multicenter networks of clinical sites that will collaborate to 

design clinical rehabilitation protocols and measures of outcomes of 

interventions for persons with paralysis. 

BACKGROUND AND NEED FOR LEGISLATION

It is estimated that a quarter of a million Americans are currently living with spinal cord injuries and approximately 4 to 5 million Americans are living with paralysis of the extremities. There 

are an estimated 10,000 to 12,000 spinal cord injuries every year 

in the United States. 

Spinal cord injuries often occur because, although the hard bones 

of the spinal column protect the soft tissues of the spinal cord, 

vertebrae can still be broken or dislocated in a variety of ways and 

cause traumatic injury to the spinal cord. Injuries can occur at any 

level of the spinal cord. The segment of the cord that is injured, 

and the severity of the injury, will determine which body functions 

are compromised or lost. Because the spinal cord acts as the main 

information pathway between the brain and the rest of the body, 

a spinal cord injury can have significant physiological consequences. 

Catastrophic falls, being thrown from a horse or through a windshield, or any kind of physical trauma that crushes and compresses 

the vertebrae in the neck, can cause irreversible damage at the cervical level of the spinal cord and below. Paralysis of most of the 

body including the arms and legs, called quadriplegia, is the likely 

result. Automobile accidents are often responsible for spinal cord 

damage in the middle back—the thoracic or lumbar area—which 

can cause paralysis of the lower trunk and lower extremities, called 

paraplegia. 

Most injuries to the spinal cord do not completely sever the spinal cord. Instead, an injury is more likely to cause fractures and 

compression of the vertebrae, which then crush and destroy the 

axons, extensions of nerve cells that carry signals up and down the 

spinal cord between the brain and the rest of the body. An injury 

to the spinal cord can damage a few, many, or nearly all of these 

axons. Some injuries will allow almost complete recovery, while 

others will result in complete paralysis. 

HEARINGS

The Committee on Energy and Commerce did not hold hearings 

on the legislation. 

COMMITTEE CONSIDERATION

The Committee on Energy and Commerce met in open markup 

session on Wednesday, March 4, 2009, and, pursuant to a motion 

by Mr. Waxman, agreed by unanimous consent to consider and apVerDate Nov 24 2008 06:41 Mar 25, 2009 Jkt 079006 PO 00000 Frm 00002 Fmt 6659 Sfmt 6602 E:\HR\OC\HR045.XXX HR045

jbell on PROD1PC69 with REPORTS
3 

prove H.R. 307 and several other bills en bloc. H.R. 307 was ordered favorably reported to the House by a voice vote. No amendments were offered during full Committee consideration of H.R. 

307. 

COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report legislation and amendments thereto. There were no recorded votes taken during consideration or ordering H.R. 307 reported to the House. 

COMMITTEE OVERSIGHT FINDINGS

Regarding clause 3(c)(1) of rule XIII of the Rules of the House 

of Representatives, the oversight findings of the Committee are reflected in this report. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

H.R. 307 states that the Director of the National Institutes of 

Health (NIH) may develop mechanisms to coordinate the paralysis 

research and rehabilitation activities of the Institutes and Centers 

of NIH in order to further advance such activities and avoid duplication of activities. H.R. 307 permits the Director of NIH to make 

awards of grants to public or private entities to pay all or part of 

the cost of planning, establishing, improving, and providing basic 

operating support for consortia in paralysis research and requires 

that the Director shall designate each consortium, funded through 

such grants, as a Christopher and Dana Reeve Paralysis Research 

Consortium. This legislation permits the Secretary of Health and 

Human Services (HHS) to study the health challenges associated 

with paralysis and other physical disabilities and carry out projects 

and interventions to improve the quality of life and long-term 

health status of individuals with such conditions. H.R. 307 permits 

the Secretary to award grants for activities related to paralysis, including to: (1) establish paralysis registries, and (2) disseminate information to the public. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee finds that H.R. 307 

would result in no new or increased budget authority, entitlement 

authority, or tax expenditures. 

EARMARKS AND TAX AND TARIFF BENEFITS

In compliance with clause 9 of rule XXI of the Rules of the House 

of Representatives, H.R. 307 does not contain any congressional 

earmarks, limited tax benefits, or limited tariff benefits as defined 

in clause 9(d), 9(e), or 9(f) of rule XXI. 


jbell on PROD1PC69 with REPORTS
4 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate on H.R. 307 

prepared by the Director of the Congressional Budget Office pursuant to section 402 of the Congressional Budget Act of 1974. 

CONGRESSIONAL BUDGET OFFICE ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House 

of Representatives, the following is the cost estimate on H.R. 307 

provided by the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974: 

H.R. 307—Christopher and Dana Reeve Paralysis Act 

Summary: H.R. 307 would authorize the appropriation of $25 

million a year for fiscal years 2010 through 2013 for the Secretary 

of Health and Human Services (HHS) to undertake activities to improve the quality of life of those with paralysis and to establish a 

population-based database to be used for paralysis research. The 

bill also would authorize the Director of the National Institutes of 

Health (NIH) to award grants to consortia focused on paralysis research and for multicenter networks focused on paralysis rehabilitation. 

CBO estimates that implementing the bill would cost $10 million in 2010 and $95 million over the 2010–2014 period, assuming the 

appropriation of the authorized amounts. Enacting H.R. 307 would 

not affect direct spending or revenues. 

The bill contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA); 

any costs to state and local governments would be incurred voluntarily. 

Estimated cost to the Federal Government: The estimated budgetary impact of H.R. 307 is shown in the following table. The costs 

of this legislation fall within budget function 550 (health). 

By fiscal year, in millions of dollars— 

2010 2011 2012 2013 2014 2010– 

2014 

CHANGES IN SPENDING SUBJECT TO APPROPRIATION 

Authorization Level ........................................................... 25 25 25 25 0 100 

Estimated Outlays ............................................................ 10 10 25 25 15 95 

Basis of estimate: For this estimate, CBO assumes that H.R. 307 

will be enacted near the start of fiscal year 2010 and that the authorized amounts will be appropriated for each year. 

HHS GRANTS FOR PARALYSIS-RELATED ACTIVITIES

H.R. 307 would authorize the appropriation of $25 million for 

each of fiscal years 2010 through 2013 for the Secretary of Health 

and Human Services to conduct studies and undertake activities to 

improve the quality of life with persons with paralysis, and to 

make grants to state and local agencies to establish a research 

database on paralysis. Based on historical spending patterns for 

similar activities, CBO estimates that implementing those programs would cost $10 million in 2010 and $95 million over the 

2009–2014 period. 


jbell on PROD1PC69 with REPORTS
5 

NIH SUPPORT FOR RESEARCH CONSORTIA

H.R. 307 would authorize the Director of the NIH to award 

grants to public or private organizations for the cost of planning, 

establishing, improving, and providing basic operating support for 

consortia focused on paralysis research. Each consortium, which 

could involve a single institution or multiple institutions, would be 

designated as a Christopher and Dana Reeve Paralysis Research 

Consortium. 

The bill also would authorize the Director of the NIH to award 

grants to public or private entities for planning, establishing, improving, and providing basic operating support for multicenter networks that would collaborate to design protocols for clinical intervention. 

According to officials at the NIH, the institutes are currently 

funding such activities. In fiscal year 2008, the NIH spent $296 

million on stroke research, $85 million on traumatic brain injury 

research, and $66 million on spinal cord injury research. Among 

the efforts funded with this money are several research networks. 

For example, the Neurological Emergency Treatment Trials network funded through the National Institutes of Neurological Disorders and Stroke seeks to engage providers on the front lines in 

emergency rooms to carry out multicenter clinical trials to understand neurological emergencies. The National Institute for Child 

Health and Human Development (NICHD) funds several research 

networks. For example, to date, NICHD has funded six grants to 

build research infrastructure in the field of medical rehabilitation. 

If H.R. 307 were enacted, the most significant change at NIH 

would likely be the naming of research consortia after Christopher 

and Dana Reeve. CBO estimates that the NIH provisions of H.R. 

307 would not have any significant cost. 

Intergovernmental and private-sector impact: H.R. 307 contains 

no intergovernmental or private-sector mandates as defined in 

UMRA. Grants and research activities authorized in the bill for the 

study and treatment of paralysis and other physical disabilities 

would benefit state and local governments. Any costs to those governments to comply with grant conditions would be incurred voluntarily. 

Estimate prepared by: Federal costs: Jamease Kowalczyk; Impact 

on state, local, and tribal governments: Lisa Ramirez-Branum; Impact on private sector: Patrick Bernhardt. 

Estimate approved by: Peter H. Fontaine, Assistant Director for 

Budget Analysis. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of federal mandates regarding H.R. 307 prepared by the Director of the Congressional Budget Office pursuant to section 423 of the Unfunded Mandates Reform Act. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act were created by H.R. 307. 


jbell on PROD1PC69 with REPORTS
6 

CONSTITUTIONAL AUTHORITY STATEMENT

Pursuant to clause 3(d)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee finds that the constitutional authority for H.R. 307 is provided in the provisions of Article I, section 8, clause 1, that relate to expending funds to provide for the 

general welfare of the United States. 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that this legislation does not relate to the 

terms and conditions of employment or access to public services or 

accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act of 1995. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

Section 1 establishes the short title of the Act as the ‘‘Christopher and Dana Reeve Paralysis Act’’. 

Section 2. Table of contents 

Section 2 contains the table of contents. 

TITLE I—PARALYSIS RESEARCH

Section 101. Activities of the National Institutes of Health with respect to research on paralysis. 

Section 101 states that the Director of NIH may develop mechanisms to coordinate the paralysis research and rehabilitation activities of the Institutes and Centers of NIH in order to further advance such activities and avoid duplication of activities. The NIH 

Director may also award grants to public or private entities to pay 

all, or part of, the cost of planning, establishing, improving, and 

providing basic operating support for consortia in paralysis research. Each consortium funded under these grants will be designated as part of the Christopher and Dana Reeve Paralysis Research Consortium. The Director of NIH may provide for the coordination of information among consortia and a mechanism to 

educate and disseminate information on the existing and planned 

programs and research activities of NIH with respect to paralysis 

and through which NIH can receive comments from the public regarding such programs and activities. 

TITLE II—PARALYSIS REHABILITATION RESEARCH AND CARE

Section 201. Activities of the National Institutes of Health with respect to research with implications for enhancing daily function 

for persons with paralysis. 

Section 201 states that the Director of NIH may make awards of 

grants to public or private entities to pay all, or part of, the costs 

of planning, establishing, improving, and providing basic operating 

support to multicenter networks of clinical sites that will collaborate to design clinical rehabilitation intervention protocols and 

measures of outcomes on one or more forms of paralysis that result 

from central nervous system trauma, disorders, or stroke. A multicenter network of clinical sites funded through this legislation may 


jbell on PROD1PC69 with REPORTS
7 

replicate the findings of network members or other researchers for 

scientific and translation purposes and may focus on areas of key 

scientific concern, including: (1) improving functional mobility; (2) 

promoting behavioral adaptation to functional losses, especially to 

prevent secondary complications; (3) assessing the efficacy and outcomes of medical rehabilitation therapies and practices and assisting technologies; (4) developing improved assistive technology to 

improve function and independence; and (5) understanding whole 

body system responses to physical impairments, disabilities, and 

societal and functional limitations. The Director of NIH may provide for the coordination of information among networks and ensure regular communication between members of the networks and 

may require the periodic preparation of reports on the activities of 

the networks and submission of reports. 

TITLE III—IMPROVING QUALITY OF LIFE FOR PERSONS WITH PARALYSIS

AND OTHER PHYSICAL DISABILITIES

Section 301. Programs to improve quality of life for persons with paralysis and other physical disabilities. 

Section 301 states that the Secretary of HHS may study the 

unique health challenges associated with paralysis and other physical disabilities and carry out projects and interventions to improve 

the quality of life and long-term health status of persons with paralysis and other physical disabilities. The Secretary may carry out 

such projects directly and through awards of grants or contracts. 

The grants or contracts may be used to fund activities such as: (1) 

development of a national paralysis and physical disability quality 

of life action plan, to promote health and wellness in order to enhance full participation, independent living, self-sufficiency, and 

equality of opportunity in partnership with voluntary health agencies focused on paralysis and other physical disabilities; (2) support 

for programs to disseminate information involving care and rehabilitation options and quality of life grant programs supportive of 

community-based programs and support systems for persons with 

paralysis and other physical disabilities; (3) collaboration with 

other centers and national voluntary health agencies to establish 

a population-based database that may be used for longitudinal and 

other research on paralysis and other disabling conditions; and (4) 

the replication and translation of best practices and the sharing of 

information across states, as well as the development of comprehensive, unique, and innovative programs, services, and demonstrations within existing state-based disability and health programs of the Centers for Disease Control and Prevention, which 

are designed to support and advance quality of life programs for 

persons living with paralysis and other physical disabilities. For 

the purpose of carrying out Title III, there are authorized to be appropriated $25,000,000 for each of the fiscal years 2010 through 

2013. 

Æ 


jbell on PROD1PC69 with REPORTS