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Rep. Giffords' Intensive Rehab Under Way
Date:1/27/2011

THURSDAY, Jan. 27 (HealthDay News) -- Arizona Congresswoman Gabrielle Giffords began intensive rehabilitation therapy in Houston Thursday, another stunning step forward for the lawmaker who was shot in the brain earlier this month.

The therapy at TIRR Memorial Hermann Hospital could last several months. As a first move, to help her talk, doctors planned to insert a valve into her breathing tube, the Associated Press reported.

Doctors, however, have not confirmed that Giffords is actually able to speak. "We can say that her speech function, along with everything else, is improving," neurosurgeon Dr. Dong Kim told the AP, but he would not elaborate.

Giffords was transferred to TIRR Wednesday from a nearby hospital, where she was in intensive care because of a buildup of fluid in her brain. But late Wednesday, doctors announced that, prior to her transfer, they had removed the catheter used to drain the fluid, the AP reported.

The congresswoman has been making surprisingly strong progress since she was shot in the head Jan. 8. Before being cleared for rehabilitation in Houston, she was hospitalized at University Medical Center in Tucson where she scrolled through an iPad, identified different colored objects and moved her lips. Still, they weren't sure if she was mouthing words, and they didn't know how well she can see, the AP reported.

The encouraging medical updates out of Tucson indicated that Giffords has a high level of motor and emotional function, experts say.

"The fact that she is able to communicate, that she is able to stand and walk, the fact that she is moving both hands is a good thing," said Dr. Kester Nedd, an associate professor of neurology and director of neuro-rehabilitation at the University of Miami Miller School of Medicine.

"Motor function is a very strong predictor of outcome," he said. In addition, her ability to express emotion and interpret human interactions, which are some of the highest levels of cognitive function, means her chances of recovery are very good, Nedd added.

Giffords was one of 18 people shot by a gunman outside a Tucson supermarket, where the 40-year-old, three-term lawmaker had been meeting with constituents. On Monday, the suspect in the shootings, Jared Loughner, 22, of Tucson, pleaded not guilty to federal charges of attempting to kill Giffords and trying to kill two of her aides, the AP reported.

TIRR Memorial Hermann Hospital in Houston is one of the best rehabilitation centers in the country, said Dr. Steve Williams, chief and chairman of the department of rehabilitation medicine at Boston Medical Center and professor and chairman of rehabilitation medicine at Boston University School of Medicine.

Nedd noted that Giffords is already starting at a very high level of functioning. "She was blessed," he said. "A lot of the force of the bullet that struck her was dissipated by the skull and the bullet exiting," he said. Also the injury was not to the deep brain, he added.

One of the first steps in rehabilitation is to help patients regain the ability to take care of themselves. "This is called activities of daily living," Nedd explained.

Giffords' rehabilitation will most likely center on her speaking ability and the processes of thinking, Williams said. She may be given medications, such as Ritalin, to stimulate the brain, he said.

One rehab goal is to retrain the brain to take over functions that may have been lost or damaged by trauma, experts said. This is done through repetition, Nedd said. "The brain has the ability to shift function from one part of the brain to another," he said.

Giffords will probably remain at TIRR Memorial Hermann for a month or two, then continue rehabilitation on an outpatient basis, perhaps for a year or more, Williams said.

Giffords, a Democrat, was elected to the House of Representatives in 2006.

More information

For more information on traumatic brain injury, visit the U.S. National Institutes of Health.

SOURCES: Steve Williams, MD, chief and chairman, department of rehabilitation medicine at Boston Medical Center and professor and chairman, rehabilitation medicine, Boston University School of Medicine; Kester Nedd, D.O, associate professor, neurology and director of neuro-rehabilitation, University of Miami Miller School of Medicine; Associated Press


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