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Rep. Giffords Standing Up, Set to Begin Rehab Friday
Date:1/20/2011

By Steven Reinberg
HealthDay Reporter

THURSDAY, Jan. 20 (HealthDay News) -- Rep. Gabrielle Giffords' remarkable progress, including standing up with the help of aides Wednesday, bodes well for her continued recovery at a Houston rehabilitation center, where she will be moved Friday, just 13 days after a bullet pierced her brain.

Latest reports from University Medical Center in Tucson indicate that the Arizona congresswoman is able to move both hands and communicate with those around her, although it is unclear if she can speak. All this indicates 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 said.

Giffords was one of 18 people shot by a gunman on Jan. 8 outside a Tucson supermarket. Six people died. On Wednesday, a federal grand injury indicted the suspect, Jared Loughner, 22, of Tucson, on charges of attempting to assassinate Giffords and trying to kill two of her aides, the Associated Press reported.

Giffords' rehabilitation will take place at TIRR Memorial Hermann Hospital in Houston. This 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.

"The key things with neurological injuries are when people begin to show signs of recovery very early," Williams said. "Very early in the ER she was able to squeeze the physician's hand and she has responded to simple commands, and yesterday she was standing.

"The issue is really going to be cognitive function, which is complex reasoning and abstract thinking," added Williams, who was not involved in her treatment but has studied the injury reports so far made public.

Physically, the 40-year-old Giffords is making great progress, Williams said, but the full extent of her injuries is still unknown.

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.

Once Giffords is settled in Houston -- where her astronaut husband Capt. Mark Kelly lives -- the medical staff will evaluate Giffords' physical and mental abilities, Williams said

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 said.

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.

Her survival has astounded experts, including Dr. David Langer, director of cerebrovascular research at the Cushing Neuroscience Institutes, part of North Shore/Long Island Jewish Medical Center in Great Neck, N.Y.

Ninety percent of people with gunshot wounds to the head die, said Langer.

More information

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

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


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