Rep. Gabrielle Giffords has begun the next phase of her recovery.
Nearly two weeks to the day after she was shot in Tucson, the Arizona congresswoman traveled Friday by ambulance, private jet and helicopter to Houston, where she will undergo lengthy rehabilitation at TIRR Memorial Hermann Hospital, which specializes in the treatment of people with severe head injuries.
As she left the University of Arizona Medical Center, where she was admitted near death on Jan. 8, people lined the streets and cheered.
"There were several times we could hear applause in the ambulance," says Dr. Randall Friese, a surgeon who made the trip with Giffords, family members and other members of the medical team. "Gabby ... responded very well to that, smiling and, in fact, even tearing a little bit. It was very emotional, very special."
At the other end of the journey, Houston neurosurgeon Dong Kim was impressed at how well Giffords is doing.
"She looks spectacular — in all ways," Kim says. "She came into the ICU and she was alert, awake, calm; she looked comfortable. We were testing the vision; she didn't like us shining the light in her eye, wanted to keep them closed. And these are all very good signs."
In the past week, Giffords has shown progress every day, say her doctors and her husband, astronaut Mark Kelly.
"Every time I interact with her, there's something quite inspiring," Kelly said at a Thursday press conference at the Tucson medical center. "In two months, you'll see her walking through the front door of this building."
By the end of this week, she was sitting up in a chair. Physical therapists got her to her feet and even outside in the sun. Doctors said she was able to pick out different stuffed animals and identify objects by color. And people marveled when she scrolled through photos on an iPad.
When Giffords arrived in Houston, Dr. Gerard Francisco, who will lead the rehab team, couldn't have been more upbeat.
"She has great rehabilitation potential," Francisco says. "She will keep us busy, and we will keep her busy as well."
Indeed they will, say experts in the rehabilitation of brain-injured patients. As optimistic as her doctors are, they say Giffords is just starting down a long and arduous road.
"I tell patients when they arrive that they're going to work harder than probably they've ever worked in their lives," says Dr. Steve Williams, head of rehabilitation medicine at Boston Medical Center, who is not involved in Giffords' case but has followed it closely. "They'll work to the point of exhaustion, but the payoff is very good in the end."
Dealing With The Unknown
There's a lot that doctors don't know yet about the extent of Giffords' brain injury. For instance, they're not sure how much damage has been done to the areas that control her right arm and leg. Doctors say right now they appear severely weakened or paralyzed, so a lot of work will focus on that.
But the biggest questions have to do with her cognitive, or thinking, ability.
She's already demonstrated that much of her cognition is intact. She can follow simple commands, such as "raise your hand." To find out more, Williams says the Houston team will need to put her through progressively more complicated tests.
"To follow a command that has many processes, such as 'close your eyes, stick out your tongue, and raise your hand,' she needs to remember the sequence of events," Williams says. "She needs to be able to perform all the events, and that's a complex task."
Specialists will also test her ability to think abstractly. That's not easy with someone who isn't yet able to talk. But Jeffrey Wertheimer of Cedars-Sinai Medical Center in Los Angeles says there are yes-or-no questions that can get at that.
"I may say, 'Does the moon burn your skin?'" Wertheimer says. "I may throw something a little more complex, a little more ambiguous, a little more abstract."
Wertheimer, a neuropsychologist and expert in gunshot wounds to the brain, says different tests probe the ability of such patients to concentrate.
"When you have left-hemisphere damage, going from the left eyebrow area back, one can expect some difficulties with attention and concentration," Wertheimer says. "We may be more vulnerable to distraction."
'Waiting To See What Happens'
Once Giffords can speak, assuming she does, Williams says she'll be asked to do endless mental drills — basically, cognitive calisthenics.
"The patient does the same task over and over and over so that they really learn and it maps into their memory," he says. "It's kind of like second grade, doing multiplication tables time and time and time again and singing songs so we could remember that two times two is four and two times three is six."
All this will take many months. Progress will go in fits and starts. There can be complications, such as seizures. It's not possible to know how far a given patient will get, or how fast.
"One of the parts that is most difficult, I think, is waiting — waiting to see what happens," Williams says. "We look for the brain to be able to take over functions for areas that were injured. And that takes time."
Williams says the best strategy is to set achievable, short-term goals — and let those achievements add up over time. Copyright 2011 National Public Radio. To see more, visit http://www.npr.org/.