As plans progress to move U.S. Rep. Gabrielle Giffords (D-Ariz.) from Tucson's University Medical Center to a rehabilitation hospital in Houston, brain injury experts warn that her road to recovery is long and uncertain.
Giffords, who was shot in the head on Jan. 8 in an attack that killed six, has impressed her doctors with her recovery so far. Last Friday (Jan. 14), Giffords' neurosurgeon Michael Lemole told the press that the congresswoman's movement and behavior put her "in the exceptional category" of victims of similar wounds. Thursday (Jan. 20), doctors said Giffords had been able to stand with assistance and seemed to be able to identify the location and colors of objects in vision exercises.
The move to TIRR Memorial Hermann, a 119-bed rehabilitation facility in Houston, will mark the next stage of Giffords' recovery. In the hospital, doctors focus on stabilizing a patient's condition, said Richard Riggs, a rehabilitation specialist at Cedars-Sinai Medical Center in Los Angeles. Priorities shift in rehab.
"In the acute care hospital, you're cared for," Riggs, who is not involved in Giffords' care, told LiveScience. "In the rehabilitation hospital, you are also cared for, but you are also regaining and taking back over the functions that you can perform."
Rehabilitation centers maintain a daily schedule for their patients, Riggs said, starting with the morning grooming routine and extending to bedtime. Daily activities such as tooth-brushing and dressing are opportunities to relearn skills the brain injury may have taken. Patients also get a minimum of three hours of physical therapy, speech therapy and occupational therapy, which focuses on activities of daily life such as dressing, shopping and getting around.
"Someone with a brain injury like Congresswoman Giffords will probably get more like four or five hours a day, just because there are so many things to work on," Riggs said.
The brain tissue lost to the gunman's bullet won't come back, though the brain will reform to fill in the wounded area. However, other brain cells can sometimes take up the tasks that old brain cells were performing. Giffords was struck only on the left side, which boosts hopes that the right side of her brain will take over lost functions. This relearning and rewiring process takes time.
Progress is measured with an 18-item scaled called the FIM, a copyrighted term which used to stand for "Functional Independence Measure." Therapists assess how independent a patient is at activities such as moving around, going to the bathroom and communicating. A final assessment when the patient leaves the hospital measures how much progress he or she has made. Giffords will also get personalized goals based on her individual abilities and disabilities, Riggs said.
Rehab could take months, but the recovery progress doesn't end there. Depending on how independent they are, patients either enroll in residential or day programs to continue therapy or graduate back to home and work life.
"Brain injury is a lifelong process," said Brent Masel, the director of the Transitional Learning Center in Galveston, Texas. Patients come to the center after they complete hospital rehab. At that point, the main challenges patients face are cognitive, Masel said.
"The cognitive issues, the planning, the organizing, the sequencing, the memory, it's that kind of thing that keeps people from being able to return to society even though arms and legs are working okay," Masel told LiveScience.
Making realistic goals is the key to living with brain injury, said Mark Palmer, a traumatic brain injury survivor and founder of RealisticHope.com, a brain injury community website. Palmer was 15 years old when the car he was riding in was hit by a bus. He was in a coma for several weeks and experienced seizures after the injury which left him in chronic pain. It wasn't until 30 years later that he got therapy for his injuries. The biggest challenge was accepting that his brain injury had changed his life for good, Palmer said.
"We're all talking about her being okay and returning to normal, and you don't return to normal," Palmer said. "The gift of rehab is when you figure out that returning to yesterday isn't possible, and from this day forward I'm going to make the best possible, the most fulfilling life, I can possibly have."
His advice to Giffords: "Dream big and set your goals one little step at a time."
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You can follow LiveScience Senior Writer Stephanie Pappas on Twitter @sipappas.