Gabrielle Giffords is moving today to a rehabilitation facility in Houston, and the time she spends there will prove critical to her recovery. She will probably have up to five hours a day of therapy to help her brain build new connections and replace nerve cells that were destroyed by the bullet wound.
Rehabilitation is crucial for nearly everyone who suffers brain trauma, whether from a bullet wound, stroke, or surgery to remove a tumor, says Dr. Steve Williams, chairman of the department of rehabilitation medicine at Boston Medical Center. Gunshot victims, like Giffords, typically spend six to eight weeks as inpatients at rehab hospitals, he says, whereas stroke patients wind up there for an average of 21 days. Rehab time varies for tumor removal and depends on the prognosis; those with life-shortening malignancies might prefer to spend the time at home with their families.
The first few days of rehab are typically spent assessing the patient, before setting up a program that involves physical therapy (walking, balancing, standing), occupational therapy (feeding, dressing, and toileting skills), cognitive therapy (memory building, word and object recognition), and speech therapy.
In Giffords' case, extra attention will be placed on helping her brain recover higher level functions, says Williams, like problem solving and putting together complex thoughts that involve abstract ideas -- the sort of skills she relied on in her job as a congresswoman.
The big unknown with Giffords is how well she will recover her language skills, because the bullet passed close to the speech center on the left side of her brain, just above her eye. "Can she understand language? Reports say she can follow simple commands, which is good," says Williams. "But doctors will also be looking at her expressive language, whether she can use words and string them together so they make sense."
Giffords will also be assessed for how well she can gauge safety risks, he adds, since the frontal lobe of the brain where she was shot is responsible for that mental function. If she can't, say, remember to turn off the stove after heating water, she might always need someone around to supervise.
She might be able to regain those skills, though, through a lot of repetitive therapy cuing her to remember things. Often patients are given stimulants like Ritalin to help them focus through these tasks.
No question, rehab is tough. "I always tell people that itís like boot camp," says Williams, "one of hardest things they'll ever do, but the rewards are great."
Fortunately, the brain has a great deal of plasticity -- the ability to adapt and adjust when areas are damaged, by assigning other nerve cells to take responsibility for lost functions. The first six months are key, says Williams. Any function achieved after that is likely to be subtle rather than sweeping.
But early signs indicate that Giffords could make a tremendous recovery. She has reportedly stood up without assistance, given her husband a neck rub, looked at photos on an iPad. "Things, thus far, have been very positive," says Williams.
June 6, 2011
By Deborah Kotz, Globe Staff Bean sprouts are likely to blame for the E. coli outbreak in Germany …
June 4, 2011
By Carolyn Y. Johnson, Globe Staff A drug that blocks production of the hormone estrogen cut breast …
June 10, 2011
By Deborah Kotz, Globe Staff Quick quiz: What's the most dangerous spot in the house? Sure, kitche …
June 9, 2011
By Elizabeth Comeau, Boston.com Staff loading video... (please wait a moment)Requires Adobe Flash …
May 16, 2011
By Deborah Kotz, Globe Staff No question, most of us sit way too much, and that's not good for our …
April 26, 2011
By Elizabeth Comeau, Boston.com Staff Last week, I asked you how you find the time to stay …
June 10, 2011
Greene, Bill Globe Staff/The Boston Globe By Deborah Kotz, Globe Staff I was bummed to hear th …
June 6, 2011
By Deborah Kotz, Globe Staff A new research finding could help parents and public health specialis …