A long road to healing

Published Sunday, Jan. 16, 2011

As Rep. Gabrielle Giffords' condition continues to improve she moves closer to beginning intensive therapy that will be part of her rehabilitation, those with expertise in addressing brain injuries say.

In general people who have survived injuries such as Giffords are good candidates for rehabilitation, said Dr. Austin Colohan, chief of the department of neurosurgery at Loma Linda University Medical Center.

However, "recovery can take several years," Colohan said.

The Scripps College graduate was shot in the head outside a Tucson supermarket Jan. 8 when a gunman opened fire at a meet-and-greet event she was hosting.

Six people were killed. Giffords was among 13 seriously wounded.

Early on, Giffords responded to simple orders and Wednesday evening while surrounded by her husband, astronaut Mark Kelly, close friends from Congress and President Barack Obama, she opened her eyes on her own.

One of her physicians, Dr. Michael Lemole said Friday her eyes are opening more frequently and she is carrying out complex sequences of activity on her own.

Experts said that based on information from news reports Giffords will probably need physical, occupational and speech therapy along with cognitive rehabilitation.

Colohan said Giffords will probably be evaluated soon for rehabilitation if that hasn't happened already.

Before she moves on to intensive therapy her medical condition must be addressed.

Giffords will probably spend a few more days in intensive care before being moved to a hospital unit where the surroundings are closer to those of regular hospital room but is still monitored closely, said David Hovda, professor of neurosurgery at the David Geffen School of Medicine at UCLA and director of the UCLA Brain Injury Research Center.

After two to three days there she will probably be sent off to rehabilitation, Hovda said.

The gunshot injured the left side of Giffords' brain.

Her injuries, treatment and recovery depend on various factors including what side of Giffords' head the bullet entered and exited from and its trajectory, experts said.

Giffords could have problems moving her right arm, leg and foot, may have vision problems on her right side and speech problems as a result of the injury.

She may also have problems controlling emotions and may become uninhibited depending on what part of her brain suffered the greatest damage, specialists said.

Such difficulties may require cognitive therapy to help her control her emotions, Hovda said.

Patients can make great strides in their rehabilitation but they can lose ground before making progress again, Hovda said.

That can be frustrating for the family and the patient, he said.

Casa Colina Centers for Rehabilitation in Pomona has worked with military personnel who suffered traumatic brain injuries while serving in Iraq and Afghanistan.

Through its Survive and Thrive program, injured service personnel and their families both learn to adapt to the new person the injured person becomes.

Patients may say things that are inappropriate because the injury affects a part of the brain that could make them uninhibited or emotional.

Families and the patient must learn to adapt to such changes, said Dr. Sepehr Khonsari, a physician specializing in physical medicine and rehabilitation, at Casa Colina.

Family is important in the progress a patient makes, he said.

"I've seen it. Patients who don't have that support, we can never make the same progress," Khonsari said.

"It's a voice that they've heard and it triggers something."

Hovda agrees the support of the family is important.

"I'm a big believer in that," Hovda said. "I think the thing that is really important is to have a very supportive family."

Patients may become emotional at times yet "patients have every reason to be emotional," he said.

Giffords will probably experience the same thing.

"The more love she receives from family, prayers and support...it's very, very good," Hovda said.

She probably will get exhausted quickly during therapy.

The human brain represents 2 percent of the body's mass but it uses 20 percent of the body's energy, he said.

The brain is working overtime to do the work of the healthy parts and those that are injured, Hovda said.

"Now it's going to add to it" by taking on rehabilitation.

Giffords will probably benefit from going to an acute rehabilitation facility, similar to Casa Colina, where the care could include the administration of neurostimulants, Khonsari said.

Casa Colina uses medications commonly used in the treatment of conditions such as Parkinson's disease and attention deficit disorder "to stimulate the brain and try to promote recovery," Khonsari said.