Rep. Gabrielle Giffords advances in rehab with music therapy
Wounded U.S. Rep. Gabrielle Giffords is walking with a shopping cart, playing tic-tac-toe and mouthing songs less than three weeks into her brain rehabilitation in Houston, according to an e-mail from her mother.
Since the congresswoman arrived on Jan. 26 at TIRR Memorial Hermann, her doctors and staff have been surprised at the "amazing things" that have happened, Gloria Giffords wrote friends in the e-mail, a copy of which was obtained by the Houston Chronicle.
"From a kind of limp noodle when you last saw her, she's alert, sits up straight with good posture ... and is working very hard," Giffords wrote last week. She later added, "As you may expect, little Miss overachiever is healing very fast."
Giffords wrote that doctors are planning to operate on her daughter again soon to replace a piece of her skull that was removed to reduce pressure and prevent secondary injuries as her brain swelled after the shooting. The "brain's losing that swelling," she wrote.
Giffords, who lives in Tucson, Ariz., but has been in Houston for much of her daughter's rehab, wrote that it was music therapy that "really flipped the switch." She mouthed Twinkle, Twinkle, Little Star and I Can't Give You Anything But Love as friends provided keyboards and chorus. She also lip-synced Happy Birthday to You in a videotape for her husband, League City astronaut Mark Kelly. Giffords wrote that they were planning to do Deep in the Heart of Texas next.
She also wrote that doctors are certain the bullet that tore through the left side of her daughter's brain did not directly affect speech centers.
Rep. Giffords was one of 19 people shot, six fatally, in a gunman's rampage outside a Tucson supermarket Jan. 8.
TIRR doctors would not confirm any details contained in the e-mail, but Dr. Gerald Francisco, the rehab center's chief medical officer and coordinator of the congresswoman's care, said Monday that Giffords is "very engaged in her rehab program and is recovering quite well."
Brain rehab specialists not involved in Giffords' care said news of her progress is encouraging but cautioned that it is clear she still has "significant deficits" that will not be overcome soon. One noted that Giffords' ability to speak is coming at an appropriate stage of her rehab but stressed that she is not speaking fluently yet.
"Those of us who do rehab day in and day out know it's a labor-intensive business in which improvement doesn't come suddenly, like with surgery or clot-busting drugs," said Dr. Richard Riggs, chairman of the physical medicine and rehabilitation department at Cedars-Sinai Medical Center in Los Angeles. "It comes over months, quarters of years and even years."
Speech, physical therapy
C.J. Karamargin, Giffords' spokesman, said "the congresswoman's mother has captured what we on her staff all know and that is that the congresswoman is working very hard. She is very determined and she is making great progress."
Gloria Giffords wrote that in addition to speech therapy, her daughter works every day on coordination, reflexes and muscle tone, performing squats, pushing the cart and other exercises. Her speech therapy involves forming shapes with her mouth.
Giffords does two sessions each of physical and speech therapy a day, between which "she's wrung out and takes a nap," her mother wrote.
Gloria Giffords noted that her daughter's visitors have included members of Congress and that she "wouldn't be surprised if President Bush Sr., who's already met with Mark, might drop later for a quick chat." But she added, "We're trying to keep it down so she's not distracted or exhausted."
Giffords wrote most enthusiastically about the sing-alongs, comparing the scenes to a tent show revival with everyone "clapping and hooting" and "an Andy Hardy movie, where (Mickey) Rooney declares my dad's got a barn ... let's put on a show."
Singing is a standard technique used with brain-injury patients having trouble putting several words together, Riggs said.
Francisco said first words are a milestone for brain-injury patients but cautioned that there is no one predictor of rehab success. Rayna Boh- mann, a speech pathologist at Baylor College of Medicine and Ben Taub General Hospital, said she has seen patients who did not speak for a year but then recovered; others spoke the day after brain trauma but years later could not manage routine tasks.
Kelly, in an interview with NBC, said Giffords has begun responding to questions often before they are completed. When asked to identify pictures of Presidents Barack Obama, George Bush and George Washington, she did not hesitate, he said.
"Before she was asked the question she picked up the card and held it up and said, 'George Bush,' " Kelly said. "So, she's a hard worker. She's trying and she's speaking a lot, and at some level they're even asking her to slow down a little bit."
Gloria Giffords, who returned to Houston on Monday after four days in Tucson, wrote in the e-mail that she plans to help her daughter and Kelly, who is at the Johnson Space Center from 8 a.m. to 5 p.m. every day, training for the last launch of the shuttle Endeavour on April 19.
"I'm here to provide support for Mark so he can finish his mission and help Gabby get back to work (so) she can finish hers," Giffords wrote.
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