Now in Houston, Giffords Faces Myriad Therapies to Regain Simple Skills

Rep. Gabrielle Giffords' ambulance passed scores of well-wishers as she was taken to Houston for the next phase of rehabilitation after being shot. Judy Woodruff discusses what therapies she faces with Dr. Alexander Dromerick of Georgetown University Hospital and Dr. Christina Kwasnica of St. Joseph's Hospital in Phoenix.

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    And to the next step in recovery for Arizona Congresswoman Gabrielle Giffords.

    Judy Woodruff has our story.


    An ambulance took Rep. Giffords from Tucson's University Medical Center this morning, the first leg of her journey to a rehabilitation hospital in Houston. The move came less than two weeks after Giffords was shot in the head outside a Tucson grocery store.

    Before the transfer, Giffords' husband, astronaut Mark Kelly, sent this tweet: "G.G. going to next phase of her recovery today. Very grateful to the doctors and nurses at UMC, Tucson P.D., Sheriff's Department. Back in Tucson ASAP."

    The ambulance headed to a nearby Air Force base, escorted by police and motorcyclists from a veterans organization. Well-wishers lined the street and waved. From there, she was flown to Houston, accompanied by Kelly, her mother, Gloria, her Tucson trauma surgeon, Peter Rhee, and a nurse. She arrived at Texas's TIRR Memorial Hermann Hospital, where her new team of doctors held a press conference late today.

  • DR. JOHN HOLCOMB, TIRR Memorial Hermann Hospital:

    She was — it certainly could have been a lot worse. She's actually doing very well. This was a tangential gunshot wound. Fortunately, it didn't go crosswise or right down through the center. It could have been a whole lot worse, and clearly didn't damage large portions of her brain, did damage some portions.

  • DR. DONG KIM, TIRR Memorial Hermann Hospital:

    She looks spectacular in all ways. From a neurological point of view first, she came into ICU, and she was alert, awake, calm. She looked comfortable. I think we were already feeling some interaction, which is important.

    She's got very good movement on the left side of her body and was very purposeful. And we were testing her vision, and she didn't like us shining the light in her eye and wanted to keep them closed. And these are all very good signs.

    She also had pretty good tone in her leg, and that is a — often a precursor to much more functional recoveries. So, it was a — as I said, she just looked spectacular.

    There's varying stages of what we would call either paralysis or weakness. And, right now, she has maybe some movements of her legs. And when there's what we call tone, she might be able to support herself, but she may not be able to move it when she wants.

    On her arm at this point, we're not seeing much tone and we're not seeing any movements, but that's only over about 30 minutes. And some of her nurses have reported — and we have heard that — that she has had some movements in Tucson.

  • DR. GERARD FRANCISCO, TIRR Memorial Hermann Hospital:

    She has great rehabilitation potential. I think those three words will sum it up, great rehabilitation potential, great rehabilitation candidate. She will keep us busy, and we will keep her busy as well.

  • DR. RANDALL FRIESE, University Medical Center:

    When she squeezed my hand the first day, the most encouraging thing that I could have seen. And when I drove with her in the ambulance today and saw her reaction to the cheering in the streets, it just confirmed to me that she — she knows what's going on.

  • DR. TRACY CULBERT, University Medical Center Intensive Care Unit:

    Her personality's coming out with her touches, the way that she touches us, the way that she looks at us. And I'm very lucky to know her.


    For a deeper understanding of the role of rehabilitation in brain-injury cases, we turn to two specialists. Dr. Alexander Dromerick is co-director of the Neuroscience Research Center at the National Rehabilitation Hospital, and he practices at Georgetown University Hospital in Washington. And Dr. Christina Kwasnica is director of the neurorehabilitation program at Barrow Neurological Institute at St. Joseph's Hospital in Phoenix, Ariz.

    Thank you both for being with us.

    Dr. Dromerick, let me start with you with this new information that we heard from this medical team in Houston. And I — and I made some notes — alert, awake, calm. We just heard the nurse talk about a sense of awareness, the doctor talk about good movement on the left side of her body. They said not sure about movement in her arms, and they said she seemed to want to keep her eyes closed when they shone a light.

    So, what does all that say to you?

  • DR. ALEXANDER DROMERICK, National Rehabilitation Hospital:

    So, in the context of somebody who has had a gunshot wound to the brain, that's pretty good news. She is clearly awake for at least parts of the day. She's clearly aware of her surroundings. She's having meaningful interactions with people.

    And the left side of her — the left side of her body is moving well. It sounds like the right side is maybe not moving so well, based on what we heard from the neurosurgeon in Texas.

    But, you know, given that she is less than two weeks out from the injury, she's making pretty good progress. But it also suggests that the brain injury was pretty significant.


    And, Dr. Dromerick, they also revealed today that she has a drain in her head, excess fluid in the brain. What does that say to you?


    So, that says to me that she's having — that there's difficulty with the circulation of the spinal fluid, the cerebral spinal fluid around her brain, that it's not circulating and being reabsorbed the way it should be. And so they have to drain it off to maintain normal pressure inside — in the brain.

    And it probably means she will be in the intensive-care unit a bit longer in Texas before she actually makes the move to the rehabilitation hospital, or at least that's the typical thing that's done.


    Now, Dr. Kwasnica, they did say they would start rehab as soon as they could. They talked about starting it this afternoon. Explain for us the theory behind rehabilitation.

  • DR. CHRISTINA KWASNICA, Barrow Neurological Institute, St. Joseph’s Hospital:

    Well, it's really important to get to know what the patient can and can't do as quickly as possible.

    It's also very important to keep them mobilized. What happens is, the longer you are in bed, you have complications of being in bed. Muscles get tight. It's harder to maintain your blood pressure. You have problems with your skin. And so it's important that we get people moving and up and normalize things as early as we can, even if we have to do so in an intensive care unit where they have monitors going on.


    And — and is rehab any different for a patient with a bullet injury, a gunshot injury, than it is for other brain injuries?


    Well, it's very similar as far as what we offer to the patients. They have physical therapy, which works on getting up and moving, occupational therapy, taking care of themselves, and speech therapy.

    But what is a little bit different is that, after a surgery such as she had, they have to wear a helmet, because there is not a bone there to protect their brain. The other thing is that we are very cautious about the risk of seizures, because, in patients with gunshot wounds, they're at risk of having seizures early on and at a delayed time after their injury is pretty high.

    So, that is always a concern we have when we are taking care of these patients.


    Dr. Dromerick, they were saying as up — up to three hours of rehab right away. What — what exactly — what are some of the things they will be doing with her, what kinds of rehab?


    I would imagine they will start with the nuts and bolts, make sure she is medically stable and that there are no lurking medical problems that might interfere with her recovery.

    The next thing they will do is get her moving. When you stay in bed, you lose about 1 percent of your muscle strength per day. So she's been in bed for about two weeks. And they will begin standing her and hopefully begin walking training.

    And then the occupational therapists will focus on what we call activities of daily living: eating, dressing, bathing, going to the bathroom, those kinds of things. The speech therapists will be working on her language and her swallowing. And all of these things are practiced-based.

    They're all on the assumption that, when you practice certain kinds of activities, just like when you go to the gym, that you are going to — you are going to become more skilled at them and that the brain is going to recover more function than it would have without those activities.


    And, Dr. Kwasnica, all these therapies going on in the same — at the same time, and, say, in the same afternoon, or in succession? How does that work?


    Generally, how the day looks for our patients in rehabilitation is they get up about the same time you would normally. They have breakfast. They work with a therapist on getting dressed, so that is considered therapy, even though they are just working on getting dressed. They may work with a speech therapist on eating.

    They have breaks scheduled during the day, because this is very hard work. And so it is not three hours straight of a workout. But it's half-hour or hour blocks, depending on how the patient can tolerate it.

    Their day usually finishes up about 3:00 or 4:00, and then they're pretty tired. And most of our families will tell you that, when they come and visit the patients at the end of the day, the patients are pretty ready for a nap or for an early bedtime, because they have worked very hard during the day.


    Dr. Dromerick, in — in addition to the — to the tube, the neural tube she has, we believe she's still on a feeding tube, still has a tracheotomy. Does that affect her — the rehab?


    You know, those are pretty routine things that we deal with in a large brain injury, a rehab program. So, that's part of the stock and trade. Yes, it's more complicated. It suggests a somewhat more severe injury.

    But those are things that generally come out as the weeks go by. I would expect, in her case, given what we have heard on the news, that, over the next several weeks, those would both come out, and that there is a reasonable shot at eating by mouth and — and much more than that.


    How much heart should we take, Dr. Kwasnica, from what we heard from that nurse and another doctor, saying that — the doctor saying he — she squeezed his hand when they heard the crowd cheering in Tucson. Is there much one can tell at this stage?


    Well, I think those are all very good signs.

    I believe that we all want to — to be able to understand what a person is feeling or seeing around them, even though they can't communicate with us. And, sometimes, they communicate nonverbally first. I also think, after an injury as big as this — as this, we have only been just under two weeks. And so to be just under two weeks and to be that alert and be that aware of your surroundings is actually quite remarkable.

    So, I think we have to put it in perspective and realize that there are many injuries like this where you wouldn't be aware of what's going on around you even at the two-week point.


    And — and, Dr. Dromerick, the doctors did say, realistically, we should look for four to six months in rehab. Is that consistent with what you see, with what you know?


    You know, it's hard to know for an individual patient, without seeing them.

    Typical patients will be in the inpatient rehab hospital for a few weeks, typically somewhere between three and eight weeks. And then the real rehab actually starts after that, as an outpatient. And that can go on for months and in some cases years. So, it really depends on the individual circumstances of the person.


    And, Dr. Kwasnica, just pulling all this together, you know, I guess so many of us, and not only her family, but the rest of the country, have been hanging on every word about her condition, and thrilled with the — with the progress that she's made over the last two weeks.

    What do we expect in the way of new news, I guess I should ask, in the weeks and days to come?


    Well, I guess that we have to realize this is a very long road. And rehabilitation is about tiny little steps along that road.

    So, I would expect in the next few weeks the first thing you're going to see is her getting out of the intensive care unit and then moving to the point where she's sitting up regularly and taking some steps.

    And one of the most important goals for families and definitely for patients is to be starting to do some eating. Those are the things that are coming, and those don't come over a couple of days. Those come over — over the course of weeks.

    The — the real issue is that this is a long-term process. And it is months of rehabilitation, not just in a hospital but afterwards. And that's really where — in the outpatient setting is really where the biggest changes occur, and people go back to resuming their normal lives.


    Well, Dr. Christina Kwasnica, Dr. Alexander Dromerick, we thank you both for helping us understand it all a little bit better. Thank you.


    You're welcome.