SUNDAY, Jan. 23 (HealthDay News) -- The beginning of Rep.
Gabrielle Giffords' intensive rehabilitation may be delayed until
the end of this week because of fluid buildup in her brain, one of
her doctors said Saturday.
Dr. John Holcomb, a trauma surgeon and retired Army colonel,
UPI that they will have to decide whether a catheter draining
the fluid can be removed and Giffords can be transferred to the
reknowned Institute of Rehabilitation and Research in Houston, or
if a permanent shunt needs to be inserted. On Friday, Giffords was
flown to Houston to begin her long road to recovery following a
gunshot wound to her brain two weeks ago.
"No one expects her to go rapidly to TIRR," Holcomb, vice chair of surgery and chief of the acute-care surgery division at the University of Texas Medical School at Houston, told UPI. "We just have to wait and see if the fluid buildup issue resolves itself."
The fluid buildup had decreased some on Saturday and doesn't
appear to be infected, he added.
Last week, staffers at University Medical Center in Tucson
brought the 40-year-old Giffords to a deck at the hospital, where
she breathed fresh air and felt the sun, trauma surgeon Dr. Peter
Rhee said, the
Associated Press reported.
"I saw the biggest smile she could gather," Rhee said. "We are very happy to have her enjoying the sunshine of Arizona."
Giffords has been making surprisingly strong progress since she
was shot in the head Jan. 8. Her doctors in Tucson highlighted
other signs of her continuing improvement -- she scrolled through
an iPad, identified different colored objects and moved her lips.
Still, they aren't sure if she is mouthing words, and they don't
know how well she can see, the
Her husband, astronaut Mark Kelly, believes she has tried to
speak and can recognize those around her. "I can just look in her
eyes and tell," Kelly said at a final briefing Thursday at the
Tucson hospital. "She is very aware of the situation."
The encouraging medical updates out of Tucson indicate that
Giffords has a high level of motor and emotional function, experts
"The fact that she is able to communicate, that she is able to stand and walk, the fact that she is moving both hands is a good thing," said Dr. Kester Nedd, an associate professor of neurology and director of neuro-rehabilitation at the University of Miami Miller School of Medicine.
"Motor function is a very strong predictor of outcome," he said. In addition, her ability to express emotion and interpret human interactions, which are some of the highest levels of cognitive function, means her chances of recovery are very good, Nedd added.
Giffords was one of 18 people shot by a gunman outside a Tucson
supermarket. Six people died. On Wednesday, a federal grand injury
indicted the suspect, Jared Loughner, 22, of Tucson, on charges of
attempting to assassinate Giffords and trying to kill two of her
Giffords' rehabilitation will take place at TIRR Memorial
Hermann Hospital in Houston. This is one of the best rehabilitation
centers in the country, said Dr. Steve Williams, chief and chairman
of the department of rehabilitation medicine at Boston Medical
Center and professor and chairman of rehabilitation medicine at
Boston University School of Medicine.
"The key things with neurological injuries are when people begin to show signs of recovery very early," Williams said Thursday. "Very early in the ER she was able to squeeze the physician's hand and she has responded to simple commands, and yesterday she was standing."
"The issue is really going to be cognitive function, which is complex reasoning and abstract thinking," added Williams, who was not involved in her treatment but has studied the injury reports so far made public.
Physically, Giffords is making great progress, Williams said,
but the full extent of her injuries is still unknown.
Nedd noted that Giffords is already starting at a very high
level of functioning. "She was blessed," he said. "A lot of the
force of the bullet that struck her was dissipated by the skull and
the bullet exiting," he said. Also the injury was not to the deep
brain, he added.
Once Giffords is settled in Houston -- where her astronaut
husband lives -- the medical staff will evaluate Giffords' physical
and mental abilities, Williams said.
One of the first steps in rehabilitation is to help patients
regain the ability to take care of themselves. "This is called
activities of daily living," Nedd said.
Giffords' rehabilitation will most likely center on her speaking
ability and the processes of thinking, Williams said. She may be
given medications, such as Ritalin, to stimulate the brain, he
One rehab goal is to retrain the brain to take over functions
that may have been lost or damaged by trauma, experts said. This is
done through repetition, Nedd said. "The brain has the ability to
shift function from one part of the brain to another," he said.
Giffords will probably remain at TIRR Memorial Hermann for a
month or two, then continue rehabilitation on an outpatient basis,
perhaps for a year or more, Williams said.
Giffords, a Democrat, was elected to the House of
Representatives in 2006.
Her survival has astounded experts, including Dr. David Langer,
director of cerebrovascular research at the Cushing Neuroscience
Institutes, part of North Shore/Long Island Jewish Medical Center
in Great Neck, N.Y.
Ninety percent of people with gunshot wounds to the head die,
For more information on traumatic brain injury, visit the
U.S. National Institutes of Health.