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Entries in Tucson (4)

Thursday
Jun162011

Giffords’ Prognosis Good, but Continued Recovery Won't Come Easy

P.K. Weis/Giffords Campaign - P.K. Weis via Getty Images(HOUSTON) -- Although Rep. Gabrielle Giffords has come far enough in her recovery to leave the rehabilitation center where she spent the past five months, doctors agree she is only at the beginning stages of her rehabilitation.

She will start outpatient therapy soon, which is likely to include speech, occupational, and physical therapy a few days a week. Experts believe her continued rehabilitation will take a long time as she attempts to recover many of the skills and abilities she lost after being shot in the head in January.

"The time frame for outpatient therapy is long, with her program continuing to be adjusted as she improves. Years of treatment is not unusual," said Dr. Brian Greenwald, assistant professor of rehabilitation medicine at The Mount Sinai Medical Center in New York. "Despite the fact that the most rapid recovery occurs in the first year, recovery continues for a long time to come."

"You need to consider rehabilitation as a parallel process to normal child development," said Dr. Gregory O'Shanick, president and medical director of the Center for Neurorehabilitatoin Services in Richmond, Va. "Children learn to control their motor and balance systems at an earlier stage than they are able to speak, read or conceptualize. Giffords' rehab has gotten her back to walking and indicating her needs in a fundamental level."

The most critical issue, he said, is to get her to the point where she can solve problems and reason the way adults do. Giffords also has to continue working toward regaining her ability to function as she did before she was shot.

"Recovery can be in the form of regaining the ability to do things in the same way that she did before as well as adapting to or compensating for persistent deficits," said Dr. Thomas Watanabe, clinical director of the Drucker Brain Injury Center in Elkins Park, Pa.

Giffords may actually do better now that she's able to go home.

"The literature shows that people often do better with cognitive outpatient therapy after reaching a certain level than with inpatient. This is because they are in more familiar surroundings and are ready for the challenges of being home," said Dr. Steve Williams, chairman of the Department of Rehabilitation Medicine at Boston University School of Medicine.

Despite the progress she has already made, the Arizona congresswoman may never recover some functions.

"Rep. Giffords may never fully recover the prior fluency of her communication abilities, but there can continue to be improvement with therapy," said Dr. Lori Shutter, associate professor of clinical neurosurgery and neurology at the University of Cincinnati Medical Center.

While she may recover physically, she also has to overcome psychological damage.

"The psychological recovery will likely take even longer," said Dr. Charles Liu, director of neurosurgery at Rancho Los Amigos National Rehabilitation Center in Downey, Calif. "The psychological recovery will obviously be impacted by her evolving role as a high-profile victim of gunshot wound to the head.

Giffords had the advantage of remaining at an inpatient rehabilitation center for five months, much longer than others who don't have the same insurance coverage or financial resources.

"As a rehabilitation physician, I always want the patient to stay as long as possible as long as medical gains and improvements are being made," said Dr. Michael Huou, assistant professor of clinical neurology and neurological surgery at the University of Southern California's Keck School of Medicine in Los Angeles. "Unfortunately, the length of stay is generally dictated by the insurance company which typically wants the patient to be discharged home or to a [nursing home] in a much quicker time frame."

Most insurance companies also only pay for about a month of outpatient rehabilitation, but doctors believe Giffords will likely get much more than that.

No one can be sure how far she will progress, and she'll be working to recover for the rest of her life.

"Brain injury rehab is a lifelong process, and she'll need to work on it every single day," said Dr. Brent Masel, national medical director of the Brain Injury Association of America.

Copyright 2011 ABC News Radio

Tuesday
Mar082011

Music Therapy Helps Gabrielle Giffords Find Voice After Shooting

Douglas Graham/Roll Call/Getty Images(HOUSTON) -- It has been two months since the Tucson shooting spree that killed six people and injured 12, including Arizona Rep.Gabrielle Giffords.  Now Giffords, who survived a gunshot wound to the left hemisphere of her brain, is finding her voice through song.

"Gabby responds to music because she knows a lot of songs," said Maegan Morrow, Giffords' music therapist and a certified brain injury specialist at TIRR Memorial Hermann Rehabilitation Hospital in Houston.

Since Giffords was transferred to TIRR on Jan. 21, reports of her singing "Happy Birthday" for husband Mark Kelly and Don McLean's "American Pie" have signaled what some have called a miraculous recovery.

"The brain can heal itself if you do the right protocol," Morrow said.  "It just needs lots of repetition, lots of consistency."

Protocols like music speech stimulation and melodic intonation therapy can help patients with damage to the brain's communication center, like Giffords, learn to speak again.

"It's creating new pathways in the brain," Morrow said.  "Language isn't going to work anymore, so we have to go to another area and start singing and create a new pathway for speech."

Music therapy was first recognized as a tool to aid soldiers returning from World War II with brain injuries.

"It was discovered that music was more than a diversion or recreational activity -- it could be incorporated into the overall treatment of an individual," said Al Bumanis, director of communications for the American Music Therapy Association.  "It could address non-musical goals in a very unique way -- sometimes coming in through the backdoor where some therapies can't."

Indeed, a person who has suffered an injury due to stroke or trauma may have difficulty speaking but be able to sing.

"Patients can be essentially mute, unable to utter a single word but put on the Beatles' "All You Need is Love" and suddenly patients can sing.  Substitute some of the words and now patients are speaking again," said Dr. Michael De Georgia, director of the Centers for Neurocritical Care and Music and Medicine at University Hospitals Case Medical Center.  "Music is very powerful."

Copyright 2011 ABC News Radio

Monday
Jan102011

Gabrielle Giffords in Medically-Induced Coma to Help Brain Recover

Photo Courtesy - Tom Willett/Getty Images(TUCSON, Ariz.) -- Doctors say that while the bullet that struck Arizona Rep. Gabrielle Giffords did not hit any critical parts of the brain, whether she will survive and how fully she will recover are still unknown.

"This was a devastating wound that traveled the length of the brain on the left side," Dr. Peter Rhee, trauma director at University Medical Center in Tucson, said during a press conference.  Giffords' family confirmed to ABC affiliate KTRK that the bullet entered the back of her head and exited through her forehead.

Giffords is currently in a medically induced coma that doctors say will help her brain rest.  She had surgery to stop the bleeding and help control swelling on the left side of the brain.  Doctors also had to decompress her eyes.  Eyelids often swell when there is trauma to the brain.

"Brain swelling is the biggest threat at this point," said Dr. Michael Lemole, chief of the the division of neurosurgery at the University of Arizona.  To help control swelling, part of Giffords skull was removed and will be reimplanted, possibly in a few months.

Giffords was awakened periodically and she has made nonverbal responses to simple commands, but Rhee said she has not spoken because she is on a ventilator.

Lemole said Giffords was able to squeeze a doctor's hand and hold up fingers when asked, and these responses are good signs.

The next few days and weeks will be critical to determine how much brain function Giffords has lost, if any.  Doctors will keep an especially close eye on the level of brain swelling and also on her ability to recover speech and movement on the right side of her body, which are controlled by the left side of the brain. 

Copyright 2011 ABC News Radio

Sunday
Jan092011

Surviving Gunshot to Brain Is Possible, Say Doctors

Photo Courtesy - Getty Images(TUCSON, Ariz.) -- Despite being shot in the head with a bullet that went through her brain, it's entirely possible for Arizona Rep. Gabrielle Giffords to survive her injury, neurosurgeons believe -- though without knowing the trajectory of the bullet, they say, it's difficult to predict how fully she will recover.

Twenty-two-year-old Jared Lee Loughner allegedly shot Giffords and several other people at a political event outside an Arizona grocery store Saturday morning. Six people have died, including a federal judge and a child.

Giffords survived and is now receiving treatment at Tucson's University Medical Center. The medical center's trauma director, Dr. Peter Rhee, says he is "optimistic" about Giffords' chances of survival.

There are a number of different scenarios that make it possible to survive a gunshot to the brain.

"If it's a glancing blow that injures the skull and a small amount of brain and doesn't go directly through the whole brain is one case," said Dr. Paul Vesta, director of neurocritical care at Ronald Reagan UCLA Medical Center in Los Angeles. "People can also survive with parts of the brain missing."

Giffords is at risk for seizures, a stroke and more bleeding.

"[There will also be] two weeks of dealing of ICU [intensive care unit] issues, infections and pulmonary embolism [clot to the lungs]," said Dr. John Boockvar, associate professor of neurological surgery at New York-Presbyterian/Weill Cornell Medical Center in New York.

After that, doctors say it will take a couple of months to determine if there has been any loss of brain function and how extensive it is. The fact that Gifford is only 40 years old works in her favor, since younger people tend to recover more easily.

"It is entirely possible to make a complete recovery," said Vesta.

Copyright 2011 ABC News Radio







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