Experts say Gabrielle Giffords needs year to show progress

Soon after Rep. Gabrielle Giffords emerged from brain trauma surgery, her doctors lauded her recovery from a gunshot wound as "miraculous." Three Democratic lawmakers, citing the "incredible strides" she has made since the Jan. 8 shopping-center shootings, say they will host a campaign fundraiser on March 15 for the 2012 election.

And Arizona Rep. Raul Grijalva floated the "distinct possibility" that, based on her progress so far, Giffords could run for the Senate seat to be vacated in 2012 by retiring Sen. Jon Kyl, R-Ariz.

Just weeks after a bullet tore through the left side of Giffords' brain, expectations of a full recovery are running high. They're fueled by Giffords' initial, encouraging responsiveness and by upbeat snippets of information released by her husband, astronaut Mark Kelly, staffers, family members and friends.

Despite her apparent progress, however, brain trauma experts say months may pass before anyone can reliably assess her progress and when, or if, she'll be able to take up her duties again.

"In a year's time, it will be pretty clear where she'll be," says Joel Stein, director of rehab at New York-Presbyterian Hospital. "It's not inconceivable that she would return to Congress, but it's unlikely that she will be exactly as she was beforehand."

To appreciate the challenges ahead, it's critical to understand the devastation caused by the bullet, says Mark Ashley, CEO of the Center for Neuro Skills, a chain of brain trauma rehab centers based in Bakersfield, Calif.

"You have a hundred billion brain cells," Ashley says. "Each one functions like a minicomputer with special functions assigned to it. And each one is connected with wires to every other nerve cell in the body. If we cut the cable to your computer, it can't connect to the world's computers. That's what happens here."

Giffords' recovery hinges on her brain's "plasticity," its power to lay down new nerve circuits capable of taking over duties performed by those destroyed by the bullet, Ashley and other experts say. It will take hard work and repetition to retrain her brain in this way, compressing a process that usually takes place over decades of growth and development into, at most, a year or two.

"It's the intensity of repetition that reprograms the brain," Ashley says.

The window of opportunity lasts a year or two, while the brain is healing; after that, the pace of improvement drops dramatically, he says.

Doctors not involved in her care say it's impossible to tell how well Giffords is doing, partly because the information on her progress has been so tightly controlled.

Only Giffords' husband can authorize the release of information under the federal Health Insurance and Portability and Accountability Act (HIPAA). Since Giffords' transfer to TIRR Memorial Hermann in Houston, where she's being treated, her doctors have been all but silent about the details of her case.

Some details released so far may appear more encouraging than they are, says William Weiner, chairman of neurology at the University of Maryland. Consider recent news accounts that Giffords, as part of her therapy, has been singing songs, including Don McLean's nine-minute rock classic American Pie.

Weiner says he and other professors use song to teach medical students about the quirkiness and complexity of the brain in stroke patients who've lost the power of speech.

"We'll say, 'Let's sing Happy Birthday together,' " he says, adding that the students end up with "amazed looks on their faces ... but it has nothing to do with speaking. It's a different part of the brain."

Recovery progresses in overlapping stages, from relearning physical skills and "the activities of daily living," Ashley says, to rebuilding cognitive function.

"It's a complex set of skills — your ability to think, concentrate, remember, problem-solve, reason, monitor yourself and adjust your behavior," he says. "Physical skills recover pretty quickly. Cognitive skills take the longest time to recover."

One of the biggest challenges for a person whose frontal lobe has been damaged — especially a politician — will be to regain inhibitions that prevent them from saying or doing things they would ordinarily regret, Ashley says, noting that patients don't always learn "to put the brakes on."

A study of more than 8,000 patients by the National Institute on Disability and Rehabilitation Research found that 76% of those entering rehab centers have major disabilities. One year later, 54% are still severely disabled and many require supervision.

"You're not going to be perfect after a brain injury," says Geoffrey Manley, chief of neurosurgery at the University of California-San Francisco. "That doesn't mean you won't return to your normal place in life."