Giffords ordeal came at dawn of new medical era

Tracy Culbert, a nurse who was treating Rep. Gabrielle Giffords in Arizona, gets support from Dr. Randall Friese while telling a story about her positive progress as Dr. John Holcomb, Dr. Dong Kim and Dr. Gerald Francisco listen during a January 2011 news conference to discuss her treatment in Houston. less Tracy Culbert, a nurse who was treating Rep. Gabrielle Giffords in Arizona, gets support from Dr. Randall Friese while telling a story about her positive progress as Dr. John Holcomb, Dr. Dong Kim and Dr. ... more Photo: Michael Paulsen Photo: Michael Paulsen Image 1 of / 3 Caption Close Giffords ordeal came at dawn of new medical era 1 / 3 Back to Gallery

When U.S. Rep. Gabrielle Giffords was shot in the head one year ago today, many thought there was little chance she would survive, let alone open her eyes, walk or talk.

But the Arizona congresswoman, who will attend a vigil on Sunday in Tucson to remember the rampage that left six dead and wounded her and 12 others, had determination, abundant resources and, most importantly, a new era in brain medicine on her side.

"We're at an evolution today with traumatic brain injury, much like where doctors were with cancer and heart disease some 40, 50 years ago," said Dr. Geoff Manley, chief of neurotrauma at the University of California San Francisco School of Medicine. "We're just now learning that people like Giffords can not only be treated but can have meaningful recoveries."

Giffords benefited from aggressive approaches to surgery and therapy born out of wars in Iraq and Afghanistan. Military doctors found that soldiers formerly dismissed as the "expectant dead" could recover with the right treatment. That approach, unheard of less than two decades ago, played a key role in Giffords' treatment and recovery.

The world also benefited from Giffords' ordeal. The spotlight on her story brought a greater awareness to a number of areas - the importance of Level 1 trauma centers, the potential of brain trauma therapy, the grueling recovery process, the need for long-term treatment to be more available to most people and the call for more research to take the field out of its infancy.

Hundreds involved

Giffords, 41, can now walk - albeit with a significant limp. She also can talk in broken speech and understand everything said to her. She still has substantial weakness on the right side of her body, a product of being shot through the left side of her brain, but she continues to improve.

Whether she has a political future hinges on her progress.

Giffords' medical journey started in Tucson and continued in Houston and North Carolina. She moved faster than expected through a series of milestones made possible by teams of surgeons, nurses, rehabilitation therapists and other specialists and support staffs.

"You're talking hundreds of people," said Dr. Brent Masel, medical director at the Transitional Learning Center in Galveston and the national spokesman for the Brain Injury Association of America. "It's an enormous project. Repairing a life is an enormous project and it takes a while."

Months of therapy

The recovery process was long and intensive, beginning with emergency responders to the shooting and a Giffords aide who kept pressure on her head wound and held her upright to prevent choking, an act her staff credits with saving her life. She underwent multiple surgical procedures at University Medical Center in Tucson and at Memorial Hermann-The Texas Medical Center. Then she engaged in months of therapy, a process that likely would've been truncated for other patients because of their insurance companies, Masel said.

The materials used to treat and rehabilitate the congresswoman included drills and scalpels used in surgery; a computer-generated synthetic implant that replaced part of her skull; plastic piping, straps and pulleys that helped to increase strength in her weakened right side; and an adapted shopping cart that helped her relearn to walk.

More Information Praise for Giffords "The fighter that she was before the shooting is the fighter that she remains today and her progress today is reflective of that." Rep. Debbie Wasserman Schultz, D-Fla., one of Giffords' closest friends on Capitol Hill who was with the congresswoman on Jan. 12, when she opened her eyes for the first time since she was shot. "When I think back to the morning of Jan. 8 and when I saw her laying on the sidewalk in front of the Safeway and I see her now, I don't think miraculous is too strong of a word. Mark Kimble, a Giffords aide who was standing within 10 feet of the congresswoman and witnessed the shooting. "Watching her progress like she has has been quite an experience. Also, getting to know the kind of person she is and watching her personality getting stronger and stronger. When she first got to the hospital, we could see that personality everyone talks about." Dr. Dong Kim, Giffords' neorologist at Memorial Hermann Hospital in the Texas Medical Center.

It wasn't cheap. The tab for her therapy alone, which was paid for by her federal employee workers' compensation insurance, has totaled about $1.26 million since she began inpatient and then outpatient work, based on daily cost estimates from the Brain Injury Association of America.

Giffords has acknowledged that most people wouldn't be able to afford such treatment, and her staff has worked with Masel and others to draw more attention to the value of extended therapy for traumatic brain injuries, said her spokesman, Mark Kimble.

A good patient

It is largely a result of her exhaustive regimen of physical, occupational, speech and music therapies, along with her and her family's positive outlook, that has allowed her to progress more quickly than expected in her recovery, said Dr. Gerard Francisco, chief medical officer at TIRR Memorial Hermann, where Giffords has been participating in therapy since Jan. 26.

While Giffords could previously only communicate in short one- or two-word bursts, she is becoming better able to talk in full sentences, said Francisco. He said she has "good days and bad days."

'She's very fortunate'

Giffords is also able to initiate questions and converse, said Dr. Nancy Helm-Estabrooks, a speech specialist who, along with another therapist, worked with the congresswoman at no cost during a two-week intensive program in Asheville, N.C. There, Giffords engaged in a range of activities designed to challenge her to express ideas by speaking, drawing, gesturing and interacting with an iPad and laptop.

The exercises have supplemented her more than 11 months of therapy through TIRR Memorial Hermann to add to her progress, Helm-Estabrooks said.

"This underscores what we've been telling people - that brain injury recovery takes place over long periods of time and have to be supported by the appropriate rehab approach," Francisco said. "She's very fortunate that she has the resources."

Other techniques she gained from were a direct result of increased exposure to brain injuries during the age of improvised explosive devices in Iraq and Afghanistan. Dr. Peter Rhee, Giffords' lead trauma surgeon in Tucson who served as a military surgeon in those countries, led the procedure to remove part of Giffords' skull in the immediate aftermath of the shooting. The procedure, pioneered in the military, relieved pressure on Giffords' swelling brain that could have been fatal. It was among a series of more aggressive approaches to surgery and treatment that have been used with wounded troops and were implemented with the congresswoman.

Manley acknowledged that treatment of traumatic brain injury still has a long way to go. Giffords has shown that recovery is possible, he noted, but now the field needs to build on the momentum - find better ways to diagnose patients and predict outcomes, produce more data on what works best and when, and pioneer even more cutting-edge treatments.

Tissue regeneration

Memorial Hermann doctors are conducting such cutting-edge research, specifically using stem cells. The research, a Department of Defense-funded trial about to enroll people who have suffered brain injuries, involves the injection of stem cells from the patients' bone marrow. Doctors hope those stem cells can regrow healthy tissue.

"Seeing patients like Gabby is really inspiring us to come up with new treatments - treatments that will return patients to normal, not just recover to a certain extent," said Dr. Dong Kim, Giffords' neurosurgeon at Memorial Hermann. "In the next 10 to 20 years, thanks to therapy that regenerates brain tissue, I think you'll see that."

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