"Giffords Begins A New, Arduous Phase Of Recovery"

SCOTT SIMON, host:

This is WEEKEND EDITION from NPR News. I'm Scott Simon.

Congresswoman Gabrielle Giffords left Tucson yesterday, nearly two weeks to the day that she was shot at a community event there. She's now at a Houston medical center where she will start her rehabilitation, which could last for several months.

As Representative Giffords was being to an Air Force base outside of Tucson, people lined the streets and cheered. Tucson surgeon, Randall Friese made the trip to Houston with Gabby Giffords.

Dr. RANDALL FRIESE (Surgeon, University of Arizona Medical Center): When we were traveling through the streets of Tucson, there was several times we could hear applause in the ambulance with Gabby, and she responded very well to that, smiling and, in fact, even tearing a little bit. It was very emotional, and very special.

SIMON: Representative Gifford's husband, the astronaut, Mark Kelly, accompanied her aboard a private jet along with family members, a nurse, and doctors from both Tucson and Houston. At the Memorial Hermann Medical Center in Houston, neurosurgeon Dong Kim said at a press conference that he was impressed with how well Representative Giffords is doing.

Dr. DONG KIM (Neurosurgeon, Memorial Hermann Medical Center, Houston): She looks spectacular in all ways. She came into the ICU and she was alert, awake, calm, she looked comfortable.

SIMON: But as optimistic as her doctors seem to be, they say that Representative Giffords is just starting down a long and arduous road.

NPR's Richard Knox looks at what her rehab might be like.

RICHARD KNOX: It's been quite a week for Gabrielle Giffords, her family, her medical team, and the millions of Americans who have followed her progress through daily press conferences.

This is woman who was brought into a Tucson hospital comatose with a gunshot wound that passed through clear through her brain. But by the end of the week, she was sitting up in a chair. Physical therapists got her to her feet and even outside in the sun.

She's reportedly scrolled through photos on an iPad and looked at get well cards. She's picked out different stuffed animals, and identified objects by color.

When Giffords arrived in Houston, Dr. Gerard Francisco, who will lead the rehab team, couldn't have been more upbeat.

Dr. GERARD FRANCISCO (Chief Medical Officer, Memorial Hermann Medical Center, Houston): She has great rehabilitation potential. I think those three words will sum it up, great rehabilitation potential. She will keep us busy, and we will keep her busy as well.

KNOX: That's just a hint of what Giffords faces over the next months. Dr. Steve Williams, the chief of rehabilitation medicine at Boston Medical Center, he's been following Giffords' case.

Dr. STEVE WILLIAMS (Chief of Rehabilitation Medicine, Boston Medical Center): I tell patients when they arrive that they're going to work harder than probably they've ever worked in their lives. They'll work to the point of exhaustion, but the payoff is very good in the end.

KNOX: Despite the encouraging signs, there's a lot that doctors don't know about the extent of Giffords' brain injury. For instance, they're not sure how much damage has been done to the areas that control her right arm and leg. Doctors say right now they appear severely weakened or paralyzed, so a lot of work will focus on that.

But the biggest questions have to do with her cognitive, or thinking ability. She's already demonstrated much of that is intact. She can follow simple commands, such as, raise your hand. To find out more, Williams says the Houston team will need to put her through progressively more complicated tests.

Dr. WILLIAMS: To follow a command that has many processes such as, close your eyes, stick out your tongue, and raise your hand, she needs to remember the sequence of events. She needs to be able to perform all the events, and that's a complex task.

KNOX: And specialists will also test her ability to think abstractly. That's not easy with someone who isn't yet able to talk. But Jeffrey Wertheimer at Cedars-Sinai Medical Center in Los Angeles says there are yes-or-no questions that can get at that.

Dr. JEFFREY WERTHEIMER (Neuropsychologist, Cedars-Sinai Medical Center, Los Angeles): I may say, does the moon burn your skin? Okay. So I may throw something a little more complex, a little more ambiguous, it's little more abstract.

KNOX: Wertheimer, a neuropsychologist, says different tests probe the ability of brain-injured patients to concentrate.

Dr. WERTHEIMER: When you have left-hemisphere damage, going from the left eyebrow area back, one can expect some difficulties with attention and concentration. So we may be more vulnerable to distraction.

KNOX: Once Giffords can speak, assuming she does, Williams says she'll be asked to do endless mental drills.

Dr. WILLIAMS: So the patient does the same task over and over and over so that they really learn and it maps into their memory.

KNOX: So this is sort of like cognitive calisthenics.

Dr. WILLIAMS: Yes. So it's kind of like when we were all in second grade, and we were doing multiplication tables time and time and time again and singing the songs so that we could remember that two times two was four and two times three was six.

KNOX: All this will take many months. Progress can go in fits and starts. It's not possible to know how far a given patient will get, or how fast.

Dr. WILLIAMS: One of the parts that is most difficult, I think, is waiting waiting to see what happens. We look for the brain to be able to take over functions for areas that were injured. And all that takes time.

KNOX: Williams says the best strategy is to set achievable, short-term goals and let those achievements add up over time.

Richard Knox, NPR News.