What Gabrielle Giffords Can Expect When She Leaves Rehab

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P.K. WEIS/GIFFORDS CAMPAIGN, VIA ASSOCIATED PRESS

Recently released photos of a smiling Rep. Gabrielle Giffords have reassured her supporters that she is recovering well. They have also sparked much media interest — a strategic ploy by Giffords’ team, who released the images in the hopes that the press will back off the Arizona congresswoman once she is discharged from inpatient treatment next month.

It’s been just five months since a psychotic gunman shot Giffords in the head while she was meeting with constituents outside of a supermarket in Tucson in early January. Since Jan. 26, Giffords has been living in the residential rehabilitation clinic TIRR Memorial Hermann in Houston. Next month, Giffords is scheduled to leave the facility to begin outpatient therapy; her team has not determined where.

(More on TIME.com: Gabrielle Giffords: Making Progress, but Not Ready for a Comeback)

Healthland spoke with Dr. Anders Cohen, chief of neurosurgery at the Brooklyn Hospital Center about what Giffords’ release means for the rest of her recovery. According to Cohen, it’s a big sign that Giffords is well enough and strong enough to take on more of the burden of rehabilitation herself.

The inpatient portion of therapy typically involves proportionally more work from therapists than from the patient, he says. “With early [inpatient] rehab, the patient can be in a coma, they can be passive and making minimal contributions to the therapy. The therapist and machines are really assisting,” says Cohen, who has treated many people with injuries similar to Giffords’, but has not observed Giffords himself.

When the patient leaves the rehab clinic, however, the balance of the work shifts to the injured person. “With outpatient therapy, the recovering patient is a major contributor,” Cohen says. “It means they can follow commands and be interactive and they are taking the lead on their treatment.”

(More on TIME.com: Barack Obama on Gabrielle Giffords – The 2011 TIME 100)

So what does that mean for Giffords? Outpatient rehabilitation following a traumatic brain injury like hers — in which a bullet pierced the left hemisphere of her brain — will involve at least four different types of therapy: physical, occupational, speech and cognitive. Physical therapy may deal with broad weakness and atrophy in the body, involving familiar strengthening exercises like walking on a treadmill or balance-training with yoga balls.

Occupational therapy will attempt to improve Giffords’ fine motor skills: for example, relearning to button a shirt or use a remote control. These “lifestyle” tasks are meant to help reintegrate the patient to work life and home life.

Because Giffords is known to have extensive language difficulties, speech therapy will be an important part of her recovery effort. That will involve everything from strengthening muscles in the face and mouth to learning to compensate for difficulties in finding words by slowing down speech.

(More on TIME.com: VIDEO Gabrielle Giffords’ Brain Injury: The Steps to Recovery)

Based on the brain regions affected by the bullet’s path, Cohen believes that Giffords probably suffers from specific cognitive difficulties, including gaps in the right half of her field of vision and weakness on the right side of her body. “The brain is so predictable to what the injury is going to look like — it’s like real estate,” he says. These problems will require the full range of therapeutic practices.

Giffords will likely undergo intensive outpatient therapy for at least the rest of the year, Cohen estimates based on timelines of his patients’ recovery experiences. While physical therapy has a shorter timeline — until the patient reaches his or her baseline strength — occupational and cognitive therapy could go for much longer depending on the patient’s speech, memory and learning deficits.

As for where Giffords will live and under what circumstances while she continues therapy, the Houston Chronicle reported:

Giffords’ staff and family have not yet determined where she will stay and how she will participate in therapy sessions as an outpatient. Her husband, astronaut Mark Kelly, lives in League City but has been staying with a friend in Houston so he could be closer to TIRR while Giffords was undergoing treatment.

Giffords has been eager to leave TIRR and has made no secret of the fact that she wants to leave Houston and get back to Tucson as soon as possible. Friends say she longs to return and misses the charm of her desert city that she used to rush to during breaks from sessions in Washington.

(More on TIME.com: PHOTOS: Messages for the Tucson Victims)

Recently, Giffords’ chief of staff, Pia Carusone, talked with a reporter from the Arizona Republic about the possibility of the congresswoman’s return to work. It’s not clear yet whether or when that will be possible, she said. “Patients recover for the rest of their lives, but it’s the first 12 to 14 months that you make the biggest jumps,” Carusone said. “In the doctors’ minds, it’s not even close to when you begin to make the final prognosis for the quality of her life.”

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