Putting Gabrielle Giffords' Recovery In Context: Brain Injuries Vary Hugely

I was having some personal trouble with the wall-to-wall coverage of the tortuous but remarkable recovery by Rep. Gabrielle Giffords, the Arizona Congresswoman who was shot in the head in January. From ABC to The Huffington Post to our own NPR, her husband, Mark Kelly, talked about her frustrations, her indomitable attitude and her plans to get back to work. The couple’s new book is called “Gabby: A Story of Courage and Hope.”

My trouble stemmed from the many survivors of severe brain injury that I saw 20 years ago after my mother was in a terrible car accident. They sat in their beds or in wheelchairs and stared blankly, for hours on end. Taped on the walls of their rooms were photos of the vibrant people they used to be; now their bodies seemed like leftover shells with the essence removed. There was no question of courage. They weren’t present enough to be brave. There was hope — isn’t there always hope? But I came to wonder whether the stories of recovery “miracles” might not do more harm than good in some ways, because they made it even harder for families like ours to accept the reality that in fact, in a case like my mother’s, there could be no recovery — ever. Not a single word. Not even a single hand-squeeze.

I took my troubles to Dr. Ross Zafonte of Spaulding Rehabilitation Hospital, an expert on rehabilitation for traumatic brain injury and chair of Harvard Medical School’s rehabilitation department. Might it not be problematic, I asked, that in the public mind, Gabrielle Giffords will now be the image of brain injury, when her recovery is actually so extraordinary? His response, lightly distilled:

Dr. Ross Zafonte
Dr. Ross Zafonte

“I would comment that the extent of the injury, the type — as well as its mechanisms — produce variability in the injury. That fact impacts our potential for recovery, as well as our own gender, and genetics.

In other words, if I’m in an auto accident, that might be different from a blast-related military injury, different from a fall, and that has so much to do with the type of injury and the potential for recovery. We have gotten very good, in the last 15 to 20 years, at maximizing motor and cognitive potential, especially motor potential.

The variability of the injury is one of its sentinel hallmarks. Two persons could fall off a mountain. They have the same kind of injury, the same kind of treatment, from neurosurgery to the same rehabilitation department, and one is very functional and returned to banking, and the other could be severely disabled.

[module align="right" width="half" type="pull-quote"]The variability of the injury is one of its sentinel hallmarks.[/module]

The point is the personal variability: And then if we apply optimal acute and intermediate interventions, often now we get a Gabby Giffords; we get a Bob Woodward, who’s back at reporting and going all over the planet. It’s very much where and how and when. What we’re trying to do now in rehabilitation is further define the biology of that injury and recovery , and understand how we could manipulate it better.

So then what, I asked, is the message you hope that people take away from the Gabrielle Giffords story?

A message of hope. A message of persistence. A message of potential. A message that recovery and rehabilitation is important. A message that we shouldn’t sell those issues short. We have so many people who are like that; her recovery is a very good one and we’re enthusiastic about it.


She still has some language issues, you can see. She still has some motor dysfunction on one side. But the reality is that we see these kinds of things nowadays on a regular basis. Not everybody recovers to that extent — that’s the problem. Particular areas of the brain are difficult for us to help recover.

Who does best?

People who have very focal injuries that are quickly operated on over a small area tend to do the best. People who are high-functioning at baseline also do better. Those who have very severe diffuse injuries that involve some of the connection areas and result in a disconnection syndrome probably face more challenges.

Even some of those persons, seen a year later, are ‘Wow!’ They have made a substantial recovery. It’s that perspective of time that people miss — looking at her from day 1 or day 2 to now — and that’s the big picture we all need to have. You may see someone early on and say, ‘Well, they don’t have much potential,’ when the reality is they do.

We’ve begun to understand the physiology of the disease — and it really is a disease — and how to manipulate things acutely. We’ve been able to cut down on people’s mortality over 20 years, and we’ve been able to gain insight into ways to help them recover their motor function. We have new ways that we teach people to walk; ways that we try to enhance the integration of their learning; ways that we try to improve their balance or their verbal output — though that one we struggle with more.

While I am not treating her it is clear that Gabby Giffords has aphasia, a language disorder. I think she’s going to undergo some further, very focused language therapy. I think they’re going to look at all the options. There’s no magic pill yet for aphasia but tremendous progress is being made.

This program aired on November 16, 2011. The audio for this program is not available.

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Carey Goldberg Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.



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