Giffords going to Houston for rehab

U.S. Rep. Gabrielle Giffords is expected to begin rehabilitation in Houston within the week.

She's expected to move Friday to TIRR Memorial Hermann Rehabilitation Hospital there, though the exact day of the move from Tucson will depend on her health, Giffords' spokesman C.J. Karamargin said Wednesday.

The congresswoman, 40, is in serious condition at Tucson's University Medical Center recovering from a gunshot wound to the head she suffered in a Jan. 8 shooting rampage at a northwest-side supermarket that killed six people. Eleven people injured were hospitalized at UMC; all but Giffords have now been released.

Giffords' husband, Capt. Mark Kelly, an astronaut, lives and works in Houston. He is scheduled to command NASA's last space shuttle flight in April, but that's uncertain now.

"I am extremely hopeful at the signs of recovery that my wife has made since the shooting," Kelly said in a written statement. The latest: she was able to stand up with assistance, her office confirmed Wednesday.

"The team of doctors and nurses at UMC has stabilized her to the point of being ready to move to the rehabilitation phase," Kelly said. "Their goal - and our goal - has been to provide Gabby with the best care possible. It is for that reason that we have chosen to have her undergo rehabilitation at TIRR Memorial Hermann, which has a national reputation for treating serious penetrating brain injuries and is also in a community where I have family and a strong support network."

Giffords' family researched rehabilitation hospitals across the country, including in Washington, D.C., New York and Chicago, before deciding on the Houston facility, doctors said.

Kelly said he and Giffords' parents weighed many factors in deciding. High among them was TIRR Memorial Hermann's relative proximity to Tucson and its outstanding reputation, he said in a news release.

For 21 years, TIRR Memorial Hermann (TIRR stands for The Institute for Research and Rehabilitation) has been recognized as one of the country's top-rated rehabilitation hospitals by U.S. News & World Report.

Giffords was shot at close range through the left side of her brain. The bullet went in through the front of her head, just above her left eye, and exited through the back, doctors say.

The trajectory of the bullet was such that it stayed in the left hemisphere and did not cross through the brain's geometric center.

The left side of the brain typically controls right-sided strength, sensation and speech, including the ability to understand simple commands. That's why doctors have been so encouraged that Giffords is able to understand simple commands, such as hand squeezes and showing fingers.

Doctors have not given a prognosis for Giffords' recovery, however.

She will have to relearn how to think and plan, experts told The Associated Press. It's unclear if she is able to speak or how well she can see. And while she is moving both arms and legs, it's uncertain how much strength she has on her right side.

Her swift transition from an intensive-care unit to a rehab center - less than two weeks after the shooting - is based on the latest research, which shows the sooner rehab starts, the better patients recover.

Doctors say the hospital is now no longer the best place for Giffords.

"When she's medically stable, there's really no reason to keep her there," where she could get infections and other complications long known to plague patients with long hospital stays, said Dr. Steve Williams, rehab chief at Boston Medical Center and the Boston University School of Medicine.

"Over the last five to 10 years, there has been a big push to getting patients rapidly to rehab," because research shows they recover faster and better the earlier therapy starts, he said.

Giffords will likely be moved to Houston by medevac jet, Williams said, and there is little risk of a brain injury from flying. Since part of her skull has been removed, there is less pressure on the brain, and there has been no problem with swelling during her recovery. During rehab, she will probably wear a helmet.

Once she arrives in Houston, doctors will do a complete assessment of what Giffords can and cannot do, said Dr. Reid Thompson, neurosurgery chief at Vanderbilt University in Nashville, Tenn.

"The rehab is going to be pretty intense for her, both cognitively and physically," because she'll need to recover frontal lobe functions, Thompson said. "She's going to have to relearn how to think, plan, organize."

A penetrating brain injury like a bullet wound leaves a specific path of damage. Giffords' wound path appears to be below the motor cortex, which controls movement, but may include an area controlling speech, Williams said. He is not involved in Giffords' care and based his comments on diagrams and reports of her injury that have been made public so far.