Arizona Rep. Gabrielle Giffords is "holding her own" and continues to respond to simple commands, Dr. G. Michael Lemole Jr., the chief of neurosurgery at University Medical Center in Tucson said Monday.
"I just came from Congresswoman Giffords' bedside and I'm happy to say she's holding her own," Lemole, who operated on Giffords after a bullet tore through the left side of her brain, told TODAY Monday. "And that is to say that she's doing the same things she was yesterday. And that's the most we can hope for at this time."
Giffords is in a medically induced coma but is responding to verbal commands — raising a thumb, showing two fingers or wiggling toes — two days after she was shot at point-blank range at a public gathering in a supermarket parking lot in Tucson, Ariz.
Tests indicate that the swelling in her brain has not increased, Lemole told reporters at a news conference Monday. Peak swelling typically occurs within three to five days of a traumatic brain injury.
"At this phase in the game, no change is good and we have no change," Lemole said.
Doctors were forced to remove part of Giffords' skull to reduce swelling after the bullet traveled — back to front — the entire length of the left side of her brain.
Giffords could remain in the ICU for a week or "maybe more," Lemole said.
Doctors continue to assess Giffords' condition several times a day through CT scans and verbal tests. Giffords will remain on a ventilator until perhaps the end of the week, and that device has prevented her from speaking. Lemole said it wasn't clear whether Giffords recognized family members.
Even after leaving intensive care, the congresswoman likely faces a long and uncertain recovery, a head injury expert said Sunday.
"She's still critically ill," said Dr. Alex Valadka, a neurosurgeon and spokesman for the American Association of Neurological Surgeons. "We get excited when people hold up a couple of fingers, but that's a long way from higher functioning."
On Monday, Lemole didn't speculate about her chances for recovery or whether Giffords would regain her speech after being removed from the breathing tube.
"I've seen the full gamut possible — from functional recovery to limited recovery," he said.
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People who suffer penetrating traumatic brain injuries often develop paralysis and cognitive problems. The left side of the brain is typically responsible for speech and controls the right side of the body, Valadka explained, noting that most people are right-handed.
Giffords was fortunate that the bullet did not cross the geometric center of the brain, Lemole said earlier. Early reports indicated she might have been shot in one temple with the bullet exiting the other, but Lemole said the single shot entered in the back and exited the front.
She also was fortunate that paramedics rushed her to the level-1 trauma center in Tucson, getting her into surgery within 38 minutes, doctors said.
With skilled surgery and access to early and comprehensive cognitive rehabilitation, some patients are able to make remarkable recoveries, noted Dr. Gregory O'Shanick, chairman and past medical director of the Brain Injury Association of America based in Vienna, Va.
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He pointed to public examples such as ABC news anchor Bob Woodruff, who suffered a brain injury in 2006 in Iraq, and has since recovered enough to go back to work. And he noted that James Brady, President Ronald Reagan's press secretary, who was shot in the head in a 1981 attempt on Reagan's life, was able to regain many of his former functions.
About 1.7 million people in the United States suffer traumatic brain injuries every year, with about 20 percent of them caused by violence, including gunshots. About 52,000 people die as a result of their injuries and about 275,000 are hospitalized, according to the Centers for Disease Control and Prevention. Of the deaths caused by traumatic brain injury, perhaps 35 percent to 40 percent are attributed to gunshots.
Victims such as Gifford receive expert treatment because many trauma surgeons have learned from the battlefield lessons of Vietnam, Iraq and Afghanistan, O'Shanick said. Access to comprehensive, sustained cognitive rehabilitation therapy is the key, he added.
Much attention will be focused in the early weeks on Giffords, like other victims of penetrating traumatic brain injury, Valadka said. But the real work of recovery lasts much longer.
"Neurological time is measured in months and years," he said.
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