Next big Giffords decision: When can she go home?

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Next big Giffords decision: When can she go home?

Congresswoman's medical team will make call in coming weeks

HOUSTON — As Rep. le Giffords spends her days relearning how to speak,

walk and care for herself, her therapists are carefully tracking every moment

and often posing one critical question: When can she go home?

Experts say they expect her medical team to make that call in the coming weeks

because Giffords is at the point in her therapy where doctors typically make

such decisions about transitioning brain injury patients into outpatient care.

Giffords has spent the last 2½ months undergoing intense therapy at TIRR

Memorial Hermann in Houston since she was shot Jan. 8 in Arizona.

" I would expect a release in mid-April, right around the 10 weeks, " said Dr.

Steve , chairman of rehabilitative medicine at Boston University.

The decision many are waiting for is whether Giffords will be able to travel to

Cape Canaveral, Fla., to watch her astronaut husband, Mark , command the

space shuttle Endeavour's last flight in late April. Some are also wondering if

she'll recover to run for office again and challenge for an open Senate seat in

Arizona in 2012.

Last month, doctors said Giffords was making " leaps and bounds " in her recovery

as she speaks more and more every day and walks with assistance. They said there

was a good chance she could attend the launch, but insisted no final decision

had been reached.

Experts say the more crucial, long-lasting decision revolves around when she

will be released.

Kristi Lanier, a speech pathologist at TIRR Memorial Hermann, said a team of

therapists meets weekly to review progress and assess a patient's program and

needs. Discharge is always the backstory.

That's the crux of the question going around, " said Lanier, who is not treating

Giffords. " That discussion starts on day one. "

Many options for continuing care

Doctors and Giffords' family have several options for the next step in her care.

The congresswoman could stay in Texas, possibly moving into her husband's home

near Houston and allowing her to undergo outpatient therapy in the TIRR clinic.

She could also return home to Arizona, where she has a home and where her family

lives. In both states, Giffords would have a valuable network of family and

friends to assist in her recovery — key factors in deciding where to send

patients.

Family or caretakers are trained before a patient is released, said Dr. Cara

Camiolo Reddy, the medical director of the brain injury program in UPMC's

Rehabilitation Institute. In most cases, therapists visit a patient's home,

advising the family on what changes may need to be made to guarantee their

safety and to ensure their needs are met. Rep. le Giffords has spent the

last 2 1/2 months in rehabilitation learning how to speak again, walk and care

for herself – but when will she be able to go home?

It’s a question that her therapists at TIRR Memorial Hermann in Houston are

carefully tracking. Experts say they expect her medical team to make that call

in the coming weeks because Giffords is at the point in her therapy where

doctors typically make such decisions about transitioning brain injury patients

into outpatient care.

Everything Giffords does at TIRR Memorial Hermann is geared toward preparing her

for release. Every day, she undergoes several hours of physical, speech,

occupational and music therapy that focus on various brain functions.

A speech pathologist such as Lanier would assist with everything from ensuring a

patient can safely swallow to helping them relearn speech. Sometimes, Lanier

uses a board with large capital letters to help a patient with initial

communication. One patient used the chart recently to tell Lanier that she likes

gospel and country music.

Using music to ignite the brain

At TIRR, another key therapy is music. Amy Culpepper, one of two neurologic

music therapists at TIRR, uses a guitar, drums, maracas and other musical

instruments to " fire up " the brain. Sometimes, she works alongside a speech

pathologist or physical therapist, using rhythm and beat to help a patient

relearn walking or talking. Culpepper has not treated Giffords, but family and

friends have described the congresswoman singing " American Pie " and " Happy

Birthday " to her husband.

Often, one of the first things music therapists do is teach a patient to put

functional phrases — such as " I want to go to the bathroom " — to music.

Eventually, they will be able to say it. Similar methods are used in group

therapy to assist with memory and orientation tasks. Here, the therapist will

help patients remember the day of the week, the month, the year or even the city

and name of the hospital by putting the information to a simple tune.

" The reason that music is so effective is because when you're using music, you

are actually firing or engaging a lot of the brain, " Culpepper said.

Hay, an occupational therapist at TIRR, may have one of the

jobs that most concretely prepares a patient for release. Her tools include

everything from a full kitchen and a garden to a plastic cup and soda bottle to

help a patient with the coordination skill of pouring a drink.

For discharge, Hay said she looks at whether a patient can dress and groom

themselves and whether they can sit upright for most of the day, critical to any

patient who will be going on to an intensive outpatient program. While in her

care, she plans and goes on outings with patients and their families. They go to

restaurants, the zoo, the mall, and once even had a tour of the Houston Astros

baseball stadium. Some patients interested in flying again are taken to the

airport and practice going through customs and security.

The final step before a release is an intensive handover with the outpatient

facility. Lloyd, director of TIRR's outpatient facility — Kirby Glen

Memorial Hermann — said documents, case work, medical history, goals and

progress are reviewed. The patient then has an in-depth outpatient assessment to

assist with goal setting.

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Kirby Glen offers a " challenge track " that can help a patient acquire the skills

needed to return to work, learn to drive again, go to school or regain

independence. Physical, occupational and speech therapists are assisted by

social workers, vocational counselors and neuropsychologists to help the patient

meet their goals. Patients can come to the clinic between one and five times a

week for therapy and it generally lasts no more than three months, Lloyd said.

" We are all about getting you able to reintegrate into the home that you came

from and the world that you came from, " Lloyd said.

But even after the outpatient program is complete, patients have a rigorous home

exercise and therapy routine. Sometimes, they can be sent back to the outpatient

clinic a year or more after the injury if their doctor feels they could still

improve.

" Traumatic brain injury doesn't get better overnight. It's a progression, " Lloyd

said. " And it will continue at home for years and years. "