Giffords moves to rehab facility
Tucson - Fresh from a sunny outing that brought a smile, Representative Gabrielle Giffords is moving to a Houston rehab centre where her husband hopes the "fighter" continues on the path to a full recovery.
University Medical Centre staffers took the wounded congresswoman to a deck at the hospital on Thursday, where she breathed in the fresh air and felt the sun, trauma surgeon Peter Rhee said.
"I saw the biggest smile she could gather," Rhee said. "We are very happy to have her enjoying the sunshine of Arizona."
Giffords has been making progress nearly everyday in her recovery from a bullet wound to the brain.
Doctors ticked off other markers of her continuing improvement: She scrolled through an iPad, picked out different coloured objects and moved her lips. They are unsure whether she is mouthing words, nor do they know how much she is able to see.
Her husband, Houston-based astronaut Mark Kelly, believes she has tried to speak and can recognise those around her.
"I can just look in her eyes and tell," Kelly said at a final briefing on Thursday at the Tucson hospital. "She is very aware of the situation."
He said he's hoping she'll make a full recovery, calling her "a fighter like nobody else that I know".
The doctors who will help her offered a more sober outlook.
"Not everyone always gets 100% restoration, but we help them to get to a new normal," said Carl Josehart, chief executive of the rehab hospital that will be the Arizona congresswoman's home for the next month or two.
Giffords is expected to be moved on Friday morning, travelling by ambulance to Davis-Monthan Air Force Base with an escort from a group of motorcycle riders from a Veterans of Foreign Wars post who know her.
Kelly; Rhee; Giffords' mother, Gloria; an intensive care unit nurse and Giffords' chief of staff will be among those on the medical flight to William P Hobby Airport in Houston.
From there, she will be moved by helicopter to TIRR Memorial Hermann hospital. US Capitol police arrived on Thursday afternoon to set up extra security measures at the 119-bed facility that is part of the massive Texas Medical Centre complex.
Big team at hand
Dr Gerard Francisco, the hospital's chief medical officer, will co-ordinate her care.
"It's going to be a very big team that will address different impairments, but they will have to work together," he said.
First, they'll check her vital signs - make sure her blood pressure and heart rate are good. Then specialists ranging from physical and occupational therapists to speech therapists and psychologists will give a slew of tests to see what she can and cannot do.
"The strength of her legs and her ability to stand and walk. The strength of her arms, and whether she can brush her teeth or comb her hair. Whether she can safely swallow on her own. How well she thinks and communicates - not just her ability to speak but also to understand and comprehend," Francisco said.
It's unclear if she is able to speak. And while she is moving both arms and legs, it's uncertain how much strength she has on her right side; the bullet passed through the left side of her brain, which controls the right side of the body.
Giffords will stay at Memorial Hermann until she no longer needs 24-hour medical care - the average is one to two months. Then she can continue getting up to five hours a day of physical and other rehab therapies on an outpatient basis, Josehart said.
"It's hard to speculate on the trajectory or course that any one patient will have," he said.
Despite the steady progress, Giffords has a long road to recovery. Doctors are not sure what, if any, disability she will have.
Difficult 12 days
Sometimes, areas of the brain that seem damaged can recover, said Mark Sherer, a neuropsychologist at the rehab centre.
"Some of the tissue is temporarily dysfunctional, so the patient appears very impaired very early on after the injury," but may not be permanently damaged, he said.
A gunman shot Giffords and 18 other people on January 8 as she met with constituents outside a grocery store in Tucson. Six people died and the others wounded. All survivors, except Giffords, have been released from hospitals.
The suspect in the attack, Jared Loughner, 22, of Tucson, is being held in federal custody.
"The last 12 days have been extraordinarily difficult for myself, my family, but not only us," Kelly said. "I think it's been very difficult for the city of Tucson, southern Arizona and our country.
Kelly added that Giffords would be proud of the way Tucson has responded. Memorials continued to grow on Thursday outside the hospital, in front of her office and at the scene of the shooting.
"I know one of the first things Gabby is going to want to do as soon as she's able to is start writing thank you notes," he said.