SALT LAKE CITY — Rep. Gabrielle Giffords, D-Ariz., is in a critical point in her recovery after sustaining a gunshot to the head, but local experts say it is too soon to know how she will fare long-term.
Most people do not survive gunshot wounds to the head. Most survivors do not return to the same level of function they were at prior to the injury.
“The fact that this congresswoman is following commands and doing some of the things that are being described is actually a good scenario,” said Brad Morris, physician assistant for Intermountain Medical Center’s trauma critical care unit on Tuesday.
While full recovery is possible, it is extremely rare and usually occurs after many years. “The majority of these patients that receive these injuries actually do not survive,” he said.
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The degree of recovery is related to severity of injury, a patient’s level of functioning prior to the injury, social support after an injury and access to rehabilitative services, said Dr. Jennifer Romesser, staff psychologist for the Veterans Administration Salt Lake City Health Care System.
Giffords, as a member of Congress, should have access to excellent medical care and good social support.
Media reports that Giffords has responded to simple commands, is breathing independently and has grabbed at her breathing apparatus are good indicators, Romesser said.
“It means that her brain is in the beginning stages of recovery,” she said. “This is a positive sign although it is likely too early to make any specific estimates about her recovery.”
Both Morris and Romesser caution that too little is known about Giffords’ condition to make definitive statements about her future prospects.
“When a person is shot in the head the first thing to know is that the damage is done at the time the bullet enters the skull,” Morris said.
Afterward, patient care is focused on preventing secondary injury from swelling and infection, Morris said. “They are doing everything they can to minimize that, to have her have a better outcome. The worst period for that, really, is in the next three to seven days.”
Caregivers attempt to control stimulation to the brain through sedation or medically induced comas. Patients can receive agents that control the movement of water and other fluids across the brain.
“One of the more direct ways we do that is we try to directly control sodium levels. By doing so, we can help control some of the swelling to the brain,” Morris said. Giffords, according to media reports, underwent removal of a portion of her skull.
“The skull is a closed environment and can allow some swelling but not very much,” Morris said.
Recovery from traumatic brain injury is measured in terms of years, not days or weeks, Morris said. Much depends on what a patient is able to do early in their treatment. “There’s a lot of literature that suggest the less a patient is able to do early in their care, or the longer it takes them to do them … the less likely they are going to have a meaningful recovery,” Morris said.
For many patients, recovery happens over a number of years, Romesser said.
“Much of the recovery will occur in the first few years, but many experience ongoing recovery over their lifespan as they learn to adjust and compensate for their change in functioning,” Romesser said.