Although Rep. Gabrielle Giffords has come far enough in her recovery to leave the rehabilitation center where she spent the past five months, doctors agree she is only at the beginning stages of her rehabilitation.
She will start outpatient therapy soon, which is likely to include speech, occupational and physical therapy a few days a week. Experts believe her continued rehabilitation will take a long time as she attempts to recover many of the skills and abilities she lost after being shot in the head in January.
"The time frame for outpatient therapy is long, with her program continuing to be adjusted as she improves. Years of treatment is not unusual," said Dr. Brian Greenwald, assistant professor of rehabilitation medicine at The Mount Sinai Medical Center in New York. "Despite the fact that the most rapid recovery occurs in the first year, recovery continues for a long time to come."
"You need to consider rehabilitation as a parallel process to normal child development," said Dr. Gregory O'Shanick, president and medical director of the Center for Neurorehabilitatoin Services in Richmond, Va. "Children learn to control their motor and balance systems at an earlier stage than they are able to speak, read or conceptualize. Giffords' rehab has gotten her back to walking and indicating her needs in a fundamental level."
The most critical issue, he said, is to get her to the point where she can solve problems and reason the way adults do.
Giffords also has to continue working toward regaining her ability to function as she did before she was shot.
"Recovery can be in the form of regaining the ability to do things in the same way that she did before as well as adapting to or compensating for persistent deficits," said Dr. Thomas Watanabe, clinical director of the Drucker Brain Injury Center in Elkins Park, Pa.
Giffords may actually do better now that she's able to go home.
"The literature shows that people often do better with cognitive outpatient therapy after reaching a certain level than with inpatient. This is because they are in more familiar surroundings and are ready for the challenges of being home," said Dr. Steve Williams, chairman of the Department of Rehabilitation Medicine at Boston University School of Medicine.
Despite the progress she has already made, the Arizona congresswoman may never recover some functions.
"Rep. Giffords may never fully recover the prior fluency of her communication abilities, but there can continue to be improvement with therapy," said Dr. Lori Shutter, associate professor of clinical neurosurgery and neurology at the University of Cincinnati Medical Center.
While she may recover physically, she also has to overcome psychological damage.
"The psychological recovery will likely take even longer," said Dr. Charles Liu, director of neurosurgery at Rancho Los Amigos National Rehabilitation Center in Downey, Calif. "The psychological recovery will obviously be impacted by her evolving role as a high-profile victim of gunshot wound to the head
Giffords had the advantage of remaining at an inpatient rehabilitation center for five months, much longer than others who don't have the same insurance coverage or financial resources.
"As a rehabilitation physician, I always want the patient to stay as long as possible as long as medical gains and improvements are being made," said Dr. Michael Huou, assistant professor of clinical neurology and neurological surgery at the University of Southern California's Keck School of Medicine in Los Angeles. "Unfortunately, the length of stay is generally dictated by the insurance company which typically wants the patient to be discharged home or to a [nursing home] in a much quicker time frame."
Most insurance companies also only pay for about a month of outpatient rehabilitation, but doctors believe Giffords will likely get much more than that.
No one can be sure how far she will progress, and she'll be working to recover for the rest of her life.
Brain injury rehab is a lifelong process, and she'll need to work on it every single day," said Dr. Brent Masel, national medical director of the Brain Injury Association of America.