Surviving a bullet wound to the head was just the first step on Rep. Gabrielle Giffords' long road to recovery. Now that her condition is stabilized, she will be transferred Friday to TIRR Memorial Hermann hospital in Houston for intensive physical and mental rehabilitation.
Though it has been less than two weeks since the Arizona congresswoman was shot, allegedly by Jared Loughner, 22, during the Jan. 8 shooting that killed six and injured 13, her fast progress has made this early transfer to a rehabilitation center possible.
To date, Giffords' recovery has been promising and she has responded consistently to commands, been awake and alert, scrolled through her iPad and even took a trip outside.
"She continues to do very well neurologically" and has made "fantastic advancements forward," he said, "but I want to caution everyone she has a long road ahead of her," Dr. Michael Lemole, one of the neurosurgeons treating Giffords at University Medical Center, said in a press conference Thursday.
TIRR was chosen, in part, for its proximity to Giffords' husband, Capt. Mark Kelly, who lives and works as an astronaut in Houston. With Giffords there, he will be able to "be there by her side as much as possible," Kelly told the press Thursday.
Kelly remains hopeful that his wife would make "a full recovery" and that "in two months, you'll see her walking through the front door of this building," he said at Thursday's press conference.
But a 100 percent recovery may not come for a while yet, if at all, rehabilitation experts caution, and as Giffords enters the rehabilitation stage, realistic expectations are an integral part of coping with the harrowing recovery process ahead both for the congresswoman and her loved ones.
What Rehab Will Look Like
In the weeks ahead at TIRR, Giffords' most likely will meet daily with a team of specialists, including speech, occupational and physical therapists, as well as a neuropsychologist who will evaluate and help rehabilitate her cognitive functioning, rehabilitation experts told ABCNews.com.
"In the hospital, people are focused on stabilizing you and keeping you alive," said Dr. Steve Williams, rehab chief at Boston Medical Center and the Boston University School of Medicine. "At a rehab center, we continue to do that but there's the added ability of really focusing on the functioning and cognitive ability. That she's going to rehab very quickly is a good sign that she's not having medical complications."
Patients of traumatic brain injury meet with a neuropsychologist who assesses cognitive functioning and helps the brain relearn.
"The idea is that we're supplying the right stimulus to the brain at the right time to allow recovery," said Dr. Roger Knakal, medical director of Rehabilitation at Fletcher Allen Hospital of Vermont. "The idle brain doesn't do much. We want to stimulate the brain and certainly want to have someone in intense rehab for that within the first 30 days."
The neuropsychologist will look at Giffords ability to think abstractly, do math and process complex thoughts, said Williams.
"Simple commands [that Giffords has been following] are very different from executive thought and abstract thinking, and a job like hers would require a very high level of abstract thinking," he adds.
In order to assist Giffords brain in relearning, Williams said it's possible that doctors will give her cognitive stimulants such as Ritalin, to increase focus, attention, and concentration.
Getting Giffords to communicate will also be a top priority, said Lyn Turkstra, associate professor of communicative disorders at the University of Wisconsin-Madison.
"For someone with the type of injury she has, it's so important to get her communicating" so that her language abilities can be assessed, she said.
Considering Giffords has a tracheotomy tube in her throat that makes speech impossible, doctors may try to swap in a valve that would allow her to speak, Turkstra said.
Getting the Body Back on Board
Physical therapy also will become more intense at the rehab center. At University Medical Center, Giffords already has begun physical therapy, dangling her legs over the side of the bed and sitting in a chair for periods of time. Once at TIRR, Giffords will begin more intensive, tailored therapy, said Williams.
A physical therapist will work on general strength, mobility and balance, he said, while an occupational therapist will be more concerned with her ability to perform daily tasks, such as grooming and feeding herself.
Coping With the Long Process for Patient and Family
While the rehabilitation process will be a long and exhausting process, one of the most challenging aspects of rehab for both the patient and their family is accepting the pace of recovery, rehabilitation experts say.
"I think one of the biggest challenges for the family is knowing what is good progress," Turkstra said. "You want this person to be back to themselves in a week, like you see on T.V., but a lot of rehab is figuring out that they may not ever be completely back and learning to accept the new version of your loved one."
Those with frontal lobe injuries, such as Giffords', can also have personality changes, Williams said. They may be "disinhibited and say things they wouldn't say before or have inappropriate actions or reactions to circumstances."
Even when recovered, many with brain injuries will be "either pretty happy or pretty sad and that's different from the normal wavering between moods that you find in people," he added.
But having loved ones present throughout the recovery process is integral to the patient's progress, Knakal said.
"Family involvement is very, very important," he said. "I [as a doctor] am a stranger to the patient when they come in. Family is going to be a familiar, stabilizing force for that patient."
For Giffords, the familiar presence of her husband and her friends already has proven an incredible asset in her recovery. It was during the first visit from close friends Sen. Kirstin Gillibrand, D-N.Y., and Rep. Debbie Wasserman Schultz, R-Fla., that Giffords first voluntarily opened her eyes and began reaching out to hold Kelly.
Giffords also will do things for Kelly, like pat him affectionately on the face, that she won't do when he is not there, Kelly told the press Thursday.
"She'll smile at me and I can just look in her eyes and tell ... she's very aware of the situation," he said. "I'm extremely confident that she's going to be back."