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February 18th, 2011
12:13 PM ET

Inside Giffords' rehab: Hard work, hard questions

When I walked into TIRR Memorial Hermann hospital, I had a few things on my mind. I would get to see firsthand the type of therapy Congresswoman Gabby Giffords was receiving after being shot in the head in early January. I also realized that, despite sending hundreds of my own neurosurgery patients for rehabilitation, I had not spent extended time learning all the various therapies currently available and how they work together to restore function. Finally, I reflected on a conversation I had with T. Christian Miller from ProPublica, about TriCare (the Pentagon’s health plan for the armed forces) and how it won’t pay to cover cognitive therapy for brain injured soldiers.

Gifford’s doctor, Gerard Francisco, greeted me and showed me a white board of a therapy schedule he tailored for me. On this day, I was playing the patient. An intensive, exhaustive seven-hour schedule was presented, full of physical therapy, speech, recreational, occupational and my personal favorite – music therapy.

The mantra of Julie Welch, my physical therapist, was “do not neglect your weak side.” While some patients may be inclined to overcompensate with the left side of the body if the right side is weak – my therapy focused on just the opposite. Giffords was shot in the left brain, and it would be her right side of the body that would be affected. Electrodes were hooked up to the muscles on my right leg, and then I was asked to ride a stationary bike. If my right leg wasn’t performing as well, small shocks stimulated the appropriate muscle during my pedaling, and also sent a message to the brain that this muscle was being ignored or neglected. Francisco explained that “it was part of the re-wiring process that takes place.” We know the brain can tell a muscle what to do – such as lift your right leg. With these stimulations, the muscle is now also telling the brain what to do.

During speech therapy, my therapist, Shap Shadravan worked on what she called apraxia of speech. This is the difficulty to say words correctly and consistently. It is not due to weakness of speech muscles, or discoordination, but rather caused specifically by an injury to the brain. Think of it as saying “len” whenever you wanted to say “when.”  We practiced making movements with my lips and tongue and re-learning sounds made at the front, middle and rear of the mouth. Given the congresswoman’s tracheotomy, we also learned how to speak with this tube in your throat, using a special valve to force air over the vocal cords.

Near the end of the day, I sat with Maegan Morrow, my music therapist, and filled in words to well-known songs. Everything from "Twinkle, Twinkle, Little Star" to "Maneater" by Hall and Oates. While it may have looked like simple and fun singing, Megan was constantly using strategies to externally cue me. I realized through music, she was working on developing my attention, memory and overall executive function.

In fact, most of the therapy I received at TIRR overlapped, and so much of it focused on cognition.  Francisco is convinced this type of approach rapidly expedites a brain-injured person’s recovery, and he has plenty of evidence to back him up. Certainly spending a day going through the therapy as I did allowed me to see that evidence for myself.

All of this, of course, got me thinking about T. Christian Miller, his report about TriCare, and the more than 200,000 service members that have suffered a brain injury since 2000.

Giffords is currently receiving proven and effective therapy at one of the premier rehabilitation centers in the country – and, very deservedly so. Question is: After considering all of this, why don’t tens of thousands of brain-injured troops have that same care available to them?


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