Rep. Gabrielle Giffords will be transferred today (Friday) to a rehabilitation center in Texas. According to MSNBC Giffords will be transported to the TIRR Memorial Hermann Institute for Rehabilitation and Research in Houston, a world-class facility that treats people for conditions ranging from brain and spinal cord injury to multiple sclerosis and Parkinson’s disease.
Just 13 days after sustaining a gunshot wound to the head, Rep. Giffords has made remarkable and rapid progress and there is considerable hope for a full recovery although doctors continue to caution that she has a long road ahead of her.
Her injury had an entry wound in the left temporal area and an exit wound in the front of the skull which could give some indication of the types of difficulties she might need to overcome.
Dr. Byran Oh, who works at the Mischer Neurosurgery Institute at Memorial Hermann in the Texas Medical Center, has worked closely with Dr. Peter Rhee, who is treating Giffords. Dr. Oh stated that he feels Rep. Giffords has been in good hands. He added that the fact that the entry and exit wound were on the same side of the brain offer some hope for optimism, as when both hemispheres of the brain are affected the prognosis is often much poorer. While the brain has specific functions in different locations there is some redundancy of function between the two hemispheres, so the brain is more likely to be flexible enough to return lost functions over time.
Based on the location of the entry and exit wounds, there is some concern about two areas of the brain, an area referred to as Broca’s area in the left temporal area of the brain which is responsible for motor speech, that is producing the movements of the mouth and associated structures to produce the sounds of speech. Some people with damages to this area have a condition called Broca’s aphasia, where they can understand words but have difficulty with articulation.
The second area that might be affected is called the prefrontal cortex, this areas is associated with executive function. Executive function relates to abilities to differentiate among conflicting thoughts, determine good and bad, better and best, same and different, future consequences of current activities, working toward a defined goal, prediction of outcomes, expectation based on actions, and social “control” (the ability to suppress urges that, if not suppressed, could lead to socially-unacceptable outcomes). Exectutive function is a major influence on the development and uniqueness of personality.
An example of the effects of damage to the prefrontal cortex can be seen in the case of Phineas Gage. Famous in rehabilitation settings, Gage was a railroad worked injured in a freak accident when an explosion caused a pipe to penetrate the skull entering just behind the cheek bone and exiting from the front of the skull. Even though it was 1848 and medical care was primitive at best, Mr. Gage survived the injury, but the damage to the prefrontal cortex cause dramatic changes in his personality and behavior. He became impulsive, unable to contain his emotions, and lacking in social skills.
Rep. Giffords does have significant advantages that were not available in 1848, including the fact that care was immediately on the scene, and treatment was much more technologically advanced, making her much more likely to have a full recovery.
Much of the recent progress in the treatment of head injuries has come from the work of the University of Texas Southwestern Medical Center and Baylor Rehabilitation Center, both located in Dallas. Research is ongoing in brain modeling in the north Texas area to help better understand brain functions.