There, a team will develop an individualized plan of achieveable goals, nutrition and rest for Giffords, said Dr. Ron Gharbo, a rehabilitation doctor at Riverside Rehabilitation Institute in Newport News.
"If you keep hearing reports that she's making improvements each day, that will likely continue," he said.
Giffords was shot in Tucson, Ariz., when a gunman opened fire, killing six people. For penetrating brain injuries, prognosis is tied to the where the bullet goes. In Giffords' case, it appears the bullet entered and exited on the left side, which can be devastating, said Dr. Jamie Bradbury, a neurosurgeon with Sentara Neurosurgery Specialists in Virginia Beach.
The left side controls speech, emotions and mood and for most people is more important than the right side, he said.
"Showing this amount of improvement in this short of time is a very good sign," Bradbury said.
After a penetrating brain injury such as a gunshot comes a series of surgeries, he said. First, the surgeon removes bone fragments carried in by the bullet and stops the bleeding. The surgeon also removes a large window of bone because the brain is expected to swell.
The second surgery Giffords underwent removed orbital fractures, or bone chips, near the eyes. She'll need surgery again in a few months to replace the removed bone. Until then, the bone may be stored in a freezer or in her abdominal fat area, he said. The latter is unlikely because it was exposed to air and would have had the chance to get infected. Another option is to make an artificial implant if the bone is too shattered to replace.
You can survive this injury, Bradbury said. "But are you interactive with your family members? Can you stand? Walk around? Live independently?"
It's like a stroke. She may need to relearn things over the next few months. Some things, though, may never be recovered, he said. The biggest gains will be in the first few months, with recovery taking up to a year. After that, it's harder to recover things, such as communicating.
"People can improve for a long time," said Dr. Matthew Chang, a Riverside Regional Medical Center neurosurgeon. He tells families that if the injured person hasn't seen improvement in a year, chances are he or she won't recover much more.
Social support is crucial for recovery, Gharbo said.
"She may have some personality changes. The family needs to be educated that this is the injury where they're saying or doing inappropriate things they would not normally be doing," Gharbo said.
The patient may look nearly normal months later but the spouse often has to deal with cognitive and behavioral changes. Checking back in with the patient and the spouse can help the immense amount of loneliness they might feel, Gharbo said.
Several things worked in Giffords' favor. Her head was elevated after the shooting, which reduces bleeding, and she was rushed into the operating room. "Time is brain," Bradbury said.
Penetrating and blast injuries to the brain are common among military veterans injured in Iraq and Afghanistan. In a recent study, the proportion of head and neck wounds from 2001 to 2005 was higher than in World War II, Korea and Vietnam.
"The caliber of bullet, the ballistics of military weaponry, is drastically different," Bradbury said. "It's much more devastating."