Doctors hope for Giffords brain 'rewiring'

2011-02-14 11:38

New York - Compared to a sleek new laptop, that 1.3kg mass of fatty tissue called the brain may not look like much. But when it's injured, it adapts and rewires its circuits in new ways.

That's the kind of flexibility that doctors and rehabilitation specialists hope to encourage in Gabrielle Giffords, the brain-injured Arizona congressional representative.

Details about her recovery have been thin. But members of her staff say she recently began speaking for the first time since the attack on January 8 by a gunman in Tucson. Brain injury patients who regain speech typically begin to do that about four to six weeks after the injury, experts say.


Too little has been revealed and it's too early to say if Giffords might be able to return to her job in Congress. One expert questioned whether that would be the best thing for her to do. Most people with such injuries have some level of impairment for the rest of their lives.


Scientists are still unravelling just how the brain works to recover from traumatic injury and how to help it repair as much as possible.

They're dealing with an organ about the consistency of cold porridge. It contains maybe 100 billion densely packed nerve cells, each of which is connected to 1 000 or so other nerve cells, called neurons. Those connections form circuits that are the foundation of the brain's activity.

Brain injuries can disrupt that in several ways. A car accident can smash a head, stretching and tearing brain tissue across a wide area. A penetrating injury like a bullet causes more localised damage, but the force of the impact can also damage neuron connections some distance away from the projectile's path.

Either way, brain injury produces an "utter quagmire" of specific disruptions in brain functioning that doctors have only blunt tools to fix, said Dr Jonathan Fellus, director of the brain injury program at the Kessler Institute for Rehabilitation in West Orange, New Jersey.

What all this disruption means to the patient depends on what brain circuits have been affected. People might have trouble reasoning, finding words, remembering things, organising priorities, recognising faces, understanding what's said to them, or doing multiple things at once. Or they could have problems walking, reaching, getting dressed or feeding themselves.

So how can the brain get better?


New connections

For example, if the damaged part of the brain is small enough, new connections might bring in neighbouring neurons to stand in for dead ones. Or existing connections can be strengthened, allowing neurons to work together more efficiently than they had to before.


So a person who used to find his way to work just by instinct may come to rely on memorising the route more formally. Or somebody who struggles to find words may emphasise facial expressions more than before. A patient who has trouble remembering what he sees may compensate by telling himself what he's looking at, bringing in his verbal memory circuitry.

Patients may develop compensation strategies on their own, though more typically they're guided by doctors and therapists, said Dr Bruce Dobkin, director of the neurologic rehabilitation and research program at the University of California, Los Angeles.


"They have to pace themselves, they have to do things in a more organized way," staying more focused on a task like memorising a phone number than they had to before, he said.

That's certainly the case with Kim Towns, 47, of Chesapeake, Virginia, even 23 years after she was shot in the forehead.




That's why patients should get into rehabilitation as soon as possible, where "people are paid to stimulate you", providing skilled expertise as well as respite for exhausted caregivers, he said.

The time course of recovery can be long. It's most dramatic in the first year, with probably more than a third of patients who survive severe injuries showing improvement by the end of that time, said Dr Alan Faden of the University of Maryland.







"I'm always impressed... at seeing how many of them have lived quite successful lives, having families and kids and working at jobs," he said. They "wind up living, in some sense, an ordinary life".

Giffords might have to make the same kind of adjustment.




  • rammstein.f4n - 2011-02-14 12:34

    It's 1.3kg not 1.3km.

  • izaanb - 2011-02-14 13:06

    God speed. Thoughts with her.

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