'Miracles happen' - Giffords opens eye for first time after Obama visit
Signs of tracking, opening left eye for up to 15 minutes, said docs
Rep. Gabrielle Giffords, shot in the head in an assassination attempt Saturday, spontaneously opened her left eye on Wednesday evening following a visit from President Barack Obama, her doctors said Thursday.
Giffords is now undergoing "aggressive physical therapy," her doctors said.
"She is starting to become aware of her surroundings," Dr. G. Michael Lemole.
"This is a major leap forward, this is a major milestone," he said.
"We're seeing spontaneous eye opening," said Dr. Peter Rhee.
Giffords was opening her eye for as long as 15 minutes at a time Thursday, doctors said.
Giffords has flickered her eyes in response to commands before, said Rhee and Lemole.
What's new about Wednesday's eye opening is that it was a spontaneous act on Giffords' part, they said.
"This is totally different," said Lemole.
"As you heard from the president yesterday, it is true, she did have spontaneous eye opening yesterday and she's becoming more and more alert at this time," Rhee said.
"Gabby opened her eyes for the first time," Obama told an overflow crowd of thousands gathered at a Wednesday memorial for the victims of the shooting rampage.
"And I want to tell you … right after we went to visit, a few minutes after we left her room and some of her colleagues in Congress were in the room, Gabby opened her eyes for the first time," Obama told the crowd, which reacted with emotional cheers. "Gabby opened her eyes for the first time."
Signs of visual tracking
"We're seeing signs of tracking, of following movement," Lemole said. Giffords is trying to focus on people and movement, he said.
Although Giffords' right eye is covered by a dressing most of the time, she is also spontaneously opening that eye, Lemole said.
Examinations of her right eye also show signs of tracking, he said.
We're just starting to see the signs of her trying to track her gaze to wherever she wants to look," he said. "That's very, very encouraging and reflects on a level of alertness."
"This is all very encouraging that she continues to do this consistently. One of the most important things in neurological recovery is consistency. We want to see people repeat things over and over again."
Doctor saw eye open
"I was there when she was surrounded by her friends from the Congress and Senate," Lemole said.
"We think it was that combination of the unexpected and the familiar" that triggered Giffords' eye opening, he said.
The presence of her family and the new experience of visits from colleague and the president caused the eye opening, he said.
"You could clearly see her become more aroused," he said.
"Her eye was wide open and she began to look around."
Eye opening is important "because it implies that not just those parts of the brain that process commands are there, but the parts of the brain that let us awake from sleeping, our arousal center, those are starting to work spontaneously," Lemole said.
"She's starting to become aware of her surroundings and the appropriate context of family and friends. That's a very important step on her next move forward," he said.
Opening eye for 15 minutes
Giffords continues to open her eye, Lemole said.
Giffords was opening her left eye for 3-5 minutes at a time on Wednesday night, Lemole said. Thursday morning, she was opening it for 10-15 minutes at a time, Rhee said.
"We saw signs of this coming," Rhee said. "Her eyes were flickering" from time to time, he said.
While Giffords has been able to open her eyes in response to commands prior to Wednesday, "it was in direct response" to an order to do so, Lemole said.
"Those were very brief periods, sometimes just flickering," he said.
While the responses to commands weren't just reflexes, it's a significant step that Giffords is opening her eyes on her own, he said.
"When we examine patients, particularly in this state we have to 'wake them up,' give them some stimulus, and with that stimulus they might crack their eyes," Lemole said. "That's very different from speaking to someone and having them open their eyes, or having them open their eyes spontaneously in response to familiarity."
'Miracles happen every day'
"Miracles happen every day," Lemole said.
"In medicine we like to attribute it to what we do, but a lot of what happens is beyond our control," he said. "We would be wise to acknowledge miracles."
Giffords can open both eyes, and both show signs of tracking. She can move both arms and hands, and lift both legs, Lemole said.
Because she still has a breathing tube down her throat to avoid pneumonia, doctors can't assess her ability to speak, he said.
Giffords is now breathing on her own, but remains hooked up to a ventilator that provides her with warm humidified air, Lemole said.
Doctors have sat her up in bed, with support, and dangled her legs over the side. Giffords can move both legs, Lemole said.
Doctors hope to sit her in a chair and perform additional physical therapy on Friday, he said.
Giffords is no longer under sedation, Lemole said.
Brain swelling is becoming less of a concern, Lemole said, but there is still the risk of pneumonia and blood clots, which any ICU patient could face.
Doctors will remove the breathing tube in the next few days and determine if a tracheostomy is necessary.
Only when the tube is removed will they be able to measure Giffords' ability to speak, the doctors said.
In assessing patients with brain injuries, "we look at whether or not someone is able to move when we ask them to, we look at whether or not they open their eyes spontaneously and the last piece is what is their verbalization," Lemole said.
Despite the progress of her recovery, Giffords is still listed in critical condition as a matter of caution, said Lemole,
"We don't want to be overconfident," he said. "There can be reverses, there can be setbacks. Recovery from a wound like this is exhausting."
Four other patients remain at University Medical Center. One will undergo a planned surgery today and one will be discharged, said Rhee.
The four are in fair condition, he said.
"Everybody is making fantastic forward progress," he said.