Cautious about Gabrielle Giffords receovery from tbi

At a press conference yesterday Dr. Peter Rhee, MD, MPH, medical director of trauma and critical care at University Medical Center who has assessed Gifford said "When you get shot in the head, and the bullet goes through your brain, the chances of you living is very small, and the chances of you waking up and actually following commands is even much smaller than that.”

Treatment during the acute phase of post traumatic brain injury is critical with doctors preventing and treating infection, bleeding and swelling. We are in this stage now and at this stage in Gifford’s recovery clinicians are cautiously optimistic that she could make a good recovery. However, it is still too early to confirm that she will have a complete recovery with no deficits or impairments in vision, speech, memory and upper and lower limb movement function.

Why can’t the doctors tell us the probability of a full recovery. Why is there just caution in their prognosis? The answer is that therapists and doctors focus on signs and symptoms rather than initial diagnosis as an outcome prediction. Patients, who have suffered brain injury e.g. stroke, traumatic brain injury, as well as other neurological or orthopedic injury, often have severe upper or lower extremity movement impairments. In short they have difficulty in doing the everyday living tasks that others take for granted. Therefore in the post acute and chronic stage of rehabilitation, doctors and therapists will look at a patient’s movement ability after brain trauma, detailed neurocognitive tests and scales based on functional movement ability will be used to determine the patients sensory movement impairment and help the therapist plan rehabilitation treatment.

Physical and occupational therapy is based on the proven efficacy of high intensity training undertaken as early as possible following brain injury which has been shown to improve both lower and upper extremity movement ability. The HandTutor and ArmTutor systems are a glove for finger movement practice and an elbow brace respectively. The system uses dedicated rehabilitation software that provides customized virtual functional arm hand and shoulder exercise tasks regardless of the patients arm movement ability. Through intensive exercise practice the patient learns how to move their arm and fingers again. HandTutor and ArmTutor teach the patient how to move their arm again as the program incorporates all the acceptable principles of neuromuscular rehabilitation:



1. The exercise tasks adopt a virtual functional approach.

2. The exercises are customized to train deficits in motor abilities or motor impairments including speed, range and co-ordination of movement.

3. Exercise training customized to these movement impairments improve functional ability.

4. The HandTutor is suitable for a wide range of neuromuscular hand movement dysfunction.

5. Dedicated rehabilitation software uses motion feedback to train proprioception which plays an important role in movement control and is often affected by musculoskeletal and central nervous system damage.

6. Adaptation is avoided as the virtual functional exercise tasks can be varied.

7. Intensive repetitive exercise training with motion feedback allows the brain to compensate for the lost function through neuromuscular plasticity.



The HandTutor and ArmTutor systems are used by all patients that have hand and arm movement dysfunction regardless of diagnosis. The system focuses on the sign and symptoms which are the amount and quality of patient’s active movement ability. This information provides the therapist and patient with real time feedback on movement ability and improvement. We all wish Gifford a full and complete recovery www.HandTutor.com.