A slice of toast – and another step to recovery for Gabrielle Giffords

The congresswoman has made a fast start, but a marathon still lies ahead

It is only a one-syllable word, but news that Gabrielle Giffords trained her eyes on a piece of bread on her breakfast tray one day this week and said "toast" has excited new hopes among her doctors and supporters that she may be on the way to a full recovery, even if the road ahead is likely still to be long and uncertain.

One month after being shot in the forehead during a meeting with some of her constituents in Tucson, Arizona, the Democrat congresswoman seems to be making exceptional progress, although it may be weeks or months before doctors can tell what her long-term prognosis will be.

For those staff members who are keeping her offices running in Tucson and on Capitol Hill in Washington, any tidbit of news of her progress is welcome.

Since her removal from the critical list and her transfer from Tucson to a Houston brain trauma rehabilitation centre two weeks ago, each nugget of news has offered new hope.

Sometimes the information comes not from the hospital itself but from Facebook postings by Mark Kelly, her husband, who last week revealed that he had resumed training at Nasa's Houston campus and would, as originally planned, command the last flight by the shuttle Endeavour when it lifts off for a mission to the Space Station in April.

"The doctors say she is recovering at lightning speed considering her injury but they aren't kidding when they say this is a marathon process," he writes in his most recent posting, which was accompanied by pictures of her hospital room festooned with get well cards and a picture of a Nasa shuttle launch.

"There are encouraging signs everyday though. Gabby's appetite is back and – even though it's hospital food – she's enjoying three meals a day," he wrote.

The investigation into the January 8 rampage that left six people dead – including a federal judge and a nine-year-old girl – and another 13 wounded has been formally wound up. Officials revealed that while the suspect in the shooting, Jared Loughner, is unlikely to testify at trial, jurors may hear from him anyway via video messages recovered from his personal computer.

Mr Loughner, 22, remains in custody without bail after pleading not guilty last month to three federal charges of murder and attempted assassination. More charges will almost certainly follow, experts say.

While Mr Kelly may be back to intensive training in advance of the two-week Endeavour mission, there is no danger of Ms Giffords being neglected. She is going through an intensive training programme of her own – to re-launch and repair her motor and speech skills.

"She has rigorous therapy every day, including speech therapy," CJ Karamargin, her spokesman confirmed. "Congresswoman Giffords is working very hard, and it is paying off. They are pushing her, but she is also pushing herself."

The stream of visitors to her room at The Institute for Rehabilitation and Research, part of Houston's Memorial Hermann Hospital, has included Debbie Wasserman Schultz, a Democrat congresswoman from Florida and close friend. She was there when Ms Giffords spoke about her morning meal.

"We were sitting and just talking with her while she was eating her breakfast and she was, you know, eating her oatmeal, hospital oatmeal, sort of playing with it and not really looking very enthusiastic. And she took a look at her tray and there was bread on the tray and she looked at it and looked up and just said 'toast'," she said.

"It's just another example of the grit and will of Gabby Giffords. All of us who know her, work with her and love her are confident that while it is a marathon, and she's got a lot of work ahead of her, she's working so hard ... And we just know she's going to walk back into the house chamber ... hopefully sooner rather than later."

What the hospital has not disclosed is if this was first word uttered by the congresswoman as she recovers. Doctors had previously indicated that they had ascertained that her powers of speech were starting to return but she was hampered by a breathing tube inserted into her throat. That tube has now been removed.

Patients with brain injuries of the kind suffered by the congresswoman can sometimes struggle to regain full speech and the fact of her saying single words does not, experts say, guarantee that she will be exempt.

One condition that may yet reveal itself is aphasia, where patients struggle to form sentences or in some cases cannot tell if they are making sense or speaking nonsense.

So far, each step she has taken has taken – from her first hand movements while in intensive care in Tucson, to standing, rubbing the back of her husband's neck and now saying "toast" – only encourages optimism.

"It's always a very good sign once patients are able to eat and, definitely based on her injury, it's a good sign that she's able to talk," Dr Christina Kwasnica, director of the neuro-rehabilitation program at Barrow Neurological Institute in Phoenix, told the Arizona Republic. "Those are signs that she is moving forward."

We will see if the next step her husband has planned for her is doable or too ambitious – taking her to Cape Canaveral to watch him blast off in April. "I have every intention that she'll be there for the launch," Mr Kelly said this week. "I've already talked to her doctors about it."

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