Doctors prepared a US congresswoman who was shot in the head to leave behind the Arizona hospital where she dazzled them with her rapid recovery.
Her next stop will be a Houston rehab center, where she will face an even more arduous task: Getting life back to normal.
Rep. Gabrielle Gifford's husband said he's hoping she'll make a full recovery, calling her "a fighter like nobody else that I know."
Giffords is recovering from a bullet wound to the brain, but has been making progress nearly everyday.
A gunman shot Giffords and 18 other people Jan. 8 as she met with constituents outside a grocery store in Tucson. Six people died and the other wounded. All survivors have been released from hospitals except Giffords.
The doctors who will help her offered a more sober outlook.
"Not everyone always gets 100 percent restoration, but we help them to get to a new normal," said Carl Josehart, chief executive of the rehab hospital that will be the Arizona congresswoman's home for the next month or two.
Late Thursday, trauma surgeon, Dr. Peter Rhee, said staff at University Medical Center in Tucson helped Giffords stand and get into a wheelchair. They then took her to a deck at the hospital, where she breathed in the fresh air and felt the sun.
Earlier, doctors ticked off other markers of her continuing improvement: She scrolled through an iPad, picked out different colored objects and moved her lips. They are unsure whether she is mouthing words, nor do they know how much she is able to see.
Her husband, Houston-based astronaut Mark Kelly, believes she has tried to speak and can recognize those around her.
"I can just look in her eyes and tell," Kelly said at a final briefing at the Tucson hospital. "She is very aware of the situation."
Giffords is expected to be moved on Friday.
During rehabilitation she will have to relearn how to think and plan. It's unclear if she is able to speak. And while she is moving both arms and legs, it's uncertain how much strength she has on her right side.
The suspect in the attack, Jared Loughner, 22, was indicted by a federal grand jury in Tucson on Wednesday, accused of attempting to assassinate Giffords and trying to kill two of her aides.
It does not include two murder charges listed in an earlier criminal complaint for the deaths of Giffords aide Gabe Zimmerman, 30, and US District Judge John Roll, 63.
Those are potential death penalty charges. Prosecutors said they require a more painstaking process. Additional charges are likely. Loughner is in federal custody. He is set for a preliminary hearing on Monday in Phoenix.
"The last 12 days have been extraordinarily difficult for myself, my family, but not only us," Kelly said. "I think it's been very difficult for the city of Tucson, southern Arizona and our country. I don't think we're going to ever fully understand the why and the how and the reason for what happened."
Though Giffords remains in serious condition, her recovery has amazed her family and impressed her doctors.
Dr. John Holcomb, retired Army colonel and a trauma surgeon at the Houston hospital, praised the care she received in Tucson and said Giffords would "move quickly toward a tailored and comprehensive rehab plan."
Over the weekend, doctors weaned her off the ventilator and replaced her breathing tube with a tracheotomy tube in her windpipe. They inserted a feeding tube to boost her calorie intake and repaired her right eye socket, which was damaged by the bullet.
Since being taken off sedation, Giffords has been alert and opening her eyes more often.
She also started rigorous physical therapy, dangling her legs over her bedside to exercise her muscles and sitting in a chair for periods at a time.
Still, the extent of her injuries and long-term prognosis won't be known for some time.
"When she's medically stable, there's really no reason to keep her there," where she could get the infections and other complications associated with long hospital stays, said Dr. Steve Williams, rehab chief at Boston Medical Center and the Boston University School of Medicine.
"Over the last five to 10 years, there has been a big push to getting patients rapidly to rehab," because research shows they recover faster and better the earlier therapy starts, he said.
"The rehab is going to be pretty intense for her, both cognitively and physically," because she'll need to recover frontal lobe functions, Thompson said. "She's going to have to relearn how to think, plan, organize."
A penetrating brain injury like a bullet wound leaves a specific path of damage. Giffords' wound path appears to be below the motor cortex, which controls movement, but may include an area controlling speech, Williams said.
He is not involved in Giffords' care and based his comments on diagrams and reports of her injury that have been made public.
"One of the questions is whether she'll be able to speak," Williams said. Giffords has a breathing tube now, and even if this impedes her speech, she might be able to mouth words.
"That would be a good indication that she at least is able to express herself," Williams said.
"The cognitive ability and the speech are the key things," he said. "We know that she's moving her limbs. The question is, how strong is she."
Remarkably, Giffords may not spend much time at TIRR. She will probably spend just five to eight weeks at the rehab center, then continue getting therapy as an outpatient, Williams said.
"Her early recovery is very promising," and bodes well for further improvement, he said.Reuse content