Giffords' SLPs often end intensive treatment sessions with a group sing-along to videos on YouTube.
Congresswoman Gabrielle ("Gabby") Giffords captured the attention—and deep sympathy—of a nation when she was shot by Jared Lee Loughner in a Safeway parking lot on January 8, 2011, in Tucson.
Giffords' recovery from injury to her brain's left hemisphere has been remarkable—and speech-language pathologists have figured prominently in her rehabilitation for aphasia. Shortly after her discharge as an inpatient from TIRR Memorial Hermann Rehabilitation Hospital in Houston in late June 2011, her husband, astronaut Mark Kelly, contacted SLP Nancy Helm-Estabrooks. Renowned for her work with aphasia rehabilitation, Helm-Estabrooks was asked to see Giffords and then develop home program speech-language services to supplement her outpatient therapy at TIRR.
Media reports over the past few months have touted a range of methods being used to help Giffords with her speech, particularly music therapy. In this interview with The ASHA Leader, Helm-Estabrooks provides a fuller picture of Giffords' communication treatment.
How did you get involved with treating Gabby Giffords?
In late June 2011, I received an e-mail message from Congresswoman Giffords' husband, Mark Kelly.
As it happened, a woman named Nancy Lefkowitz, who was the head of speech pathology at Spaulding Rehabilitation Hospital in Boston [Helm-Estabrooks worked for 32 years at the Harold Goodglass Aphasia Center in Boston], started a campaign to get the message to Congresswoman Giffords' family that I should be consulted.
Once I connected with Mark by phone, we had a long talk about Gabby, so I had an idea of where she was in her recovery. Then, in July, I went to Texas to see Gabby at Mark's home. Mark thought she could work with me for three hours. Well...outside of her taking a 20-minute nap mid-afternoon, she worked with me from 9:30 that morning 'til 6 at night. That was a very good sign.
How did you start your treatment with her?
I didn't do any formal, standardized testing. One of my mentors, Harold Goodglass, said a good aphasiologist should be able to test someone on a desert island using the materials at hand, but I did bring some special materials, such as pictures of politicians, members of the Supreme Court, and leaders of various countries. With those and other informal tasks, I used a dynamic assessment approach.
In August we used Skype to interview a team to work with her. We hired three experienced speech-language pathologists. Then, we set up a secure website so I could read chart notes, and every week her team in Texas and I had a conference call to discuss her response to the therapy program and make any necessary modifications. As Gabby continued to improve, her Texas team has come up with very good ideas to "tweak" the ongoing program. Most of their ideas have been incorporated into the therapy sessions.
Next you worked with Mark to set up two weeks of intensive speech therapy in Asheville. How did it go?
During 10 weekdays, SLP Marjorie Nicholas—a close colleague who worked with me at the Boston VA and now is at the MGH Institute for Health Professions—did 70 hours of speech-language therapy. Then, in March, we did another go-round of intense aphasia therapy in Tucson.
Neighbors, friends, and family dropped by and she attended evening events. Marj and I were impressed with the many ways she had progressed in a variety of independent activities.
In Tucson, she directed Mark as he drove to the Mexican restaurant of her choice. She was out of the car before any of us and first at the cash register, ordering. So she continues to make good progress.
She's been a very hard worker all her life and continues to be. She keeps up on all her therapy assignments as well as on politics, the news of the world, movies, and so forth. She has more stamina at this point sometimes than I do, which is not surprising, I guess, given our age difference.
What's your next plan for intensive treatment with Gabby?
We're planning eight days of very intensive language therapy in the Smoky Mountains this summer. Again, Gabby will have to forego her OT and PT for a while. But her main rehab doctor has been very approving of all this language treatment. Again, Marj Nicholas will join me in administering day-long therapy.
You are obviously renowned in the field for co-founding Melodic Intonation Treatment (MIT). Have you used MIT with Gabby?
I haven't, but it was one of the first things they used at TIRR when she was an inpatient. This fact contradicts the opinion of Harvard researcher Dr. Gottfried Schlaug, who stated in an NPR interview that MIT is rarely used. You can see the early use of MIT with Gabby in the footage [in the ABC 20/20 Special Edition, "Gabby Giffords & Mark Kelly: Courage and Hope"]. I have no doubt that MIT got her going on the road back to use of intentional speech. But by the time I saw Gabby in the beginning of July, right after her TIRR inpatient discharge, her language skills were really too good for MIT. One of the things MIT does is improve repetition, leading to improved propositional speech, and her repetition was already quite good. So maybe MIT got her started, but once her home program started, we took many different approaches to restoring her language skills.
There's been a lot of press coverage about the use of music therapy with Gabby. What has its role been in her treatment?
Gabby is a very good singer and instrumental musician, so she enjoys her music therapy in which they use drums, play instruments, and sing popular songs. But I think that it's erroneous to think that music therapy alone was the treatment that got Gabby to where she is now [as some press accounts have intimated]. In the intense therapy that Marjorie and I do, we might end the day logging on to YouTube and find tunes Gabby likes to sing. In the fall, before Gabby came to Asheville, she had just seen Jersey Boys, and she knew all the songs of Frankie Valli and the Four Seasons. We often started out the singing session with one or two of their songs, which she sang much better than I do. So in a sense we were using a form a music therapy. But her formal music therapy in Texas has been accompanied by a lot of very good language therapy that keeps up with her current skill level.
What is the focus of your speech-language work with her now?
It surprised me, but when I saw Gabby in July, she displayed no motor speech problems. Her articulation of words was excellent. Maybe in producing a very long word she might have an occasional phonemic paraphasia, but she's not somebody with dysarthria or—certainly by the time I saw her—anything I would call apraxia of speech.
When I first saw her the biggest challenge was to address agrammatism and to increase phrase length, and that is being done with good success.
One day in Tucson, her mother was present at a therapy session, and we sat around the table after finishing formal therapy. We told each other stories from our past, which was lots of fun. Gabby and her mother have great senses of humor.
What do you think Gabby's legacy is for the communication sciences and disorders profession—for treatment of people with TBI and aphasia generally?
She's a very tough woman, you know, she...she almost died. That she's on such a good road to recovery is a testimony to the natural healing of the brain, good medical care, to our field, to OT and PT, and rehabilitation medicine in general.
The issue, however, is that most people don't get as much therapy as Gabby has. In most cases, the insurance of people with aphasia (if they have it) dries up quickly.
This fact, however, has led to the development of many community aphasia programs that are either free of cost or have a sliding fee scale. All in all, however, I'm hoping that Gabby's case will bring to the public attention how well people can do with more rehabilitation and how little rehab most people with aphasia are getting or are allowed.