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The following is an opinion piece from Chron.com (which, I assume, is The Houston Chronicle), written by Kurt Mossberg:


The tragic circumstances surrounding the incident in which U.S. Rep. Gabrielle Giffords was shot in the head have significantly increased awareness of traumatic brain injury (TBI). I believe her decision to resign from her congressional seat was the right thing to do. Rather than go through the rigors of a re-election campaign, she has chosen to continue to go through the rigors of rehabilitation. This is a good choice, not only for herself but also for the 5.4 million other Americans who live with the consequences of a TBI.
In the U.S. it is estimated that there are 1.7 million new cases of TBI per year and many more that go unreported. In contrast, there are estimated to be up to 11,000 new cases of multiple sclerosis and approximately 40,000 new cases of Parkinson's disease each year.
Fortunately, most TBIs are considered mild. However, a concussion, which is considered a mild brain injury, was once thought to have little to no residual effects. We are just now learning about the long-term effects on cognition and behavior. Post-mortem studies of professional football players are finding that multiple hits to the head result in changes in the brain that resemble Alzheimer's disease.

There have been tremendous advances in the treatment of TBI but we still have a long way to go in the area of post-acute and long-term rehabilitation. Robotic interventions are being explored in which isolated arm, wrist or hand movements are facilitated mechanically and even electrically. Leg movements and body weight can be controlled by a robotic device to help regain the ability to walk. While it is still early, some evidence suggests that a robotic intervention does not require enough effort on the part of the patient and the patient plays a less active role in the therapy session. The more the patient actively participates, the more likely there are to be long-term gains as the brain responds and adapts in a more normal fashion.
Our own research suggests that some individuals can benefit from high-intensity, long-duration physical therapy even years after the injury. Our preliminary studies have shown that a properly prescribed aerobic conditioning program can improve the cardiorespiratory fitness of a person with a TBI. Improved cardiorespiratory fitness has physiologic, biochemical and psychological benefits in many patients, and certainly we should all strive to be more physically active to help prevent cardiovascular disease, Type 2 diabetes and early onset dementia, just to name a few chronic disabling conditions.
Rep. Giffords' injury was serious and could have lifelong effects. It has been more than a year since she was injured, and she is fortunate to have the resources available that enable her to continue her rehabilitation. If you watched the YouTube video on her website where she announced her resignation, you could see she still has challenges that hopefully she will be able to overcome.
Rep. Giffords is fortunate that her costs are covered by the workers' compensation plan available to all federal employees. Unfortunately, not everyone is going to receive the kind of care that Giffords has and will continue to receive. If we assume you were covered by Medicare (total coverage is capped at $1,880 per year for physical and speech therapy combined), your number of one-hour sessions would be significantly less than what the congresswoman is receiving. Additional sessions would have to be paid for by other third-party payers or out-of-pocket.
The kind of care the average American can expect is dependent on the insurance plan (if any), state of residence and, probably most importantly, how strongly they or family members/caregivers advocate for their needs.
Rep. Giffords' office has made it known that not everyone has been as fortunate as she in receiving the full spectrum of treatment. Our biggest challenges are funding for research and access to high-quality treatment.
As she continues her therapy, Rep. Giffords will teach us all about the potential for improvement long after the initial event. Her world changed in an instant, and it could happen to anyone.
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Mossberg is a brain injury expert and the Fannie Kempner Adoue Distinguished Professor in the department of physical therapy and rehabilitation sciences at the University of Texas Medical Branch at Galveston.

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