PHOENIX — Rep. Gabrielle Giffords, an eloquent speaker before she was shot in the head last month, is relearning the skill — progressing from mouthing words and lip-synching songs to talking briefly by telephone to her brother-in-law in space on Sunday.
With a group of friends and family members acting as a backup chorus, Giffords has been mouthing the lyrics to Twinkle, Twinkle, Little Star, and I Can't Give You Anything but Love, Baby. And as a surprise for her husband, who is celebrating his birthday this month, a longtime friend who has been helping her through her rehabilitation videotaped her mouthing the words to Happy Birthday to You.
"It's not like she's speaking the way she spoke, but she is vocalizing and making progress every day," Pia Carusone, the congresswoman's chief of staff, said in a telephone interview on Sunday. "She's working very hard. She's determined. It's a tight schedule. A copy of it is hanging on her door."
Outside specialists say it remains unclear, despite the hopeful early signs, what functions in Giffords' mind were affected by the traumatic injuries she suffered when she was shot at point-blank range on Jan. 8 at a constituent event in Tucson.
It is not uncommon for patients with a similar injury to have trouble communicating or to undergo personality changes, brain specialists say. Everything from one's ambition and concentration to one's short-term memory and social inhibitions can be affected, doctors say.
But relatives and friends who have been at her side as she undergoes rehabilitation at a hospital in Houston said in interviews and e-mail exchanges that though her recovery was slow-going and exhausting, it was marked by significant progress.
Carusone said that on Sunday afternoon, Giffords' husband, Capt. Mark E. Kelly, put the congresswoman on the phone to talk to his twin brother and fellow astronaut, Scott, who is aboard the International Space Station.
"She said, 'Hi, I'm good,' " Carusone said.
With the help of therapists at TIRR Memorial Hermann hospital in Houston, the congresswoman known for her active, outdoorsy ways now labors through the halls clutching a shopping cart and does squats and repetitive motions to build her muscles, her mother, Gloria, said in an enthusiastic e-mail she sent about a week ago to friends that recounted her daughter's progress. Others who have visited Giffords recently have left similarly upbeat.
Aides conduct bedside briefings for her, telling her about the events unfolding in Egypt, for instance, and the decision by Sen. Jon Kyl, R-Ariz., not to run for re-election next year.
"We tell her everything that's going on," Carusone said. "Don't get the idea she's speaking in paragraphs, but she definitely understands what we're saying and she's verbalizing."
In long days that begin with breakfast at 7, Giffords, 40, has beaten one of her nurses at tic-tac-toe and transformed herself, her mother wrote, from "kind of a limp noodle" to someone who is "alert, sits up straight with good posture (in fact anyone in the room observing, unconsciously sucks it up and throws back their shoulders) and is working very hard."
Giffords' mother says that doctors are regularly surprised by her latest achievement. They say, "She did WHAT?" she wrote in her e-mail, adding that "little Miss over achiever is healing very fast."
Reached by telephone on Sunday, Giffords' mother offered a one-word assessment of her daughter's road to recovery. "As far as Gabby's progress you can quote me as saying, 'Yippee!' " she said.
The rehabilitation center referred requests for comment to Giffords' staff.
Dr. David Langer, an associate professor of neurosurgery at the Cushing Neuroscience Institutes at North Shore University Hospital in Manhasset, N.Y., who is not treating Giffords, pointed to encouraging signs.
"She's obviously communicating, obviously verbal," he said. The gunshot wound, he said, "probably didn't irreversibly damage her speech center."
"Until she's really talking, giving a speech," Langer said, "you won't know if there's a subtle speech problem. But it sounds like with rehabilitation, with time, she ought to be very functional."
The use of singing, he said, is a standard technique to help restore speech in people with brain injuries. (It is sometimes used to help treat stuttering, Langer said, citing the movie The King's Speech in which King George VI sang to overcome his speech impediment.) The part of the brain that controls singing is not the same as one that controls speech, though it is close.
Langer also said it was good news that Giffords was walking. "People's ultimate endpoints are often based on how rapidly they improve," he said. "If there's rapid progress, the recovery potential is much higher. It sounds like she hasn't plateaued yet and is improving really quickly."
Brad Holland, a Tucson lawyer and old friend, has been a regular presence at Giffords' bedside. Sen. Kirsten Gillibrand, D-N.Y., has spent the night in the congresswoman's room in what Gloria Giffords called a "sleepover."
A visit by Rep. Nancy Pelosi, the Democratic minority leader, is planned soon, and former President George H.W. Bush, who lives in Houston, may stop by for a visit as well, those close to the congresswoman say.
Despite some obvious signs of progress for Giffords, experts offer some caution.
The human brain has what amounts to redundant circuits for some simple tasks, like walking, and it is possible for patients to make rapid progress on those skills and still have trouble with mental work and speaking, doctors said.
"There are backup systems in the brain for the more basic functions that have been around longer in human beings," said Dr. Jonathan Fellus, director of the Brain Injury Program at the Kessler Institute for Rehabilitation in New Jersey. "Conversely, for things such as language, which are uniquely human, it's a highly specialized and delicate network that doesn't get reconstructed so easily."