Malala Yousafzai's survival from a bullet wound to the head and early signs of hope bear a strong resemblance to the case of U.S. Congresswoman Gabrielle Giffords – and if anyone knows, it's the doctors who treated the American politician shortly after she was shot in the head and helped her through a gruelling rehabilitation.
"There are some very strikingly similar features: the left-sided gunshot wound, the fact that the reports are that [Malala] was moving everything and responding to commands by the initial triage doctors out in Swat [Pakistan]. These are all good things – so that should give some real optimism to everyone involved," said Dr. Michael Lemole, the neurosurgeon who operated on Ms. Giffords at the University Medical Center in Tucson, Arizona.
An injury resulting from a bullet passing through the head – hitting the left and right sides of the brain – would have been almost certainly fatal. But like Ms. Giffords, Malala appears to have been spared that scenario.
The Pakistani advocate of girls' education, shot last week by a Taliban assassin, can expect a "good recovery," according to her British medical team. The effect of any brain damage on her ability to move, speak or remember remains unclear. And as the case of Ms. Giffords shows, the road to recovery will be long, gruelling and have its ups and downs.
In the immediate aftermath of the Giffords shooting, two signs encouraged Dr. Lemole before and after the neurosurgery to reduce any swelling of the brain – a dangerous complication that could have led to the congresswoman's death. "[She] was following commands right before the surgery and very quickly afterwards we got her to wake up gain. Those were the most important key moments," he recalled.
"And then those little poignant vignettes you hear from in the press – when Mark Kelly her husband came and sat next to her, she started fiddling with his ring – little things like that that I can't measure but that he told me and subsequently told others that were very meaningful because it implies a much higher level of cognition, much higher level of brain processing than the simple rudimentary test that I can do," said Dr. Lemole.
The surge of optimism felt by Dr. Lemole and others during those early stages is no doubt what Malala's British medical team is experiencing today after news that the Pakistani girl was able to stand with assistance, write and communicate – although a tracheotomy prevents her from trying to speak. Dr. Lemole says the Giffords medical team had to be careful about appearing overly enthusiastic.
"We were very cautious in dealing with the press – we didn't want to promise anything we couldn't deliver," recalled Dr. Lemole.
After two weeks of acute care under Dr. Lemole's supervision, Ms. Giffords was transferred to the care of Dr. Gerard Francisco, chief medical officer at TIRR Memorial Hermann Hospital in Houston, Texas, where she began an extensive rehabilitation program involving speech and motor therapy
Dr. Francisco recalls that Ms. Giffords struggled to speak but was able to sing her husband Happy Birthday and the lyrics to the song American Pie. "A lot of the songs that we're familiar with – the popular songs – have been ingrained in our brain for a long time, so they come up almost naturally. Whereas spontaneous speech – we ask someone a question, and you expect a particular answer – is not practiced. So one can assume that is more difficult," he explained.
Dr. Francisco says the key to Malala Yousafzai's recovery and rehabilitation may well be her age.
"The young brain is what we call a plastic brain – it is a very flexible brain that's more amenable to be guided by rehabilitation efforts. And that, in general, the younger the brain the higher the chance of recovery. So that is something in her favor," said Dr. Francisco.
Less than four months after being shot, Ms. Giffords – with the help of Dr. Francisco and his rehabilitation team – was able to travel to Florida to witness the space shuttle launch on which her husband was a crew member. Earlier this year, Ms. Giffords announced that she would not be seeking re-election.
At the Democratic National Convention in September, she moved thousands of delegates to tears when she recited the American pledge of allegiance. Dr. Francisco said the scene was amazing.
"She's an amazing person, she's a hard worker. Am I surprised? I'm not, because I know with the appropriate therapy, with the appropriate practice she will be able to accomplish that," said Dr. Francisco.
Dr. Francisco says he may not know all the facts of Malala's medical case, but he has "high hopes."
"I've seen a lot of people who've gone through the same type of injury and they've recovered quite well," he said. "She's young, she seems to be a very strong-willed person – and all those bode well for her."