Just seven weeks ago, a would-be assassin left Gabrielle Giffords for dead after shooting her at point-blank range outside an Arizona shopping mall.
The 40-year-old US congresswoman not only survived a bullet through her brain, but is now delighting family, friends and doctors with her astonishing recovery.
Today, The Sunday Telegraph can reveal how a pioneering music therapy technique is helping Miss Giffords regain her faculties, after being granted behind-the-scenes access to her Houston rehabilitation clinic.
Remarkably, a nursery rhyme that generations of parents have sung to their children to lull them to sleep has played a key role in bringing her back to life as she learns to talk and, eventually, walk again.
When Miss Giffords mouthed the words of Twinkle Twinkle Little Star as her music therapist Maegan Morrow sang the ditty and strummed a guitar, it brought tears to those gathered at her bedside.
She has now progressed to sing-alongs of jazz and rock classics such as I Can’t Give You Anything But Love and American Pie in her sixth-floor room at The Institute for Rehabilitation and Research (TIRR) in Memorial Hermann hospital.
Miss Giffords was shot on January 8 during an unprovoked rampage by Jared Loughner, a mentally disturbed 22-year-old. In scenes that shocked the world, he fired opened fire on the politician and went on to kill six and injure 12 others at a public forum in Tucson, Arizona.
Initial reports at the time suggested Miss Giffords had died in the attack, and even when it was later confirmed that she had survived, it was widely presumed that she would spent the rest of her life in a vegetative state. Since then though, she has confounded all expectations, partly through what doctors describe as a sheer willpower on her behalf.
She has taken her first few steps, gently pushing a shopping trolley aided by her therapists, spoken her first words, and added sushi and matzo ball soup, a traditional Jewish dish delivered by her rabbi, to her hospital diet.
She is recovering so well that her husband Mark Kelly, a US astronaut, hopes that in April she will travel to Florida to see the blast-off of the final space shuttle mission under his command from Cape Canaveral.
For now, he visits every day after his own rigorous training sessions at the nearby Johnson Space Centre. On Monday she delivered a rendition of Happy Birthday To You for his 47th birthday.
She has also added American Pie to her repertoire after a recent visit by her rabbi Stephanie Aaron, who accompanied Mr Kelly and the congresswoman’s teenage step-daughters. “She was singing it with Mark and Mark’s daughters, who noticed that she knew the words better than they did,” said Miss Aaron.
Miss Gifford’s mother, Gloria, has told friends that her daughter’s transformation from a “limp noodle” after the attack owes much to music sessions where family and friends “clap and hoot” as back-up chorus and band.
The neurologic music therapy – an integral part of her packed daily routine of physical, occupational and speech therapy – “really flipped the switch” for the congresswoman, Mrs Giffords said.
The bullet fired punctured the left hemisphere of Miss Giffords’ brain – the control centre for language and right-side body movement.
Miss Morrow, a young Texan former opera student from a Christian rock and roll background, explained how music and rhythm work across all parts of the brain, helping a patient not just to speak again, but also to walk and even cope with the daunting emotional challenges.
“Neurologic music therapy works on both the physical and mental aspects of a patient’s recovery,” said Miss Morrow, who is prevented by confidentiality laws from discussing the specifics of Miss Gifford’s case.
“It helps with words and memory. The patients automatically join in with songs they know and love. And of course songs and emotions go hand-in-hand.”
Miss Morrow also uses music to help patients back onto their feet. Like a strolling minstrel, she plays a simple chord and shifts her weight from foot to foot with a basic waltz move – and the patients follow suit.
“We all have rhythm,” she said. “It’s so simple but so complicated. I play a little rock and roll or country beat and the rhythm immediately has its effect on everyone.”
Miss Morrow asks patients and their families for their favourite songs – Mrs Giffords said that her daughter had also been lip-synching I Can’t Give You Anything But Love, which has been recorded by the likes of Louis Armstrong and Ella Fitzgerald. The therapist also throws in popular hits by The Beatles and others.
“Loss of language and loss of cognition are not a loss of intellect or knowledge,” said Shina Morrow, another member of the TIRR speech therapy team. “Our goal is to retrieve that knowledge. The role of the individual patient is crucial. Their willpower and determination and motivation is incredibly important.”
A valve has been fitted to the congresswoman’s tracheostomy tube that allows her to speak. Although little has been revealed about specific conversations, she did tell her husband she was “better” when he asked her how she felt and requested toast with breakfast recently.
Mrs Giffords described her daughter’s progress in a recent email to friends in Arizona. “From a kind of limp noodle when you last saw her, she’s alert, sits up straight with good posture … and is working very hard,” she wrote.
She said that doctors were planning another operation on the congresswoman to replace a piece of skull removed straight after the shooting to reduce pressure when her brain swelled. She added that doctors believed the bullet did not directly affect her main speech control centres.
Dr Gerard Francisco, the head of her rehabilitation team at TIRR, emphasised that while the eventual prognosis for every brain injury was different, a patient’s level of personal motivation was crucial.
“The patients may not return to what was normal for them before injury, but our goal is for them to reach a new normal,” he said. “We have been very pleased with the congresswoman’s progress. She is a hard worker who is engaged in the rehabilitation process.”
He oversees a therapy programme that ranges from low-tech tools – such as the shopping trolley that doubles as Miss Giffords’ walking aid – to state-of-the art equipment. It includes a robotic arm hooked up to video-game technology and the so-called “Superman” weight-bearing computer-driven harness that supports patients as they learn to walk on a treadmill.
The congresswoman’s own room is packed with pictures, mementoes and messages from well-wishers and a hive of activity for therapists, family, friends and aides.
The challenge, said her mother, was to restrict the number of visitors so that her daughter did not become too tired – although an exception is expected to be made for President George Bush Sr, who lives nearby and is planning to drop by.
Another regular face is her chief of staff Pia Carusone, who briefs her boss each day on the latest news from her home state of Arizona, Capitol Hill and the Middle East.
However, while the congresswoman knows that she herself was shot, she is not yet aware of the deaths and injuries to others.
“Doctors have said it’s not really fair to tell someone something so tragic,” said Miss Carusone. “Especially if they might not have the ability to ask the detailed questions that they will have when they hear this news.”