A WCU professor emerita leads the language therapy team for former U.S. Rep. Gabrielle Giffords

By RANDALL HOLCOMBE

Images of Gabrielle “Gabby” Giffords on stage and leading 3,500 people in reciting the Pledge of Allegiance were distributed across the nation by news organizations in early January of this year. With a broad smile on her face, the then-congresswoman used her left hand to hold her right hand firmly across her heart as she repeated the pledge during a candlelight vigil. It was one of a series of events held in Tucson, Ariz., to mark the one-year anniversary of a brutal attack that resulted in a bullet piercing Giffords’ brain and taking away her normal speaking ability, as well as movement on the right side of her body. It was the first time Giffords had spoken at a public gathering since Jan. 8, 2011, when a lone gunman opened fire during an assassination attempt as she met with constituents in the parking lot of a Tucson supermarket.

Two weeks after the anniversary events, Giffords announced she was resigning from Congress to continue focusing on her recovery. Nancy Helm-Estabrooks, Western Carolina University professor emerita of communication disorders, has been a first-hand witness to Giffords’ journey back to health, which doctors have called miraculous. Helm-Estabrooks said Giffords led the pledge flawlessly. “The fact that Gabby was able to take the stage at this huge and emotionally difficult public event was another milestone in her recovery,” she said.

Email from an Astronaut

WCU professor emerita Nancy Helm-Estabrooks leads Giffords’ language therapy team as she fights to recover from an assassination attempt.

The involvement of Helm-Estabrooks in the former congresswoman’s rehabilitation began last June, when she received an email from Giffords’ husband, space shuttle astronaut Mark Kelly. Kelly had been directed to Helm-Estabrooks by several individuals, including Nancy Lefkowitz, former director of the Department of Communication Disorders at Spaulding Hospital in Boston. A part-time resident of Tucson, Lefkowitz is an acquaintance of the mother of Gabe Zimmerman, Giffords’ community outreach director who was one of six people killed in the attack. Lefkowitz assured Kelly that Helm-Estabrooks was a highly respected specialist in acquired communication disorders who could provide expert advice and assistance in Giffords’ recovery program.

Kelly and Helm-Estabrooks became acquainted over the phone, and Kelly told The Magazine of Western Carolina University in an interview that he “liked her immediately.” Helm-Estabrooks traveled to Houston in early July to meet Kelly and Giffords and to test Giffords’ cognitive and linguistic skills as the first step in developing a therapy plan to help her recover the language skills taken from her during the attack, which wounded a total of 13 people. It was agreed that she would work with Giffords for three hours during that first session. “It turned out that Gabby had such stamina that I worked with her from 10:30 in the morning to six o’clock that evening,” Helm-Estabrooks said. It was a very positive sign for her response to therapy, as Giffords had impressed both her doctors and therapists with her determination to recover from her injuries, Helm-Estabrooks said.

The language therapy Giffords is receiving is designed to help her recover from aphasia, which is not an intellectual disorder, but a language disorder that often is a result of a brain injury caused by a stroke, traumatic brain injury or neurological diseases, Helm-Estabrooks said. The professor emerita helped recruit a team of speech pathologists that has been working with Giffords in home visits since July, and Helm-Estabrooks is overseeing the therapy through weekly conference calls and reviews of chart notes. “Gabby really liked (Helm-Estabrooks) on a personal level, so we decided to put her in the lead,” Kelly said. The WCU professor emerita’s work with Giffords has been a major factor in the former congresswoman’s recovery, he said.

Former Arizona congresswoman Gabrielle Giffords and her husband, Mark Kelly.

Helm-Estabrooks suggested early on that Giffords might benefit from a period of intensive therapy, and she recommended Asheville, about 50 miles east of Cullowhee, as the location. Giffords arrived in Asheville on Oct. 23 and over a 10-day period went through 70 hours of therapy with Helm-Estabrooks and her friend and colleague Marjorie Nicholas, an associate professor at the MGH Institute of Health Professions in Boston. Giffords spent her nights at the Governor’s Western Residence in Asheville. Daily lunches at local restaurants were incorporated into the therapy, and the contingent also attended the music festival Moogfest and toured the Biltmore Estate. Giffords was guarded by Capitol Police during the outings. Helm-Estabrooks said the people of Asheville were respectful and kind as Giffords went out in public. “They left us alone for the most part, but people did come by occasionally and give her some encouraging words,” Helm-Estabrooks said. “Gabby ended up loving Asheville.” Kelly, who spent part of that time in Asheville, said the couple doesn’t have any definite plans on their calendar, but they would like to return to the city in the future.

The ABC Special

Helm-Estabrooks’ involvement in the case, along with other details of Giffords’ recovery, were kept under wraps until the broadcast of an hourlong special focusing on Giffords was shown nationwide on ABC News on Nov. 14. Hosted by the network’s Diane Sawyer, the report included comments from Helm-Estabrooks, and Sawyer referred to the WCU professor emerita as “one of the country’s most respected specialists in brain injury.” One day after the ABC report, Kelly and Giffords’ book about the attack and her recovery, “Gabby: A Story of Courage and Hope,” was released. The book included a four-page account of Helm-Estabrooks’ first meeting with Giffords in Houston.

Mark Kelly and Gabrielle Giffords speak with Diane Sawyer of ABC News during filming of the hourlong special.

Emails from across the country started arriving in Helm-Estabrooks’ inbox immediately after the ABC broadcast – hundreds of them and “most of them pretty sad stories,” she said. The messages mostly came from family members of people trying to recover from brain injuries and aphasia, and some were from the individuals with aphasia themselves. Across the board, the senders had been impressed by the remarkable progress shown in Giffords’ recovery, and they were asking for help, Helm-Estabrooks said. She set about answering all the emails, trying to “triage” by determining where the people were located and referring them to local sources of help. “I’ve worked with people with brain damage for more than 45 years. It’s very hard to ignore those pleas for help,” she said.

Helm-Estabrooks said the deluge of emails she received are an indication that individuals across the country who have suffered brain injuries are not getting the treatment they need – a commonly known fact among communication disorders professionals. Brain injury patients who do not have insurance cannot afford the long-term therapy they need, and for those with insurance, “the insurance runs out long before they come anywhere near their potential for recovery,” she said. More than one million people in the United States have aphasia, but the level of therapy they receive is “shameful,” Helm-Estabrooks said. Vital sources of help for those people are university communication disorders programs and the clinics they operate, such as WCU’s Speech and Hearing Clinic, and support groups such as those sponsored by WCU in Asheville and Cullowhee, she said.

Capacity to Serve Increasing

The WCU clinic has provided speech and hearing services to the people of Western North Carolina for more than 40 years, and patients are charged on a sliding scale based on their income, said Bill Ogletree, head of the university’s Department of Communication Sciences and Disorders. In 2010, the most recent year that figures are available, the clinic provided more than 2,700 individual patient sessions, and the clinic has “maxed out” its space in McKee Building, Ogletree said. Individuals who come to the clinic seeking help for aphasia and other language disorders are typically seen by a communication disorders graduate student who is supervised by one of the certified speech language pathologists on the faculty.

The clinic staff’s ability to serve local residents is expected to increase dramatically with the opening of WCU’s new Health and Human Sciences Building in the fall, along with the subsequent opening of a multidisciplinary clinic in the new facility that predominately will offer speech and hearing services but also will provide space for specialized diagnostic and rehabilitative services through the faculty and students from WCU’s programs in physical therapy, nursing, social work, nutrition, athletic training and recreational therapy. Rising more than four stories and including more than 160,000 square feet of space, the $42 million building, the first structure on WCU’s “west campus,” will bring together under one roof all of WCU’s growing health professions programs. Helm-Estabrooks said she is excited by the possibilities for collaboration among different health disciplines that will be available in the new facility. “This building could provide a wonderful place to have a large aphasia clinic where people with aphasia could take part in experimental treatment programs,” she said. “A lot of universities are going to be envious when they see this building because it’s really state of the art.”

Bill Ogletree, head of WCU’s Department of Communication Sciences and Disorders, works with a client in the university’s Speech and Hearing Clinic. Facilities in WCU’s new Health and Human Sciences Building will boost the clinic’s ability to serve Western North Carolina.

Ogletree said WCU’s communication disorders students and faculty “have benefited tremendously” from Helm-Estabrooks’ expertise since she first joined the faculty as adjunct professor in May 2009. Several months after her arrival at WCU, Helm-Estabrooks was appointed the university’s first Catherine Brewer Smith Distinguished Professor of Communication Disorders. She previously had been working as a research professor in the School of Medicine at the University of North Carolina at Chapel Hill. Prior to moving to North Carolina in 2004, Helm-Estabrooks was a clinical investigator for 32 years at the world-renowned Harold Goodglass Aphasia Research Center at the Boston University School of Medicine. Ogletree said Helm-Estabrooks literally wrote the book on aphasia in co-authoring the landmark work “Manual of Aphasia and Aphasia Therapy.” “I can certainly understand Mark Kelly and Gabby Giffords choosing to work with Nancy,” Ogletree said. “In a similar circumstance, I would have made the same choice.”

Helm-Estabrooks and Nicholas are scheduled to travel to Tucson in March to provide Giffords with another seven days of intensive therapy. Throughout her involvement in the case, Helm-Estabrooks has been working with the former congresswoman without financial compensation. Giffords was injured as she carried out her congressional duties, and Helm-Estabrooks said she considers her services to be “payback” for the grant support and training she has received during her career courtesy of the federal government. She said working with Giffords, “one of the most likeable people I’ve ever met,” has been an honor and privilege. “Aphasia is not an easy disorder to treat,” she said. “It takes a lot of persistence. I don’t see any instant miracles, but with Gabby I have seen such steady progress. It’s a joy working with someone who stays positive and works very hard.”