PHOENIX - Rep. Gabrielle Giffords' efforts to relearn how to speak have included mouthing song lyrics, such as "Twinkle, Twinkle, Little Star" and "Happy Birthday to You," as friends and family sang along, a newspaper reported late Sunday.
Giffords also briefly spoke with her brother-in-law Scott Kelly by telephone Sunday afternoon as he orbited aboard the International Space Station, The New York Times reported on its website.
"She said, 'Hi, I'm good,'" her chief of staff, Pia Carusone, told the paper. He is the brother of Giffords' husband, astronaut Mark Kelly.
She has also been receiving bedside briefings from aides on the recent uprising in Egypt and on last week's decision by Republican Sen. Jon Kyl of Arizona not to seek re-election,
"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."
Giffords was shot in the head Jan. 8 while meeting with constituents outside a Tucson grocery store. Six people, including a 9-year-old girl and a federal judge, were killed in the attack, and 13 others, including Giffords, were wounded.
The congresswoman began intensive rehabilitation at TIRR Memorial Hermann in Houston late last month. The Times reported that an e-mail sent to friends about a week ago by Giffords' mother said that Giffords has been doing squats and repetitive motions to build her muscles and walking through the hospital's halls while holding onto a cart.
The 40-year-old Giffords has beaten one of her nurses at tic-tac-toe and has changed from "kind of a limp noodle" to someone who is "alert, sits up straight with good posture," the e-mail from Gloria Giffords said.
Doctors said in late January that they planned to insert a speaking valve into her tracheostomy a tube inserted into Giffords' throat to assist her breathing immediately after the shooting. Her doctors have not said whether that procedure took place or whether the tube was removed since she no longer needs it.
Rehabilitation specialists say brain injury patients who regain speech typically begin to do so about four to six weeks after the incident. Several news organizations reported last week that Giffords asked for toast with her breakfast one recent morning.
Still, recovery for the 40-year-old Giffords will be a long, tough journey, as it is for anyone with a significant brain injury. Patients can make remarkable progress. But experts caution that they shouldn't expect to return to exactly the way they were before.
Too little has been revealed and it's too early to say if Giffords might be able to return to her job in Congress. One expert questioned whether that would be the best thing for her to do.
Most people with such injuries have some level of impairment for the rest of their lives.
Scientists are still unraveling just how the brain works to recover from traumatic injury and how to help it repair as much as possible.
They're dealing with an organ about the consistency of cold porridge. It contains maybe 100 billion densely packed nerve cells, each of which is connected to 1,000 or so other nerve cells, called neurons. Those connections form circuits that are the foundation of the brain's activity.
Brain injuries can disrupt that in several ways. A car accident can smash a head, stretching and tearing brain tissue across a wide area. A penetrating injury like a bullet causes more localized damage, but the force of the impact can also damage neuron connections some distance away from the projectile's path.
In any case, brain rewiring scientists call it plasticity is driven by what a patient is learning and experiencing, said Jordan Grafman, director of the Traumatic Brain Injury Research Laboratory at the Kessler Foundation Research Center in West Orange.
That's why patients should get into rehabilitation as soon as possible, where "people are paid to stimulate you," providing skilled expertise as well as respite for exhausted caregivers, he said.
The time course of recovery can be long. It's most dramatic in the first year, with probably more than a third of patients who survive severe injuries showing improvement by the end of that time, said Dr. Alan Faden of the University of Maryland.
Grafman said progress often slows in the second six months of the first year, becoming perhaps not evident to those who see the patient every day, but noticeable to someone who drops by only every three months.