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TUCSON, Ariz. — The neurosurgeon treating U.S. Rep. Gabrielle Giffords said Friday doctors are "actually confident" she's making progress in her recovery.
Dr. Michael Lemole said her eyes are opening more frequently and she can carry out more complex sequences of activity in response to commands and on her own.
She remained in critical condition with a breathing tube still in, though it is expected to be removed Friday. The wounded congresswoman may also sit up in a chair.
Once the breathing tube is removed, "they'll be able to hear her speak and evaluate her brain," Dr. Nancy Snyderman said on TODAY Friday.
The medical team at University Medical Center in Tucson, Ariz., aren't as concerned about brain swelling at this point, Snyderman said, but are watching for signs of pneumonia and blood clots.
"She is progressing normally without any complications or setbacks. She's on schedule as we had hoped," said trauma chief Dr. Peter Rhee on MSNBC cable. "She’s progressing at a good speed for this time period. Even overnight, she’s made significant progress."
Rhee said the UMC medical team may at some point perform a tracheostomy, a surgical procedure to create an opening through the neck into the windpipe, in order to clear an obstructed airway.
Earlier, doctors reported Giffords has been sitting up, dangling her legs on the edge of the hospital bed and moving her limbs in response to commands. That's after she spontaneously opened her eyes during visits with her colleagues Wednesday night. She is able to lift both of her legs on command and is yawning and starting to rub her eyes, doctors said.
"She's becoming more aware of her surroundings," Rhee, who has treated soldiers in Iraq and Afghanistan, saidThursday.
But moving forward, Rhee expects changes to be less dramatic than they've been this week. "We’ll see a lot of things in the next two months," the surgeon said on MSNBC cable Friday. "Then the changes will be more subtle for the next year ... and after that.”
Six people were killed when gunman opened fire outside a Safeway store in Tucson on Saturday. Giffords, who investigators say was the primary target, was among 13 people wounded. Giffords remains critical and four patients are in fair condition. One patient was to be discharged Thursday.
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"Everybody is making fantastic progress forward," Rhee said.
Giffords' neurosurgeon, Dr. Michael Lemole, said after five days of pushing for caution, "We're wise to acknowledge miracles."
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'Gabby opened her eyes'
At the memorial service Wednesday evening for the victims of the Tucson shootings,
President Barack Obama went off-script to announce Giffords' latest medical triumph.
"Gabby opened her eyes," Obama said to a loud cheer from the audience on the University of Arizona campus, adding that the congresswoman "knows we are here." Although the president wasn't in the room at the moment Giffords' eyes opened, he said her husband, astronaut Mark Kelly, had given him permission to break the news.
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House Democratic Leader Nancy Pelosi of California, Rep. Debbie Wasserman Schultz of Florida and Sen. Kirsten Gillibrand of New York, three of Giffords' close female friends in Congress, were in Giffords' hospital room when she opened her eyes, NBC News confirmed.
"She was rubbing our hands and gripping our hands so ... we knew she could hear and understand what we were saying and she moved her leg, and so we knew she was responding," Gillibrand said.
Giffords' husband realized the significance of the moment. "Gabby, open your eyes, open your eyes," he said, according to Gillibrand. "And then she's struggling, struggling. And she opens her eyes," Gillibrand told NBC News. "And then he's just almost beyond himself, because he's so excited. And he said, "Can you see me? Can you see me?" ... If you can see me, give me a thumbs up.
"And she doesn't just put a thumbs up, she raises her entire arm," Gillebrand continues.
So, it was the biggest thumbs up she could have given.
"(T)he doctors couldn't believe what they were seeing," she said, adding later that "it was truly the most inspiring moment that I'd ever witnessed."
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Gillibrand said on CNN that Giffords signaled by raising her hand that she was able to see.
'A glorious, glorious experience'
Speaking on "Countdown with Keith Olbermann" on MSNBC cable, Pelosi said: "We witnessed almost a miracle. We saw the power of prayer, the power of the effect of the excellence of her medical care and we saw a little girl power too because we were trying to amuse
Gabby, trying to get through to her about how much she was loved and missed in the Congress and what was waiting for her when she came back."
"And being there with her parents and her husband and when she opened her eyes was quite remarkable. ... It was a glorious, glorious experience. We thought we brought a little fun to the room and she reacted," she said.
Giffords' husband has remained by her bedside. Kelly is supposed to command shuttle Endeavour's final mission in April. NASA says Kelly remains commander of the mission while veteran astronaut Rick Sturchow will serve as a backup commander for the launch.
"I recommended to my management that we take steps now to prepare to complete the mission in my absence, if necessary," Kelly said. "I am very hopeful that I will be in a position to rejoin my crew to finish our training."
The difference between life and death
The path of the bullet that struck Giffords' brain, quick and quality medical care, and luck meant the difference between life and death, say her doctors and brain experts.
Doctors think the bullet pierced the front of Giffords' head and exited the back, slicing the left side of the brain, which controls speech abilities and muscles on the right side of the body.
Had the bullet damaged both sides of the brain or struck the brain stem, which connects to the spinal cord, the outcome would likely be worse — extensive permanent damage, vegetative state or death.
"So far, she's passed with flying colors of each stage" of her recovery, said neurologist Dr. Marc Nuwer of the University of California, Los Angeles, who is not involved in the congresswoman's treatment.
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When Giffords arrived at the hospital, doctors first checked to make sure she didn't have any other injuries. They took a brain scan and wheeled her to the operating room in a swift 38 minutes.
The same attack in the desert many miles away from a trauma center may have led to a different ending.
It's too early to tell the extent of damage Giffords suffered, but experts say it's rare for people with gunshot wounds to the head to regain all of their abilities. Damage to the left side of the brain can result in memory loss, difficulty reading and hand-eye coordination problems. Giffords' doctors have not been able to determine how well she can speak since she still has a breathing tube.
"Her full-time job now for the next year is working on her recovery and rebuilding her life around her disability whatever it may be," said Dr. Stephan Mayer, professor of clinical neurology at Columbia University Medical Center in New York, who has no role in Giffords' care.
About 1.7 million people in the United States suffer traumatic brain injuries every year, with about 20 percent of them caused by violence, including gunshots. About 52,000 people die as a result of their injuries and about 275,000 are hospitalized, according to the Centers for Disease Control and Prevention. Of the deaths caused by traumatic brain injury, perhaps 35 percent to 40 percent are attributed to gunshots.
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This article contains reporting from NBC News, msnbc.com staff and The Associated Press.
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