Aide: Time nearing for U.S. Rep. Gabrielle Giffords' hospital release

HOUSTON (AP) - An aide to U.S. Rep. Gabrielle Giffords said Saturday that she could be released from a rehabilitation hospital in Houston as early as this month, offering the latest indication that the Arizona congresswoman is making progress in recovering from a gunshot wound to the head.

Chief of Staff Pia Carusone told The Associated Press that doctors and family are considering "many factors" while making the critical next-step decision to release Giffords from TIRR Memorial Hermann, the hospital where she has been undergoing intensive daily rehabilitation since late January.

"We're looking at before the end of the month. We're looking at early July," Carusone said. "We don't have a date."

Giffords arrived in Houston just weeks after being shot on Jan. 8 while she was at a meet-and-greet with constituents in her home district of Tucson, Ariz. Six people were killed and a dozen others wounded in the attack outside a supermarket.

While Giffords' release from the hospital after five months of intensive inpatient therapy will mark an important step in her recovery, she still must undergo months of outpatient rehabilitation that will include speech, occupational and physical therapy. Giffords' husband, astronaut Mark Kelly, has indicated she will begin her outpatient therapy in Houston.

Giffords has made remarkable progress in the last five months, with neurosurgeon Dr. Dong Kim describing it as "almost miraculous," and doctors previously had noted the congresswoman's remarkable survival.

Only 10 percent of people shot in the head live and many who do remain in a vegetative state.

Within days of the shooting, Giffords was moving both arms and legs, as well as responding to family and friends. Since arriving in Houston, she has regained some ability to walk and talk.

But in an interview published Thursday in the Arizona Republic, Carusone made clear that Giffords remains a shadow of her former self as she has difficulty stringing together sentences and relies heavily on gestures and facial expressions to communicate. She also faces some difficulty in expressing bigger, more complex thoughts, Carusone said.

The challenges are typical of what experts describe for people who have suffered traumatic brain injury.

The only images the public has seen of Giffords since the shooting were taken in late April as she boarded a plane to watch her husband rocket into space from Cape Canaveral, Fla. Blurry footage showed her, at a distance, purposefully ascending a flight of stairs to a NASA jet.

That mission was delayed until May, and after Giffords returned from a second trip to Florida - where she watched the launch while sitting in a wheelchair - she underwent surgery to replace a portion of her skull that was removed immediately after the shooting to give her brain room to swell.

After the surgery, doctors told the media that Giffords was walking better than was seen in the April footage and that her speech was continued to improve.

It remains unclear if - or when - Giffords would be able to resume her congressional duties, Carusone said.

Giffords was shot in the left side of her brain, the area that controls speech and communication. Bullet fragments remain lodged in her brain, preventing doctors from conducting an MRI, a magnetic scan that would provide a more accurate picture of the damage.

Giffords' doctors in Houston won't speculate on her future abilities, but they have repeatedly talked about their patient learning to live with a "new normal."

Early in her treatment, some experts who weren't involved in her case expressed caution about Giffords chances of returning to Congress. Along with the expected limitations, they noted that impairment can add stress for those who strive to return to a high-pressure job, and stress can further harm mental abilities.

Experts say recovery from a major brain injury is most dramatic in the first year, with progress often slowing in the second six months, even to the point of being imperceptible to someone who sees the patient every day. During the second year, gains are often minimal.