By RAMIT PLUSHNICK-MASTI, Associated Press
HOUSTON (AP) - Images of a smiling Rep. Gabrielle Giffords were posted Sunday on her Facebook page, two photos that show her with shorter, darker hair but few signs that she suffered a gunshot wound to the head.
The photos were taken May 17 outside the Houston rehabilitation facility where Giffords has been undergoing treatment since she was wounded five months ago at a meet-and-greet event with constituents. Six people died and a dozen others were hurt in the Jan. 8 attack in Tucson, Ariz.
Since then, access to the Arizona congresswoman has been tightly controlled. Until Sunday, no clear images had been released.
The only recent sign of Giffords came in late April, when grainy television footage showed her slowly ascending a flight of steps to a NASA plane that took her to Florida to watch her astronaut husband rocket into space. The image was so blurry that it was impossible to confirm it was Giffords until doctors did so at a news conference in mid-May.
Giffords spokesman C.J. Karamargin said staff members released the photos Sunday to help satisfy "intense interest in the congresswoman's appearance."
The timing coincides with plans to release Giffords from the hospital later this month or in early July. Her staff hopes the images will help curb unwanted photography when she begins visiting an outpatient clinic in a more public setting.
"What we wanted to avoid was a paparazzi-like frenzy," Karamargin said.
The professionally shot pictures were taken before Giffords underwent surgery to replace a piece of her skull that had been removed shortly after the shooting to allow her brain to swell. The images suggest the congresswoman is returning to her former appearance -- though she still looks slightly different than before.
But the photos give little indication of Giffords' cognitive abilities -- what, for example, her speech is like after being shot in the left side of the head, which controls communication. The images also provide no hints as to when, or if, she will be able to resume her job.
"There's nothing that unique about the outer presentation," said Jordan Grafman, director of the Traumatic Brain Injury Research Laboratory at the Kessler Foundation Research Center in West Orange, N.J., explaining that many brain injury patients look good within months of being hurt.
"But the image doesn't tell us the inner mental state or the brain itself, how it's functioning," said Grafman, who has not treated Giffords. "What's their social skills? Do they have a nuanced sense of humor? Can they participate in activities? All that is what's important."
Pia Carusone, Giffords' chief of staff, has indicated that while the congresswoman is able to speak and walk, she remains a shadow of her former self.
Karamargin said Giffords' left eye appears smaller in one of the photos because part of her skull was missing when it was taken. That has since been repaired. He also said her hair is shorter now because it was shaved for the surgery that repaired her skull.
The photos capture Giffords' ecstatic mood following her husband's space shuttle launch.
"She got to see her husband successfully ride a rocket into space," Karamargin said. "So who wouldn't be pleased?"
He added: "I think this photo speaks volumes about the congresswoman's resilience and recovery. It shows someone in very good spirits, someone who is happy, someone who has a very positive attitude."
Of the two pictures, one is more clearly posed, that of a smiling Giffords looking directly at the camera. The left side of her head appears slightly distorted and swollen. A second photo shows Giffords in a more casual light -- smiling while sitting alongside her mother, Gloria Giffords, with the hospital's greenery evident behind them.
The pictures were taken by Tucson photographer P.K. Weis.
Carusone told the Associated Press late Saturday that doctors and family were considering "many factors" while weighing when to release Giffords from the hospital. She did not elaborate.
"We're looking at before the end of the month. We're looking at early July," Carusone said. "We don't have a date."
In an interview published Thursday in the Arizona Republic, Carusone said Giffords can express her basic wants and needs, but has difficulty stringing together sentences to verbalize more complex thoughts and feelings. Giffords, she said, relies on hand gestures and facial expressions.
"She is borrowing upon other ways of communicating. Her words are back more and more now, but she's still using facial expressions as a way to express. Pointing. Gesturing," Carusone said.
The description matches what experts expect from someone who has suffered a traumatic brain injury. Often, they can be easily disoriented, have trouble prioritizing, suffer from some memory loss and could have difficulty recognizing people. Some have difficulty doing several tasks at the same time.
Most cognitive recovery occurs in the first six months to a year after an injury, though it becomes less noticeable as time progresses. In the second year, progress sharply drops.
Carusone said if Giffords' recovery were to plateau now, "it would not be nearly the quality of life she had before."
"All that we can hope for is that she won't plateau today and that she'll keep going and that when she does plateau, it will be at a place far away from here," she said.
While Giffords' release from the hospital will mark a crucial step in her recovery, she still must undergo months of outpatient rehabilitation that will include speech, occupational and physical therapy.
The release of the photos seemed to please the public and her admirers.
On Facebook, the photos immediately generated conversations and comments, with dozens blessing Giffords and her family, complimenting her for her perseverance and courage and her ability to overcome the odds.
Some mentioned Jared Lee Loughner, 22, the shooting suspect who has pleaded not guilty to charges stemming from the shooting and is being held at a Missouri facility. A judge declared him incompetent to stand trial, but prosecutors hope his competency can be restored so he can be put on trial.
Still, others wondered about how far Giffords has progressed.
"It would be nice to get a truly honest assessment of her internal cognitive experience," Alex Hakkinen, who told the AP he works with brain injury patients at a rehab center in Lawrenceville, N.J.
Hakkinen said Giffords' staff has an obligation to bring her out in public at some point so constituents can assess her abilities, maybe in a "fireside chat" of sorts. Or they should acknowledge that she's incapable of doing so right now, he said.
State Sen. Linda Lopez said Giffords looks beautiful.
"Wow! I saw her at the very end of March, and even then, Gabby was all there, her smile, her personality," Lopez commented on Facebook. "And she looks even better now."
Associated Press Writer Bob Seavey contributed to this report from Phoenix.
(Copyright 2011 by The Associated Press. All Rights Reserved.)