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Giffords may leave hospital in coming weeks

The first photos released of Gabrielle Giffords since a gunman assaulted her in January show have renewed questions about when the Arizona congresswoman might be released from a Houston hospital where she is undergoing rehabilitation.

A Giffords spokeswoman, Pia Carusone, told the Associated Press late Saturday that doctors and family are considering "many factors" while making the critical next-step decision to release Giffords from the hospital.

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

Carusone cautioned that Giffords still has a long way to go in her recovery.

The pictures, by Tucson photojournalist P.K. Weis, were posted on Facebook by Giffords' office early Sunday. They were taken on May 17 at TIRR Memorial Hermann Hospital in Houston, the day after the launch of the space shuttle Endeavour (commanded by her husband, astronaut Mark Kelly) and the day before she underwent cranioplasty surgery.

Giffords spokesman C.J. Karamargin said the photos were released to help satisfy "intense interest in the congresswoman's appearance."

First photos of Gabrielle Giffords released

The pictures - one full-face, smiling; the other, grinning alongside her mother - give few indications she has been hurt, let alone shot in the forehead.

Giffords' aides say she could be ready to be released from a rehabilitation center later this month or in early July. The idea behind the photo release was to discourage a "paparazzi-like frenzy" of photography when she attends outpatient therapy in a more public setting, they said.

Karamargin acknowledged that the congresswoman looks different now than in the photos. Her hair is shorter because her head was shaved ahead of surgery to repair a gap in her skull that had initially been left open to allow her brain to swell. Doctors also fixed what appear to be subtle inequities between her eyes seen in the pictures, he said.

In an interview Thursday with the Arizona Republic, Carusone said despite what doctors are calling a "tremendously good recovery," Giffords is still limited in how she communicates - relying on facial expressions, gestures, pointing, and fractured sentences. "Her words are back more and more now," Carusone said, "but when it comes to a bigger and more complex thought that requires words, that's where she's had the trouble."

The time it will take - and the extent to which she may regain her faculties - are unknown, given the complexities of brain injuries and the nature of her wound.

"With cancer or a heart issue, doctors can tell you a lot more. With brain injuries, they can't," Carusone told the Republic. Hampering a diagnosis is the fact that bullet shards in her head negate the use of a Magnetic resonance imaging (MRI) scanner. "Because MRI is magnetic, that obviously would be bad," Carusone said. "That is a problem that shooting victims have. They have to use a CT scan. If she had suffered a stroke, they could do an MRI and get a much better picture of the damage to her brain. But that will never happen."

The pictures posted Sunday on Facebook were the first clear photos of the Arizona congresswoman who rose to national prominence after a gunman opened fire on her in January as she met with constituents in Tucson. Six people were killed and 13 others wounded.

Complete coverage: Tragedy in Tucson

But the images left unanswered many questions about her cognitive abilities and when — or even if — she will be able to resume her job in Congress.

"The image doesn't tell us the inner mental state or the brain itself, how it's functioning," said Jordan Grafman, director of the Traumatic Brain Injury Research Laboratory at the Kessler Foundation Research Center in West Orange, New Jersey, explaining that many brain-injury patients look good within months of being hurt.

"What's their social skills? Do they have a nuanced sense of humor? Can they participate in activities? All that is what's important," asked Grafman, who has not treated Giffords.

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