PHOENIX (AP) - U.S. Rep. Gabrielle Giffords struggles to find words and put together sentences as it remains unclear five months after she was shot in the head in Tucson whether she will eventually be able to resume work in Congress, an aide said in an interview published Thursday.
The interview with Chief of Staff Pia Carusone published in the Arizona Republic provides the most up-to-date information about the congresswoman's condition since she was shot and injured in a rampage that killed six people and wounded a dozen others on Jan. 8.
A decision on whether Giffords will return to work in Washington does not have to be made until May 2012, Carusone said, adding that if the progress the congresswoman has made so far were to slow down or stop she would be unable to fulfill her legislative responsibilities.
Carusone said Giffords' limited speaking ability has led her to rely primarily on facial expressions and hand gestures to communicate.
"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 told the Arizona Republic. "Add it all together and she's able to express the basics of what she wants or needs. But, when it comes to a bigger and more complex thought that requires words, that's where she's had the trouble."
Often, Giffords is clearly frustrated by her limits, Carusone said.
"When she is trying to come up with a word or a sentence and she's clearly struggling, putting everything she's got into it, and sometimes she's not successful. When she is, there's a relief that comes across her face that she has found the word. But when she can't come up with that, it is absolute frustration," she said.
Giffords was shot in the left side of her head, which controls speech and communication, while meeting with constituents in Tucson.
A judge has declared shooting suspect Jared Loughner mentally incapable of participating in his defense and sent him to a federal facility where they will try to treat his condition and make it possible to put him on trial.
Giffords' survival was considered a major feat by doctors, and the progress she has made while undergoing intensive rehabilitation at TIRR Memorial Hermann in Houston has also been described as almost miraculous. However, the public has not seen Giffords since the shooting, and information regarding her recovery has been scant.
The only image of her since she arrived in Houston has been blurry footage taken from a distance as she ascended the steps of a NASA jet when she flew to Florida to watch her astronaut husband, Mark Kelly, rocket into space this spring. Kelly commanded the space shuttle Endeavour's last flight into space.
Carusone's comments make clear that despite doctors' optimism and the rosy picture they have painted, Giffords is still a shadow of her former self.
"She's living. She's alive. But if she were to plateau today, and this was as far as she gets, it would not be nearly the quality of life she had before," Carusone said. "There's no comparison. 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."
Experts have said they expect Giffords will be released in the coming weeks from the inpatient hospital setting she has been in since arriving in Houston in late January. Once that happens, she will undergo months of intensive outpatient care in Houston. For some brain injury patients that therapy can include training them to return to work.
Most frustrating for Giffords, her staff and her family are the unknowns, Carusone said. It isn't possible to know the full extent of the damage because bullet fragments still lodged in Giffords' brain prevent doctors from conducting an MRI, a comprehensive scan that uses magnets.
Family, friends and staff are making many decisions for Giffords, Carusone said. Until now, Giffords has not wanted to release images of herself, though she may agree to do that soon, she added.
"A lot of this is a waiting game. That is a difficult thing to explain when speaking to the public. But she was a perfectly healthy 40-year-old who was injured on the job. I'm hoping that buys her a little more patience," Carusone said.