Giffords released from Houston hospital

More than five months after she was shot in the head while greeting constituents, Rep. Gabrielle Giffords was released Wednesday from the Houston hospital where she had been undergoing physical therapy.

The Arizona congresswoman will travel from a Houston suburb to the hospital each weekday for physical therapy, officials said.

“Congresswoman Giffords has shown clear, continuous improvement from the moment she arrived at TIRR [Memorial Hermann Hospital] five months ago,” Dr. Gerald Francisco, the hospital’s chief medical officer, said in a statement. “We are very excited that she has reached the next phase of her rehabilitation and can begin outpatient treatment.”

Giffords, 41, will move in with her husband, astronaut Mark E. Kelly, in League City, where she will receive care from a 24-hour home health provider. Francisco will continue to oversee her rehabilitation.

“Anyone who knows Gabby knows that she loves being outside,” Kelly said in a statement. “Living and working in a rehab facility for five months straight has been especially challenging for her. She will still go to TIRR each day but, from now on, when she finishes rehab, she will be with her family.”

An expert who is not involved in Giffords’ care hailed the step as progress. “This is really great news, especially because it indicates she doesn’t need 24-hour medical oversight or the structure that the in-patient unit provides in terms of routine, medication and medical interventions,” said Dr. Richard Riggs, chairman of physical medicine and rehabilitation at Cedars-Sinai Medical Center in Los Angeles.

The move is “a natural stepping stone that will help her regain quality of life, especially after being hospitalized” for months, Riggs added.

But he cautioned that the transition to home is often filled with “unexpected, uncontrollable stimulation” that might interfere with her recovery — people visiting, phone calls, television, the intrusion of the media and “simply, life. That can be somewhat tiring for patients.”

Riggs noted that Giffords still had a long road ahead of her.

“In general, for this type of recovery, it is rare when they are finished with rehab before a year or a year and a half,” he said. Motor skills will return relatively quickly, he added, but mental functioning, speech, memory and multitasking will take much longer.

But there will almost certainly be limits on how far she can progress.

“She has zero chance of making a full recovery, getting back to the way she was,” said Dr. David N. Alexander, director of neurological rehabilitation and research at UCLA’s Ronald Reagan Medical Center. “There is no question in my mind that there is a core of brain tissue that has been permanently damaged.”

Giffords’ staff released photos of her on Sunday showing a smiling, apparently recuperating woman. But “there is a lot those pictures don’t tell us,” Riggs said, including how well she speaks, moves and so forth.

In an interview this month in the Arizona Republic, Giffords’ chief of staff said much of the congresswoman’s communication was still conducted through pointing, gesturing and facial expressions.

“She’s able to express the basics of what she wants or needs,” Pia Carusone said. “But when it comes to a bigger and more complex thought that requires words, that’s where she’s had trouble.”

That means her language is still profoundly impaired, Alexander said: “If she is still that impaired at this time, there are areas of the brain that will never recover.” Judging from his experience with other patients, Alexander said that she has probably recovered 80% to 90% of the motor skills that she is going to get back and 70% of the cognitive and language skills.

Carusone also said Giffords was nowhere near being able to resume her position in Washington. The only deadline the staff is considering for a potential return is May 2012, when Giffords must file a petition for reelection.

“That’s a firm timetable,” Carusone said. “Short of that, we’d love to know today what her life will be, what her quality of life will be, which will determine whether she’ll be able to run for office and all sorts of other things involving her life. But we just don’t know yet.”

A close friend of Giffords, Rep. Debbie Wasserman Schultz (D-Fla.), said she and Giffords spoke on the phone last week for the first time since the shooting.

“She spoke to me in full sentences, initiated those sentences, instead of just responding, which is what she’d really only been able to do recently,” Schultz said on NBC’s “Meet the Press.”

Giffords was shot in the head Jan. 8 in a Safeway parking lot in Tucson during a meeting with constituents. Twelve others were wounded and six were killed.

She was lucky in that the bullet passed through only one hemisphere of her brain and did not produce lethal damage: In 90% of cases, gunshot wounds to the brain are deadly, according to the Centers for Disease Control and Prevention. She underwent surgery at University Medical Center in Tucson and was transferred to the Houston hospital Jan. 21. Her husband was training in Houston for the Endeavour space shuttle mission, which recently concluded.

Jared Lee Loughner, 22, is accused in the shooting rampage but has been declared mentally incompetent to stand trial. He could be prosecuted if his condition improves.

thomas.maugh@latimes.com