Words are still a struggle, but the picture says it all

(GETTY/AP)

Five months after US Congresswoman Gabrielle Giffords nearly died after being shot in the head by a gunman whose bullets killed six others, the first pictures of her released since the massacre show the smile of a woman recovering remarkably well.

The two images were published on her Facebook page yesterday, having been taken the day before an operation to replace part of her skull last month. There is still much rehabilitation ahead for the 41-year-old despite the promising signs so far. Her chief of staff, Pia Carusone, said last week that she was some way from being able to hold a full conversation.

"She is borrowing upon other ways of communicating," Ms Carusone told her local newspaper The Arizona Republic. "Her words are back more and more now, but she's still using facial expressions as a way to express. Pointing. Gesturing. 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."

She added: "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, 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."

The images were taken by PK Weis, a photographer who has known Giffords for more than a decade.

Jared Lee Loughner, the 22-year-old who denies carrying out the attack in Tucson in January, has yet to be declared mentally fit to assist his lawyers or understand the charges he faces.