3/3/23 Update.

 Things have been fairly stable with steady improvements in most areas.  Praise God.  The dermatologist's treatment of the scalp scars have definately helped.  We are alternating two different medicated shampoos every other day which seems to be the ideal frequency to keep away the scalp dermatitis.  Voice volume is much better.  Speech processing is faster.  Speech content has returned to normal.  Cognition and memory are much better. Cognitive and physical processing speed is improving with medication adjustments.  Swallowing is essentially back to normal.  Neck spasms which were causing migraines have resolved since we switched to a "cervical pillow" and been doing the McKenzie neck therapy program.  The neck tightness that was constantly pulling Rie's head down and to the left is much improved.  Right shoulder tightness and weakness is getting better, partly due to our home therapy program but mostly due to Rie's diligence and insistance on using the right arm for activities of daily living even though using the left side would be much faster and easier.  Gait and standing balance is much improved but still needs my frequent verbal cues for safety.  Leg spasms are minimal and no longer painful.  walking and a climbing the stairs are going well.  She can now use her standard quad walker without me holding her but I do have to follower her closely and give frequent verbal cues to avoid tripping when the right leg fatigues. We have not tried going down the stairs in a while as it was causing knee pain on the strong side.  Limping due to right knee hyperextension is now minimal whenever she agrees (!) to wear her lower leg brace.  The Botox leg injections seem to be helping with the leg spasms and preventing "foot drop" and contractures. She is doing 30 to 40 minutes on the statinary bike most days and seems to be enjoying it.  The 40 lb weight gain from the prolonged lack of mobility is starting to respond to increased activity level and a better diet.  We started 2023 on a fairly strict ketogenic eating program (now called the Proper Human Diet: P.H.D.).  We are also skipping dinner. Our night time acid reflux has resovled.  Fat loss is steady.  We enjoy the food and the regimen seems to be working for us.  I suspect Rie's mobilty and independence will improve significantly once she returns to her pre-stroke weight.