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Medical management of Parkinson’s includes medication like Monomania oxidase and Carbidopa. Potential complications include motor fluctuations, falls, dyskinesia, cognitive decline, and depression.

BIG and LOUD program, Weight sifts on balance board 15x2reps anterior/posterior and lateral.

Treatment considerations include what time they got their medication usually 30-60 min after medication is best. Afternoon is normally better for patients because many experience morning stiffness. Fatigue is also another factor that should be considered during treatment.

BIG and LOUD program https://m.youtube.com/watch?v=pgtGOgVIhqc.

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Medical management of multiple sclerosis includes symptom management, and physical therapy. Some medications used are Avonex, Betaseron, and Copaxone. Potential complications include disability, infections, and cognitive decline.

Standing glute kickbacks 12x3reps. Seater Hamstring stretch’s 30 sec holds x4reps

Treatment considerations include setting the clinic temperature a little lower because warmer temps worsen fatigue. Also determining when or what medication they had last.

MS support group https://www.nationalmssociety.org/how-you-can-help/get-involved/calendar-of-all-programs-and-events/cognifitness-ms-and-social-group-minneapolis

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Terminal progressive disease involving both UMNs and LMNs, symptom management, multi-disciplinary approach, first presentation consists of arm or leg weakness, difficulty speaking or swallowing, muscle cramps, atrophy, fatigue

Preventive exercises in early stages: increase strength and mobility to prevent loss of function, avoid heavy eccentric exercise

Positioning for comfort, family education / training / support, energy conservation

https://www.massgeneral.org/neurology/als/patient-education

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The Sean M. Healey & AMG Center for ALS has compiled these informational articles for ALS patients and their families.

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Involves peripheral nerves that result in flaccid paralysis, autoimmune disorder triggered by viral or bacterial infection, acute generalized weakness

Pulmonary / respiratory support: diaphragm stretching and strengthening, pain management: medications or modalities that the patient enjoys

IVIG is typically used to treat and may need to be repeated, exercise when patient is feeling best and has had rest

https://kidshealth.org/en/parents/gbs.html

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Period of partial or complete functional recovery followed by relative stability lasting at least 15 years, muscular and joint pain

Short duration at sub maximal level, stretching and mobility

Treatment when the patient is fully rested and doesn't feel too tired

https://www.health.ny.gov/diseases/communicable/polio/

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Polio in New York State

A CASE OF PARALYTIC POLIO IN ROCKLAND COUNTY: On July 21, 2022, the New York State Department of Health (NYSDOH) and the Rockland County Department of Health (RCDOH) alerted the public to a case of paralytic polio in an unvaccinated young adult in Rockland County. The case was identified by NYSDOH's Wadsworth Center Laboratory and confirmed by the Centers for Disease Control and Prevention (CDC) through testing. The individual experienced severe symptoms, including paralysis, and was hospitalized. New Yorkers should know that paralysis from polio is typically permanent, resulting in life-long disability.

WASTEWATER SURVEILLANCE TO IDENTIFY THE VIRUS IN COMMUNITIES: NYSDOH launched wastewater surveillance - a tool to check for signs of the virus in sewage water in communities, as people infected with polio shed virus in their stool. Testing and sequence analysis from the Centers for Disease Control and Prevention (CDC) has detected poliovirus repeatedly in samples collected from Rockland County, Orange County, Sullivan County and in samples collected from New York City and Nassau County. All samples reported are samples of concern, meaning they are types of poliovirus that can cause paralysis in humans. 82 of these samples have been genetically-linked to the case in Rockland County. The latest wastewater surveillance results are here.

DRIVING IMMUNIZATIONS: Working with local and national health authorities, healthcare providers and clinics, and community-based organizations, particularly in the affected areas, NYSDOH is driving immunizations among unvaccinated and under-vaccinated children, for whom coverage is lower, and adults. The inactivated polio vaccine the only vaccine available in the U.S., protects 99 to 100 percent of people against disease who receive all recommended doses. Learn more about polio immunization here, and check polio vaccination rates for children by two years of age by county here and by ZIP code here.

What is polio?

Polio is a debilitating and life-threatening disease. A virus that can affect the brain and spinal cord, polio can cause paralysis or even death. This makes polio very dangerous, especially for New Yorkers and children who are unvaccinated or not up to date with their polio immunizations.
There is no cure for polio, but disease, including paralysis, is preventable through safe and effective vaccination. IPV-the only vaccine available in the U.S.-is safe, and contains no live virus. It protects 99 - 100 percent of people against disease who receive all recommended doses.
How does polio spread?

Polio spreads from person-to-person through contact with the poop (often tiny, invisible amounts) of an infected person. More rarely, it can spread through the sneeze or cough droplets from an infected person.

This can happen when someone is in close contact with an infected person, such as by caring for them or sharing food or utensils with them.

Polio is very contagious, and not everyone who is infected with polio will show symptoms. Some have mild or flu-like symptoms that can be easily mistaken for another type of virus.

Still, all infected people can spread the virus and infect others, even if they have no symptoms.

The best way New Yorkers and children can ensure they are protected from this highly contagious virus that can cause paralysis and even death is by staying up to date with polio immunizations.

What are the symptoms of polio?

There are a range of symptoms people infected with polio may experience, ranging from having no symptoms, to mild and flu-like symptoms, to serious symptoms, including paralysis, permanent disability, or post-polio syndrome, and even death. New Yorkers should not take comfort in the fact that some people will not experience symptoms from polio; this only makes the danger of this life-threatening virus invisible until the irreversible occurs.

New Yorkers should know:

While immunization is the only way to protect against disease, handwashing with soap is also important to prevent the spread of germs. Alcohol-based sanitizers do not work on some types of germs, like polio.

Who should get immunized against polio?

All unvaccinated children (17 years of age or younger) or those children not up to date with immunizations should get immunized. This is particularly urgent if they live, work, attend school, or have frequent social interactions with communities where poliovirus has been repeatedly detected in wastewater which currently includes Rockland, Orange, and Sullivan Counties.

Most adults (18 years of age or older) are already up to date with their polio vaccine series. Adults who were born and raised in the United States or outside the United States can assume they were vaccinated for polio as children, unless there are specific reasons to believe they were not vaccinated.

Adults who live or work in the areas where poliovirus has been repeatedly detected in wastewater (Rockland, Orange, and Sullivan Counties) and are unvaccinated, under-vaccinated, or don't believe they are vaccinated should get all recommended vaccine doses.

New York adults outside of these areas who are unvaccinated, unsure of their vaccination status, or not up to date with vaccinations should consult with a healthcare provider. If vaccination is recommended and a provider does not have doses on hand, New Yorkers should contact their local health department.

Learn more about polio immunization here.
Who should get a booster dose?

One lifetime booster dose of IPV should be offered to adults 18 years of age and older who have previously completed their polio vaccination series and are at the highest risk of infection. This includes:

Individuals working in a laboratory or healthcare setting and handling specimens that might contain polioviruses. In New York State, this may include individuals who collect or work with wastewater specimens for poliovirus testing.

Healthcare providers or other caregivers who have close contact with a person who could be infected with poliovirus. In New York State, this would include:

Healthcare workers who work in areas with community transmission of poliovirus and who could care for patients with poliovirus (e.g., urgent care, emergency department, neurology, pediatrics).

Individuals who will or might have exposure to a person known or suspected to be infected with poliovirus, such as household members and other close contacts of a case or suspect case who provide care.

Child care or pre-K providers who work in areas with community transmission of poliovirus and provide diapering or toileting care or assistance.

Individuals traveling to a country where there is a documented increased risk of exposure to poliovirus, in accordance with CDC guidance for travelers.

Areas considered to have community transmission of poliovirus include those where poliovirus has been repeatedly detected in wastewater. At this time, that includes Rockland, Orange, and Sullivan Counties. At this time, booster doses are not recommended for individuals traveling to the New York City metropolitan area, including Rockland, Orange, or Sullivan Counties, merely because of their travel status.

What should healthcare providers do?

The on-time administration of polio immunizations is critical to keep New Yorkers and children protected against paralytic polio disease, especially for those in Rockland County, Orange County, and Sullivan County, as well as New York City and Nassau County.

NYSDOH urges all healthcare providers, especially pediatricians, to ensure their patients are up to date with their polio vaccine schedule.

Healthcare providers should consider polio in the differential diagnosis of patients with sudden onset of limb weakness, especially with a recent history of fever and/or gastrointestinal illness.

Providers should especially be on alert for these symptoms in unvaccinated individuals, those currently at increased risk of community transmission, or those with recent international travel or exposures to international travelers.

Improving vaccination coverage for polio and other vaccine preventable diseases is critical to the public health of all New Yorkers. Providers should take time in every primary care visit, for both adults and children, to ensure that they are up to date with the recommended vaccines for their age.

Providers should order and stock IPV so they can provide polio vaccination for their patients who are unvaccinated and/or request polio vaccination.