2.6 GBS Intro

Question 1

What is the stereotypical clinical presentation of Guillain-Barre Syndrome?

Answer 1

Rapid ascending weakness, usually affecting the lower extremities followed by upper extremities in a symmetrical pattern.

Question 2

What neuroanatomy is involved to explain this clinical presentation?

Answer 2

Targets the peripheral nervous system, the myelin sheath surrounding the axon fibers.

Question 3

What is the disease course?

Answer 3

It platos within 4 weeks of onset. Recovery 2-3 weeks after plato. Remyelination occurs partial/ abnormal and not fully recover.

Question 4

Grossly, what is the initial medical management of Guillain-Barre Syndrome?

Answer 4

PLEX – removes cross reactive antibodies from blood stream to limit extent of autoimmune attack. Best within 7 days.

IVig – targets the immune cells currently attacking the myelin sheath. Helps with recovery but not mortality. It is most effective when administered within 2 weeks of system onsets.

Question 5

As a physical therapist, what would be your priorities be for this patient in acute care?

Answer 5

MMT, CN’S, sensory, functional mobility

Question 6

In the tertiary rehabilitation care setting?

Answer 6

Range of motion maintained respiratory exercises and upright positions to increase endurance.

Monitor hypertension

Involve patient and caregiver

Question 7

In outpatient care? What outcome measures could you use?

Answer 7

Disability Scale – Score of 4 and over age of 60 has a 70% of walking in 6 months.

Over the age of 60 and requires ventilation has 50% chance of walking in 6 months.

Assessment of Fatigue – rate pain on a scale of 0-10. Muscle belly tenderness. Also used for perceived fatigue and impact that fatigue has on their daily function and participation.

Question 8

What outcome measures would assess fatigue?

Answer 8

Fatigue severity scale

Question 9

What is the muscle belly tenderness test?

Answer 9

Pressure between the palmar surface of hand and fingers to a relaxed muscle belly of a major muscle group.

Question 10

Peripheral Fatigue

Answer 10

changes at neuromuscular junction with muscle activation, brought on by physical activity and movement

Question 11

clinical phase 1

Answer 11

tingling of hands and feet

Question 12

clinical phase 2

Answer 12

difficulty in arising from chair

Question 13

clinical phase 3

Answer 13

areflexia, weakness, distal sensory loss

Question 14

Miller fisher variant

Answer 14

autoimmune attack on known antigens that induce demyelination

Question 15

AIDP variant

Answer 15

myelin membranes are attacked. occurs on motor peripheral nerves only.

Question 16

AMSAN

Answer 16

autoimmune attack on both motor and sensory peripheral nerve axons

Question 17

AMAN variant

Answer 17

autoimmune attack targets the axonal membranes of motor nerves only

Question 18

GBS

Answer 18

LMN presentation- peripheral nerves

hypotonia
hyporeflexia
areflexia

Question 19

durable medical equipment

Answer 19

ankle foot orthotics – AFO : used to help with foot drop and propulsion during gait.

1/3 use one a year after, 2/3 at discharge

Question 20

Core 6 outcome measures

Answer 20

BERG
functional gait assesment
activites-specific balance confidence scale
10 m walk test
6 m walk test
5x sit to stand