Exam 1 Lecture 3 GBS and PPS

Question 1

Last case of Polio in US was in

Answer 1

1979

Question 2

Polio is transmitted how

Answer 2

by fecal oral

not washing hands after going to the bathroom, etc

Question 3

Polio has spikes when

Answer 3

summers-

Question 4

Polio has 2 types of vaccines (names and details)

Answer 4

~The Salk vaccine- dead virus

~The Sabin vaccine- alive/weakened virus

Question 5

Is polio still in the US? Outside the US?

Answer 5

~No- no case since 1979

~yes- still around; middle east, etc

Question 6

What are the three patterns that polio can take?

Answer 6

~ asymptomatic
~flu-like symptoms (GI pains and some muscular pain)
~paralytic infection that starts with flu like symptoms

Question 7

where does polio attack in the body?

Answer 7

the virus invades and damages motor cells bodies

Question 8

Polio (description)

Answer 8

~focal and asymmetric motor impairments
~can lead to respiratory failure
~However, most just had flu s/s and never know that they had it

Question 9

Post polio syndrome occurs when

Answer 9

decades after the acute polio event

Question 10

Why does PPS occur?

Answer 10

~deinnervation occurred when the pt has polio
~the pt had axonal collateral sprouting to reinnervate the muscles
~all the collateral sprouting and the nerve create the GMU unit
~the GMU will wear out over time when the collateral sprouting wear away
~causes weakness (pt will think that they have polio again)

Question 11

Dos and Don’ts for to save GMU

Answer 11

~Do Preservation!
~Don’t try and increase strength (if less than 3/5 strength)
~Do not put heat on
~Do educate the pt

Question 12

How can you test to see if you need to strengthen or preserve GMU?

Answer 12

MMT the pt: needs to be 3/5 or better to strengthen; if less than 3/5- preserve!

Question 13

Main goal with PPS is to

Answer 13

save the GMU (if higher then 3/5 can strengthen them, if less than 3/5 then preserve the GMU as long as possible)

Question 14

Energy Conservations: 5 P’s

Answer 14

~Planning
~Prioritizing
~Pacing
~Positioning
~Power
*we are trying to maintain these pts; try to keep them below or at target heart rate; not a huge workout like we have bc they do not need to be overworked

Question 15

Energy Conservation: Planning

Answer 15

~plan the activity in the day to be the most efficient
~think about your day and spread out your activities throughout the week (don’t just do all your activities in one day)
~know what part of the day you have the most energy and plan to do activities during this time

Question 16

Energy Conservation: Prioritizing

Answer 16

~you do not have to do EVERYTHING

~try and delegate activities/ ask for help at times

Question 17

Energy Conservation: Pacing

Answer 17

~everything does not have to be at a fast pace= SLOW DOWN
~you can sit to brush teeth, sit in the shower, sit to cook, etc; you can then have this energy to use at a different time

Question 18

Energy Conservation: Positioning

Answer 18

~need to be as close biomechanically correct as possible (when exercising, doing ROM, etc)
~correct position will put less stress on the joints will be less stressful on the body

Question 19

Energy Conservation: Power

Answer 19

~eventually, they are not going to be able to ambulate anymore
~you will have to talk to them about devices for longer distances (at first)
~these devices can help them keep going for a little longer

Question 20

Guillian Barre Syndrome is linked to

Answer 20

No one really know
~linked to bacterial and viral (epstein-barr) infections as well as vaccines
~2/3 of people reported acute infection w/in 2 months; 90% had illness (respiratory or GI) in past 30 days

Question 21

GBS s/s

Answer 21

~motor and sensory
~starts distal and moves proximal
~”stocking and gloves”- see it in feet and hands first
~rapid onset
~symmetrical- doesn’t have to be perfect, but it moves up the body at the same pace

Question 22

GBS- what is happening

Answer 22

~demyelination of PNS
~the Schwann cells are being attacked (anti-body mediated demyelination); this occurs at the nodes of Ranvier b/c macrophages respond to the inflammation by the antibodies
*this can be motor, sensory, autonomic

Question 23

When does GBS reach its peak?

Answer 23

~75% of people will reach their weakness in 2 weeks

~95% will get there by 4 weeks

Question 24

GBS diagnosis

Answer 24

~lumbar puncture (protein will be evaluated in the CSF)
~nerve conduction test (slowed)
~full body scans/ EMGs, etc
~evaluate s/s

Question 25

What to do with the pt with GBS?

Answer 25

~not going to strength muscles (they are less that 3/5), just passive move
~positioning/ splinting
~check for wounds
~educate the patient

Question 26

Treatment for GBS

Answer 26

~this is an autoimmune disorder so we don’t know the trigger
~can do a plasma transfusion- plasmaphorisis (take out the plasma) which can hopefully stop the demyelination
~may just need a massive does of plasma (don’t remove yours first)

*if the pt’s GBS gets high enough, will need venting, etc to keep alive

Question 27

What are the 3 phases of GBS

Answer 27

~acute
~plateau
~recovery

Question 28

GBS- acute phase

Answer 28

~2-4 weeks

~when they are getting worse- want to try and get them to slow down/ stop the process as early as possible (if possible)

Question 29

GBS- plateau phase

Answer 29

~can take some/ can be days, weeks, months depending on how far GBS traveled
~keep them stable
~stretch, positioning, check for wounds
~should be able to reach recovery if they get to this phase

Question 30

GBS- recovery phase

Answer 30

~will take months to years to get to 95-100%
~everything is weak so you get to have fun deciding what to help these pts with
~don’t want to work them too hard when they are below 3/5, but they will need to start walking
~Form fatigue plays a role here

Question 31

what is form fatigue?

Answer 31

~when the pt is tired and the fatigue is causing the pt to do the activity completely wrong
~once the form breaks down- STOP!
~if the pt learns it incorrectly, it is heard to learn it correctly