Exam 1 Lecture 3 GBS and PPS Flashcards
Last case of Polio in US was in
1979
Polio is transmitted how
by fecal oral
not washing hands after going to the bathroom, etc
Polio has spikes when
summers-
Polio has 2 types of vaccines (names and details)
~The Salk vaccine- dead virus
~The Sabin vaccine- alive/weakened virus
Is polio still in the US? Outside the US?
~No- no case since 1979
~yes- still around; middle east, etc
What are the three patterns that polio can take?
~ asymptomatic
~flu-like symptoms (GI pains and some muscular pain)
~paralytic infection that starts with flu like symptoms
where does polio attack in the body?
the virus invades and damages motor cells bodies
Polio (description)
~focal and asymmetric motor impairments
~can lead to respiratory failure
~However, most just had flu s/s and never know that they had it
Post polio syndrome occurs when
decades after the acute polio event
Why does PPS occur?
~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)
Dos and Don’ts for to save GMU
~Do Preservation!
~Don’t try and increase strength (if less than 3/5 strength)
~Do not put heat on
~Do educate the pt
How can you test to see if you need to strengthen or preserve GMU?
MMT the pt: needs to be 3/5 or better to strengthen; if less than 3/5- preserve!
Main goal with PPS is to
save the GMU (if higher then 3/5 can strengthen them, if less than 3/5 then preserve the GMU as long as possible)
Energy Conservations: 5 P’s
~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
Energy Conservation: Planning
~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
Energy Conservation: Prioritizing
~you do not have to do EVERYTHING
~try and delegate activities/ ask for help at times
Energy Conservation: Pacing
~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
Energy Conservation: Positioning
~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
Energy Conservation: Power
~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
Guillian Barre Syndrome is linked to
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
GBS s/s
~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
GBS- what is happening
~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
When does GBS reach its peak?
~75% of people will reach their weakness in 2 weeks
~95% will get there by 4 weeks
GBS diagnosis
~lumbar puncture (protein will be evaluated in the CSF)
~nerve conduction test (slowed)
~full body scans/ EMGs, etc
~evaluate s/s
What to do with the pt with GBS?
~not going to strength muscles (they are less that 3/5), just passive move
~positioning/ splinting
~check for wounds
~educate the patient
Treatment for GBS
~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
What are the 3 phases of GBS
~acute
~plateau
~recovery
GBS- acute phase
~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)
GBS- plateau phase
~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
GBS- recovery phase
~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
what is form fatigue?
~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
