GBS Flashcards
Define GBS
Autoimmune rare disorder in which a person’s immune system attacks the peripheral nerves and is characterised by rapidly evolving symmetrical limb weakness, loss of tendon reflexes, absent or mild sensory signs, and variable autonomic dysfunctions.
Pathology of GBS
The underlying pathology is usually multifocal inflammation and de-myelination throughout the peripheral nervous system, (peripheral polyneuropathy) with secondary axonal degeneration in the most severely affected.
It does often develop a week or two after a throat or intestinal infection
How is GBS diagnosed?
Bilateral Clinical history / medical examination Blood tests EMG (electromyogram) Lumbar puncture Exact cause is unknown
Types of GBS
Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) - the most common form. The most common sign of AIDP is muscle weakness that starts in the lower part of your body and spreads upward.
Miller Fisher syndrome (MFS) - in which paralysis starts in the eyes also associated with unsteady gait. MFS occurs in about 5 percent of people with Guillain-Barre syndrome in the U.S.A. but is more common in Asia.
Acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN)
Outline the common course of the disease (AIDP):
Disease is ascending ( begins in legs often distal to proximal body segments)
Nadir ( maximum S&S) reached 2-4 WEEKS
Plateau period lasts approx 4-6 weeks but can be up to a year.
15% require ventilation
Recovery can start from week 4 over several months
AIDP Signs and symptoms may include:
Prickling, pins and needles sensations in your fingers, toes, ankles or wrists
Weakness in your legs that spreads to your upper body
Unsteady walking or inability to walk or climb stairs
Difficulty with eye or facial movements, including speaking, chewing or swallowing
Severe pain that may feel achy or cramp like and may be worse at night
Difficulty with bladder control or bowel function
Rapid heart rate
Low or high blood pressure
Difficulty breathing
Explain the medical management of GBS:
Steroids alone are ineffective
Plasma exchange (plasmaphoresis) - Plasma is separated from blood cells by a machine recognized as a cell separator. The cells collected are returned to the patient, although the plasma that includes the antibodies is useless and restored by other fluids. 6-10 treatments within 2-10 weeks.
Gamma Globulin (immunoglobulin) - Lessen the immune attack on the cells. 400mg/kg/d IV for 5 days.
Plasma exchange and Gamma Globulin equally effective
Analgesics for pain
Management in acute phase:
Respiratory care Passive movements Positioning Splinting Teach the family members how to perform passive movements for their daughter/wife
Management in 1st stage of rehab:
Sitting practice
Getting out of bed
Practice moving the patient in bed and sitting over the side of the bed
Which apply to GBS? Optic neuritis Pain Ataxia Plaques Infarction Spasticity
Optic neuritis
Pain
Ataxia
Spasticity
A patient has been admitted to a medical ward with a weeks history of worsening limb weakness and some loss of trunk control. He has been diagnosed with GBS. Which outcome measures would you use in his assessment?
Lung function tests
Oxford scale
ROM
Timed sitting
Which symptoms of GBS would be the main focus of physiotherapy in a patient like this?
Muscle weakness
Pain
True or false?
Onset of GBS often follows a viral infection
All patients make a full recovery
GBS may reoccur after a patient recovers
GBS is more common in males
GBS is associated with obesity
Pain is a common feature of the condition
True or false?
Onset of GBS often follows a viral infection
GBS may reoccur after a patient recovers
GBS is more common in males
Pain is a common feature of the condition
State some secondary problems that can occur in patients with GBS?
Joint contractures Pressure sores DVT Muscle atrophy Psychological problems
A patient is in the recovery phase of GBS and is undergoing intensive neurorehab. Which of these techniques would be appropriate to increase muscle strength?
Exercise
Hydrotherapy
Standing practice
