GBS

Question 1

pts w. GBS present with LMN, UMN, or symptoms of both?

Answer 1

only LMN symptoms

(weak, hyporeflexia and hypotonicity, atrophy, fascinations)

Question 2

explain GBS syndrome

Answer 2

body’s immune system attacks myelin causing generalized paralysis; pts often have some type of infectious disease 2wks prior to GBS onset

Question 3

name some viral infections that can causes autoimmune issues that lead to GBS

Answer 3

mono (epstein barr)
pneumonia
food poising
herpes

Question 4

In GBS, the trigger causes damage to myelin of? (2)

Answer 4

spinal roots and peripheral nerves

Question 5

what is 1 reason why GBS has good prognosis?

Answer 5

axons themselves are left intact and can remyelinate

Question 6

Do nerves in GBS demyelinate usually in the descending pattern or ascending?

Answer 6

Ascending
starts in feet -> legs
->hips

Question 7

what would u find in pt’s CSF to help diagnose GBS

Answer 7

Increase in protein from fragments of myelin

Question 8

would there be progressive weakness of 1 or more than 1 nerve roots?

Answer 8

more than 1
(polyradiculopathy)

Question 9

pts with GBS present with (bilateral/unilateral) and (symmetrical/asymmetrical) weakness?

Answer 9

bilateral; symmetrical

Question 10

pt’s w. weak intercostals, diaphragm, and abdominals have diff. time coughing which can inc their risk for?

Answer 10

pneumonia and need for ventilator

Question 11

T/F 50% of pts with GBS have issues with cranial nerves and exhibit general fascial weakness

Answer 11

T

Question 12

pt’s with GBS present with loss of sensation in what type of pattern?

Answer 12

glove/stocking distribution that doesn’t follow dermatome

Question 13

what are ANS symptoms that pt’s can present with?

Answer 13

ortho. hypotension
cardiac dysrhythmias
BP fluctuations
& ileus (no contraction in intestine)

Question 14

80% of pts progress to Nadir within how many wks

Answer 14

3wks

Question 15

when does plateua occur once they hit nadir?

Answer 15

2-4wks after

Question 16

pts without respiratory issues prior to reaching plateu have better or worse prognosis?

Answer 16

better

Question 17

what is the most common residual effect during recovery from GBS?

Answer 17

weak ant. tib causing drop foot

Question 18

list some factors assoc. w/ poor outcomes (5)

Answer 18

1. severe weakness
2. CN inv. w loss of ocular control
3. need for resp. vent
4. rapid progression and longer length until nadir
5. > age at onset w. hx of GI illness

Question 19

what are the 3 ways to manage GBS medically?

Answer 19

1. immunotherapy of plasma exchange or IVIg via IV
2. corticosteroids in combo with immunother.
3. pain management via gabapentin & carbamazepine

Question 20

during PT you wnat to optimize strength & endurance while monitoring ___ and prevent ____

Answer 20

fatigue; overwork

Question 21

T/F strenuous exercise + fatigue during early periods are assoc. w/ recurring episodes of temporary loss of function

Answer 21

T

Question 22

in regards to pain, when should you stop exercise and educate the patient

Answer 22

if pt starts to have body or muscle ache vs usual neuropathic pain

Question 23

what can u use to help desensitize the pt?

Answer 23

TENS, cradle to keep sheets away from body, frequent consistent stimulus for short durations

Question 24

when plateau is reached what are some things u can do in PT

Answer 24

AROM, inc upright posture, tilt table w. abdominal binder for ortho hypo.

Question 25

(low/high) reps of (high/low) resistance should be used until strength is 3/5

Answer 25

Low x2

Question 26

what are some factors that inc risk for mortality?

Answer 26

1. bulbar or ANS dysfunction
2. severe weakness w. rapid onset
3. > 60yo
4. pulmonary infx