GBS

Question 1

what is the pathphysiology of GBS

Answer 1

acute, inflammatory, post inflammatory polyneuropathythat causes the demyleination of peri nerves and auto nerves

results in sensory and motor loss

Question 2

what structures starts the attack of the mylein

Answer 2

macrophages

Question 3

what are other names of GBS

Answer 3

acute polyneuritis

acute inflammatory neuropathy

acute inflammatory polyneuropathy

Question 4

when does the incidence of GBS increase

Answer 4

with infectious disease

Question 5

age and GBS

Answer 5

occurence increases with age

any age group can be affected

Question 6

what GBS replase in a patient

Answer 6

yes this occurs in 2-5%

Question 7

what is the mortality rate of GBS

Answer 7

3 - 10%

Question 8

resp failure and GBS

Answer 8

20% of patients on mechanical venitaltion due to respirtory failure

Question 9

GBS signs and symptoms - motor

Answer 9

rapid progression of bilateral limb weakness the porgresses distal to proximal
LE
UE
trunk
face

hyporefelxia
areflexic

Question 10

GBS signs and symptoms - sensory

Answer 10

distal impairments are common

hyperparathesia, parathesia, numbness, decreased positional sense

pain

Question 11

GBS signs and symptoms - CN

Answer 11

bilateral weakness of the facial muscles

Question 12

GBS signs and symptoms - auto NS

Answer 12

blood pressure and heart rate instability

Question 13

what is the presentation of classic sensormotor GBS

Answer 13

acute inflammatory demylinating polyradiculopathy (predominently effects the mylein)

acute motor axonal neuropathy (motor neurons effected)

affect sensory axons

Question 14

how does pure motor GBS present

Answer 14

motor weakness without sensory signs

Question 15

how does paraparetic GBS present

Answer 15

paresis is restricted to the LE

Question 16

how does miller fisher syndrome present

Answer 16

weakness of the eye muscles (ophthalmaoplegia)

lack of coordination (ataxia)

areflexic

Question 17

what does areflexic mean

Answer 17

the absents of deep tendon relfexes

Question 18

how do we diagnosis GBS

Answer 18

clinical features

course of illness

absence of other CNS involvement

Question 19

GBS and CFS

Answer 19

present with increase CFS protiens

Question 20

GBS and electrodiagnostic testing

Answer 20

reduced nerve coduction velocity

reduced sensory and motor amps

motor conduction blocks

Question 21

is MRI helpful for GBS

Answer 21

not helpful but can help to rule out other diagnoses

Question 22

are there a lot of DD for GBS

Answer 22

yes

Question 23

what is included in the medical management of GBS

Answer 23

IVIg

plasmapheresis

Question 24

what is IVIg treatment

Answer 24

this is an antibody that is created by immune cells to help us protect from infection

most common immunoglobin found in the blood

high does of IVG intravenous admission

Question 25

what does intravenous mean

Answer 25

taken through the viens into the blood stream

Question 26

what is plasmapheresis

Answer 26

the removal of plasma from circulation and filtering it to dilute circulating antibodies that are contributing to the immune systems attack on the peri NS

Question 27

how long does the progressive phase of GBS normally last

Answer 27

2 weeks

Question 28

how long can the plateau phase of GBS last

Answer 28

day, weeks, months

Question 29

what happens in the recovery phase of GBS

Answer 29

the patients inflammation resolves and remylienation begins

Question 30

what presentage of pt can walk following 6 months of GBS onset

Answer 30

60 - 80%

Question 31

when is the greatest improvment of GBS normally seen

Answer 31

in the first year progression can continue for >5 years

Question 32

what are some features that are associated with poorer GBS outcomes

Answer 32

>40 >60 presensce of resp impairment, need for resp support, length of resp support rapid onset (days from hospitalization) progression to quadreiplegia facial or bulbar weakness on admission patient showing no improvement at 3 weeks of plateua

Question 33

PT exam - systems review

Answer 33

cardiovascular integumentary system respiratory function bowel/bladder changes

Question 34

in the pt exam what are we looking at with the cardiovascular system

Answer 34

ID autonomic dysfunction such as orthostaic hypotension, monitor vitals

Question 35

in the pt exam what are looking at with respiratory function

Answer 35

RR Incentive spirometer

Question 36

PT exam - CN

Answer 36

facial or bulbar weakness

Question 37

PT exam - sensation

Answer 37

distal to proximal involvement global sensory loss

Question 38

PT exam - motor

Answer 38

weakness (distal to proximal, LE and UE involvement) tone (hypotonicity)

Question 39

PT exam - coordination

Answer 39

deficits to sensory and motor

Question 40

what are the rehab goal of GBS patients

Answer 40

achieve optimal level of function - close to PLOF AD pain management fatigue management pt edu

Question 41

GBS and exercise

Answer 41

exercise is linked to improved outcomes

Question 42

impairments in the acute setting (ICU, acute care)

Answer 42

progressive loss of strength and sensation resp dysfunction autonomic dysfunction

Question 43

what basic function does the ANS serve

Answer 43

heart rate body temperature breathing rate digestion sensation

Question 44

what is the goal of treating GBS patients in the acute phase

Answer 44

prevent complications pressure ulcer DVT infections contractures

Question 45

what are some examples of interventions that PT can do in the acute phase

Answer 45

AA/PROM transfer skills positioning splinting patient eduction

Question 46

when the patient is in recovery phase where are they

Answer 46

IPR outpatient homehealth

Question 47

when the patient is in recovery phase what are we focusing on

Answer 47

monitoring the patient recovery decreased strength and impaired sensation resp dysfunction autonomic dysfunction

Question 48

what are some PT interventions of the recovery phase

Answer 48

progressive mobilzation, strengthing and aerobic conditioning funtional mobility - transfers, gait. stairs splinting and orthoses as needed AD

Question 49

what do we want to avoid during the recovery phase

Answer 49

overworking that patient

Question 50

is exercise helpful in those with GBS

Answer 50

yes showing to improve: fatigue strength functional mobility cardio and resp outcomes

Question 51

evidence based treatment for GBS

Answer 51

cycling walking progressive functional training progress from PROM, AAROM, AROM, PRE low intesity, high intensity can be used with caution

Question 52

what do we want to avoid with GBS

Answer 52

overworking weakness avoiding stressing musculature with anything more then antigravity strength avoid intense eccentric training

Question 53

avoid overworking weakness - more details

Answer 53

delayed onset of muscle soreness that peak 1 -5 days following activity and results in reduction in max force production

Question 54

antigravity strength - more details

Answer 54

exercise weak muscles the gravity eliminated plane position only using the weight of the limb until 3/5 strength is obtained

Question 55

eccentric training - more details

Answer 55

do eccentric work at submax resistance with a low number of reps only a few times a week eccentric work should occur in functional movement patterns once the pt has antigravity strength

Question 56

what are the two phases or rehab for those with GBS

Answer 56

phase 1 - dimish disability burden phase 2 - support reconditioning

Question 57

what are some intervention techniques for the fatigue associated with GBS

Answer 57

energy conservation techniques lifestyle changes pacing regulated sleep schedule AD home modifcations

Question 58

is paina common presentation associated with GBS

Answer 58

yes 66% of patients complain of pain in the acute phase

Question 59

how long can pain presist for

Answer 59

10 years muscle pain, paraesthesia, arthalgia, radicular pain

Question 59

what is paraesthesia

Answer 59

abnormal sesnation, normally pin and needles, due to issues with the peripheral nerves

Question 60

what is arthalgia

Answer 60

joint pain

Question 61

what are some treatment for the pain associated with GBS

Answer 61

mobilization exercise pharm