GBS Flashcards
what is the pathphysiology of GBS
acute, inflammatory, post inflammatory polyneuropathythat causes the demyleination of peri nerves and auto nerves
results in sensory and motor loss
what structures starts the attack of the mylein
macrophages
what are other names of GBS
acute polyneuritis
acute inflammatory neuropathy
acute inflammatory polyneuropathy
when does the incidence of GBS increase
with infectious disease
age and GBS
occurence increases with age
any age group can be affected
what GBS replase in a patient
yes this occurs in 2-5%
what is the mortality rate of GBS
3 - 10%
resp failure and GBS
20% of patients on mechanical venitaltion due to respirtory failure
GBS signs and symptoms - motor
rapid progression of bilateral limb weakness the porgresses distal to proximal
LE
UE
trunk
face
hyporefelxia
areflexic
GBS signs and symptoms - sensory
distal impairments are common
hyperparathesia, parathesia, numbness, decreased positional sense
pain
GBS signs and symptoms - CN
bilateral weakness of the facial muscles
GBS signs and symptoms - auto NS
blood pressure and heart rate instability
what is the presentation of classic sensormotor GBS
acute inflammatory demylinating polyradiculopathy (predominently effects the mylein)
acute motor axonal neuropathy (motor neurons effected)
affect sensory axons
how does pure motor GBS present
motor weakness without sensory signs
how does paraparetic GBS present
paresis is restricted to the LE
how does miller fisher syndrome present
weakness of the eye muscles (ophthalmaoplegia)
lack of coordination (ataxia)
areflexic
what does areflexic mean
the absents of deep tendon relfexes
how do we diagnosis GBS
clinical features
course of illness
absence of other CNS involvement
GBS and CFS
present with increase CFS protiens
GBS and electrodiagnostic testing
reduced nerve coduction velocity
reduced sensory and motor amps
motor conduction blocks
is MRI helpful for GBS
not helpful but can help to rule out other diagnoses
are there a lot of DD for GBS
yes
what is included in the medical management of GBS
IVIg
plasmapheresis
what is IVIg treatment
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
what does intravenous mean
taken through the viens into the blood stream
what is plasmapheresis
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
how long does the progressive phase of GBS normally last
2 weeks
how long can the plateau phase of GBS last
day, weeks, months
what happens in the recovery phase of GBS
the patients inflammation resolves and remylienation begins
what presentage of pt can walk following 6 months of GBS onset
60 - 80%
when is the greatest improvment of GBS normally seen
in the first year
progression can continue for >5 years
what are some features that are associated with poorer GBS outcomes
> 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
PT exam - systems review
cardiovascular
integumentary system
respiratory function
bowel/bladder changes
in the pt exam what are we looking at with the cardiovascular system
ID autonomic dysfunction such as orthostaic hypotension, monitor vitals
in the pt exam what are looking at with respiratory function
RR
Incentive spirometer
PT exam - CN
facial or bulbar weakness
PT exam - sensation
distal to proximal involvement
global sensory loss
PT exam - motor
weakness (distal to proximal, LE and UE involvement)
tone (hypotonicity)
PT exam - coordination
deficits to sensory and motor
what are the rehab goal of GBS patients
achieve optimal level of function - close to PLOF
AD
pain management
fatigue management
pt edu
GBS and exercise
exercise is linked to improved outcomes
impairments in the acute setting (ICU, acute care)
progressive loss of strength and sensation
resp dysfunction
autonomic dysfunction
what basic function does the ANS serve
heart rate
body temperature
breathing rate
digestion
sensation
what is the goal of treating GBS patients in the acute phase
prevent complications
pressure ulcer
DVT
infections
contractures
what are some examples of interventions that PT can do in the acute phase
AA/PROM
transfer skills
positioning
splinting
patient eduction
when the patient is in recovery phase where are they
IPR
outpatient
homehealth
when the patient is in recovery phase what are we focusing on
monitoring the patient recovery
decreased strength and impaired sensation
resp dysfunction
autonomic dysfunction
what are some PT interventions of the recovery phase
progressive mobilzation, strengthing and aerobic conditioning
funtional mobility - transfers, gait. stairs
splinting and orthoses as needed
AD
what do we want to avoid during the recovery phase
overworking that patient
is exercise helpful in those with GBS
yes showing to improve:
fatigue
strength
functional mobility
cardio and resp outcomes
evidence based treatment for GBS
cycling
walking
progressive functional training
progress from PROM, AAROM, AROM, PRE
low intesity, high intensity can be used with caution
what do we want to avoid with GBS
overworking weakness
avoiding stressing musculature with anything more then antigravity strength
avoid intense eccentric training
avoid overworking weakness - more details
delayed onset of muscle soreness that peak 1 -5 days following activity and results in reduction in max force production
antigravity strength - more details
exercise weak muscles the gravity eliminated plane position only using the weight of the limb until 3/5 strength is obtained
eccentric training - more details
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
what are the two phases or rehab for those with GBS
phase 1 - dimish disability burden
phase 2 - support reconditioning
what are some intervention techniques for the fatigue associated with GBS
energy conservation techniques
lifestyle changes
pacing
regulated sleep schedule
AD
home modifcations
is paina common presentation associated with GBS
yes
66% of patients complain of pain in the acute phase
how long can pain presist for
10 years
muscle pain, paraesthesia, arthalgia, radicular pain
what is paraesthesia
abnormal sesnation, normally pin and needles, due to issues with the peripheral nerves
what is arthalgia
joint pain
what are some treatment for the pain associated with GBS
mobilization
exercise
pharm
