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Neuromus 3 > GBS > Flashcards

GBS Flashcards

1
Q

what is the pathphysiology of GBS

A

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

results in sensory and motor loss

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2
Q

what structures starts the attack of the mylein

A

macrophages

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3
Q

what are other names of GBS

A

acute polyneuritis

acute inflammatory neuropathy

acute inflammatory polyneuropathy

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4
Q

when does the incidence of GBS increase

A

with infectious disease

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5
Q

age and GBS

A

occurence increases with age

any age group can be affected

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6
Q

what GBS replase in a patient

A

yes this occurs in 2-5%

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7
Q

what is the mortality rate of GBS

A

3 - 10%

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8
Q

resp failure and GBS

A

20% of patients on mechanical venitaltion due to respirtory failure

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9
Q

GBS signs and symptoms - motor

A

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

hyporefelxia
areflexic

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10
Q

GBS signs and symptoms - sensory

A

distal impairments are common

hyperparathesia, parathesia, numbness, decreased positional sense

pain

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11
Q

GBS signs and symptoms - CN

A

bilateral weakness of the facial muscles

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12
Q

GBS signs and symptoms - auto NS

A

blood pressure and heart rate instability

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13
Q

what is the presentation of classic sensormotor GBS

A

acute inflammatory demylinating polyradiculopathy (predominently effects the mylein)

acute motor axonal neuropathy (motor neurons effected)

affect sensory axons

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14
Q

how does pure motor GBS present

A

motor weakness without sensory signs

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15
Q

how does paraparetic GBS present

A

paresis is restricted to the LE

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16
Q

how does miller fisher syndrome present

A

weakness of the eye muscles (ophthalmaoplegia)

lack of coordination (ataxia)

areflexic

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17
Q

what does areflexic mean

A

the absents of deep tendon relfexes

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18
Q

how do we diagnosis GBS

A

clinical features

course of illness

absence of other CNS involvement

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19
Q

GBS and CFS

A

present with increase CFS protiens

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20
Q

GBS and electrodiagnostic testing

A

reduced nerve coduction velocity

reduced sensory and motor amps

motor conduction blocks

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21
Q

is MRI helpful for GBS

A

not helpful but can help to rule out other diagnoses

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22
Q

are there a lot of DD for GBS

A

yes

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23
Q

what is included in the medical management of GBS

A

IVIg

plasmapheresis

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24
Q

what is IVIg treatment

A

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

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25
Q

what does intravenous mean

A

taken through the viens into the blood stream

26
Q

what is plasmapheresis

A

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

27
Q

how long does the progressive phase of GBS normally last

A

2 weeks

28
Q

how long can the plateau phase of GBS last

A

day, weeks, months

29
Q

what happens in the recovery phase of GBS

A

the patients inflammation resolves and remylienation begins

30
Q

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

A

60 - 80%

31
Q

when is the greatest improvment of GBS normally seen

A

in the first year

progression can continue for >5 years

32
Q

what are some features that are associated with poorer GBS outcomes

A

> 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

33
Q

PT exam - systems review

A

cardiovascular

integumentary system

respiratory function

bowel/bladder changes

34
Q

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

A

ID autonomic dysfunction such as orthostaic hypotension, monitor vitals

35
Q

in the pt exam what are looking at with respiratory function

A

RR

Incentive spirometer

36
Q

PT exam - CN

A

facial or bulbar weakness

37
Q

PT exam - sensation

A

distal to proximal involvement

global sensory loss

38
Q

PT exam - motor

A

weakness (distal to proximal, LE and UE involvement)

tone (hypotonicity)

39
Q

PT exam - coordination

A

deficits to sensory and motor

40
Q

what are the rehab goal of GBS patients

A

achieve optimal level of function - close to PLOF

AD

pain management

fatigue management

pt edu

41
Q

GBS and exercise

A

exercise is linked to improved outcomes

42
Q

impairments in the acute setting (ICU, acute care)

A

progressive loss of strength and sensation

resp dysfunction

autonomic dysfunction

43
Q

what basic function does the ANS serve

A

heart rate
body temperature
breathing rate
digestion
sensation

44
Q

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

A

prevent complications

pressure ulcer
DVT
infections
contractures

45
Q

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

A

AA/PROM

transfer skills

positioning

splinting

patient eduction

46
Q

when the patient is in recovery phase where are they

A

IPR

outpatient

homehealth

47
Q

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

A

monitoring the patient recovery

decreased strength and impaired sensation

resp dysfunction

autonomic dysfunction

48
Q

what are some PT interventions of the recovery phase

A

progressive mobilzation, strengthing and aerobic conditioning

funtional mobility - transfers, gait. stairs

splinting and orthoses as needed

AD

49
Q

what do we want to avoid during the recovery phase

A

overworking that patient

50
Q

is exercise helpful in those with GBS

A

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

51
Q

evidence based treatment for GBS

A

cycling

walking

progressive functional training

progress from PROM, AAROM, AROM, PRE

low intesity, high intensity can be used with caution

52
Q

what do we want to avoid with GBS

A

overworking weakness

avoiding stressing musculature with anything more then antigravity strength

avoid intense eccentric training

53
Q

avoid overworking weakness - more details

A

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

54
Q

antigravity strength - more details

A

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

55
Q

eccentric training - more details

A

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

56
Q

what are the two phases or rehab for those with GBS

A

phase 1 - dimish disability burden

phase 2 - support reconditioning

57
Q

what are some intervention techniques for the fatigue associated with GBS

A

energy conservation techniques

lifestyle changes

pacing

regulated sleep schedule

AD

home modifcations

58
Q

is paina common presentation associated with GBS

A

yes

66% of patients complain of pain in the acute phase

59
Q

how long can pain presist for

A

10 years

muscle pain, paraesthesia, arthalgia, radicular pain

59
Q

what is paraesthesia

A

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

60
Q

what is arthalgia

A

joint pain

61
Q

what are some treatment for the pain associated with GBS

A

mobilization

exercise

pharm

Neuromus 3 (7 decks)

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