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Adult Neuro > GBS > Flashcards

GBS Flashcards

1
Q

Axonopathy: definition, chronic examples

A

Wallerian degeneration of the axon
Acute- regrowth = 3-4mm/day
Cronic- no regrowth: DM, toxins, hereditary (CMT)

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2
Q

Myelinopathy: definition, examples

A

degeneration of myelin producing cells (Schwann- peripheral, oligodendrocytes- central)
example = GBS

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3
Q

Neuronopathy: definition, examples

A

damage to the cell bodies (no regrowth possible)

examples = ALS, SMA, Polio

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4
Q

Neuropathic Weakness

A

weaker distal > proximal

example = polyneuropathy (GBS)

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5
Q

Myopathic Weakness

A

weaker proximal > distal

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6
Q

Cause of Mortality in GBS

A

inability to breath; complications from respiratory or autonomic issues

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7
Q

Etiology/Pathology of GBS

A

Autoimmune illness
inflammatory process –> T cells create antibodies that target myelin and the axons –> macrophages destroy schwann cell or axon

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8
Q

Clinical symptoms of GBS used in diagnosis

A 
Flaccid paralysis, symmetrically ascending (no spasticity)
Respiratory failure and ANS dysfunction
diminished or absent DTRs
slowed nerve conduction velocity
CSF with elevated proteins
nonspecific lab tests
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9
Q

3 clinical subtypes of GBS

A

AIDP- acute inflammatory demyelinating polyneuropathy
AMAN- acute motor axonal neuropathy
AMSN- acute motor-sensory axonal neuropathy

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10
Q

AIDP

A 
only myelin affected (demyelination)
Motor neurons > sensory (but could be reversed)
most often in western hemisphere (80%)
EMG = prolonged motor response
*best prognosis
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11
Q

AMAN

A 
20% (2nd most common type in western hem)
axonal damage (degeneration)
EMG = decreased conduction velocity, + spike waves
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12
Q

AMSAN

A 
Rare!
Axon affected (degeneration)
EMG = decreased conduction velocity, + spike waves
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13
Q

Miller-Fisher Syndrome

A

Allied with GBS
more brainstem involvement- cranial nerves > axial muscles
issues with eye movements, swallowing, facial movements

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14
Q

Only way to know type of GBS

A

EMG analysis!
AIDP- increased motor latencies
AMAN/AMSAN- decreased conduction velocity, (+) spike waves

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15
Q

Recovery period for GBS

A

up to 2 years

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16
Q

Poorer outcomes associated with:

A
  1. Quadriplegia
  2. respiratory dependency > 1m
  3. failure to show improvement within 3 weeks of plateau
  4. AMAN/AMSAN v AIDP
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17
Q

3 temporal phases of GBS

A

Acute/Before stabilization –> deterioration
Nadir/Plateau phase –> stabilization
Recovery phase –> acute care - rehab/homecare/OP

18
Q

Acute/Before stabilization stage

  • location/what’s happening
  • pattern of weakness
  • peak weakness
A

deterioration- in ICU
symmetrical, ascending weakness
Peak of weakness: 3-21 days

19
Q

Nadir/Plateau Phase

  • location/what’s happening
  • peak weakness
A

stabilization/quiet period- in ICU (ventilation) or ward (no ventilation)
lowest the pt will get (functionally)

20
Q

Recovery Phase

  • location/what’s happening
  • duration
  • pattern of return
A

location depends on severity (could be in the ICU if weaning off ventilator)
up to 2 yrs
Return in reverse order: proximal before distal

21
Q

5 phases of Pt’s Perspective of Recovery

A
  1. Experiencing dependency (unable to do anything)
  2. Encountering helplessness
  3. Wanting to know more about GBS (most at rehab level)
  4. Discovering inner strength
  5. Regaining independence
22
Q

Hughe’s Disability Scale:
Purpose
Study that followed pts in the UK findings

A

Grades GBS based on functionality/presence of temporal summation
UK study found that:
1. more acutely, more impaired, many on ventilator
2. by 2 years, no one on ventilation, some in w/c, all becoming less impaired

23
Q

Hughe’s Disability scale: Ordinal scale

A 
0 = healthy, all functional activities as before
1 = minor signs or symptoms, able to run
2 = able to walk > 10m without symptoms, unable to run
3 = able to walk more than 10m with assistance
4 = requires wheel chair
5 = requiring assisted ventilation for at least part of the day
6 = dead due to GBS
24
Q

Why is running a good criteria for ability to recruit more and have temporal summation

A

Running requires speed, which requires at least 1 of 2 things:

  1. increase firing rate: temporal summation (rate coding)
    - requires myelin to send down AP
  2. increase # of muscles firing: engaging more alpha motor neurons (recruitment)
25
Q

Plasmaphoresis: how long is it administered, what is done?

A

administered for 5 days to eliminate items in plasma causing inflammation

  • all blood withdrawn
  • replace plasma with saline and electrolytes
26
Q

Intravenous Immunoglobulin: how long is it administered, why?

A

3-5 days, to prevent immune system from attacking

27
Q

Standard of acute care in GBS (medically)

A

Plasmaphoresis and Intravenous immunoglobulin

28
Q

Is neuropathic pain a potential issue for GBS pts?

A

yes! inflammatory process is occurring along the nerves

29
Q

What is the distribution of pain?

A

Stocking glove distribution

30
Q

Which types of muscles are particularly painful to stretch?

A

2 joint muscles (HS)

31
Q

Specific areas of interest in integumentary system

A

EARS
heels
no ER of feet - fibular head

32
Q

Autonomic dysfunction: symptoms to be aware of

A

decreased temperature regulation
impaired HR response (may be racing)
Orthostasis (unstable BP)

33
Q

3 settings where pt might enter respiratory distress when exercising on the ventilator

A
  1. routine exercises when weaning off ventilator
  2. new exercise or activity performed at usual setting
  3. progressing difficulty at same setting
34
Q

Rehab goals: Compensation or restoration?

A

Both! ideally you want restoration, but if you want them to be functional they may need to compensate for muscles that haven’t returned yet

35
Q

Strengthening issues

A
  1. Core is critical for all movements (limbs overworked)
  2. Train fast-twitch fibers for force production (speed and force training)
  3. No Eccentric work until anti-gravity strength! (avoid DOMS- results in dec. strength)
  4. submaximal exercise with small reps + sets
36
Q

Definition of submaximal exercise:
in LE and UE
appropriate reps and sets

A

LE: 30% or 40% max
UE: 10%, 15%, or 20% max
Reps: 4, 6, 8 with small sets

37
Q

When to begin training in anti-gravity positions:

A

Muscle must be at least a 3/5 - needs to handle resistance of the limb

38
Q

3 residual syndroms in patients without full recovery

A
  1. severe parathesias, dyesthesias
  2. sensory ataxia
  3. foot drop + intrinsic hand weakness
39
Q

Long term studies: what does recovery look like?

A

Full recovery with subclinical signs:

  • speed/force issues
  • “full”, but activities not as enjoyable/performed at same level
  • recovery highly related to fast twitch fibers
40
Q

Long term studies: what do pts with good recovery still report?

A
  1. Fatigue: can do everything, but get tired

2. Pain: residual

41
Q

Chronic Inflammatory Demyelinating Polyradiculopathy (CIDP)

A

Recurrent form of GBS, acute and insidious
Looks like GBS at first, progression is much slower
steady decline in functioning: small recovery followed by another episode

42
Q

CIDP PT intervention

A

requires more compensatory strategies

HEP of daily strengthening+ cycle/walking for 6 weeks –> shown to increase strength and diminish disabilty

Adult Neuro (15 decks)

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