GBS, CI, Polio Flashcards
1
Q
Guillain-Barre’ Syndrome characteristics
A
- Affects CNS and/or PNS
- Generally Chronic, Usually Progressive
- Not curable; Treatment can alter course of disease
- Little known of etiology: Usually considered autoimmune process.
- Suspected multiple dynamics which may include genetic predisposition, viruses, environmental influences
- Deterioration of function over time;
- Requires coping with existing disability & threat of future loss
2
Q
GBS
A
- GBS is an acute, demyelinating inflammatory polyradiculoneuropathy.
- Demyelination
- Affects nerve roots (brachial plexus)
- Affects peripheral nerves
- Leads to motor neuropathy and flaccid paralysis
- Peripheral nerves
- Flaccidity
- Can be caused by reaction to flu shots
3
Q
GBS Epidemiology: Causation
A
- Autoimmune disorder
- Often occurs a few days to weeks after a respiratory (49%) or gastrointestinal viral infection (10%).
- Bacteria–Campylobacter jejuni (associated w/ undercooked food, esp. poultry)
4
Q
GBS Epidemiology
A
- 1 – 2 cases per 100,000 persons
- All ages
- Mostly young adults (15-35) and older (50-75).
- Men slightly more affected
5
Q
GBS Diagnosis
A
- Syndrome, not disease
- Spinal tap: abnormal amounts of protein.
- NCV: Nerve Conduction Velocity (speed of nerve transmissions).
- Exclude other relevant disorders.
- Diagnosis of exclusion
6
Q
GBS Acute Inflammatory Phase
A
- Weakness & tingling sensations in legs
- Rapidly progressing (hours, days or weeks)
- Symmetrical ascending paralysis
- Spreads to arms and upper body
- Intensity increases until almost total paralysis often including respiratory muscles
- in 30% of cases, respirator necessary.
- Medical emergency: 5% die.
- Cranial nerve involvement: eye and facial movement, speaking, chewing, and swallowing.
- Severe pain in legs, low back.
- Loss of bladder control.
- Slow or abnormal heart rate, low or high blood pressure.
- Symptoms can vary from mild (subclinical) to severe (death)
7
Q
GBS Plateau Phase
A
- Stage of greatest weakness/disability
- 50% of patients reach their full extent of paralysis in 1 week, 70% by 2 weeks, and 90% by three weeks.
- No change during this phase; can last days, weeks, or (rarely) months
- Monitored for cardiovascular, respiratory problems, infections, blood clots, bed sores
- Patient often in ICU & monitored closely
8
Q
GBS Progressive Recovery Phase
A
- Recovery most often starts at 2-4 weeks AFTER progression of the symptoms stops.
- Remyelination and axonal regeneration, lasting a few weeks up to 2 years; average length 12 wks.
- Recovery begins at head/neck; proceeds distally
- Stage when therapy oriented to resumption of occupation
9
Q
GBS Prognosis
A
-Complete return of function in approximately 50% of patients
-Residual weakness that may not resolve (present after 3 years) in 35%
-Significant permanent disability in 15%
3% may suffer relapse many years after initial attack
10
Q
GBS Medical Management
A
- Most critical, keep the body functioning while the nervous system recovers.
- Plasmapheresis: Plasma exchange demonstrates promise as an intervention because of the autoimmune nature of the illness (begun within 2 weeks of onset); reduces severity and duration of symptoms
- High dose IV immunoglobin: proteins that the body uses naturally to fight invading organisms; slows the body’s immune reaction.
- High dose steroids (reduce inflammation)
11
Q
GBS: Acute/ICU OT
A
- Communication tools matching physical abilities
- Adapted call button, TV controls, lights, telephone
- Bed positioning for patients and families
- Tolerance to upright/ chair positioning. Ensuring head, trunk and UE stability
- Strategies to reduce anxiety
- Pain management (modalities, positioning, visual imagery) [what and how]
- PROM/Stretching to prevent contractures (splinting)
- Progressive program of passive & active assisted exercise while monitoring for overuse and fatigue.
- Patient/Family EDUCATION.
12
Q
GBS: Recovery/Rehabilitation Phase OT
A
- Occupational performance (ADL, IADL, work)- adaptations, modifications
- Transfer Training
- Activities, splinting to preserve limb ROM, particularly wrists, hands, ankles
- Adapting communication
- Energy conservation training
- Progressive activity/exercise
- Improve hand function by enhancing strength, coordination, sensation
- Encouraging access to community
- Recommending adaptive equipment/techniques for home, work
- Psychosocial support/remediation (coping skills)
13
Q
GBS: Activity/ Exercise
A
- In one study if more than 1/3 of motor units remained intact, exercise produced strengthening, if less than 1/3, it damaged muscle tissue.
- Rule of thumb: exercise will NOT hasten or improve nerve regeneration, nor will it influence the reinnervation rate during the rehabilitation process so be conservative in early stages.
14
Q
GBS: Exercise/Activity Progression
A
- Short periods of activity/ exercise appropriate to the patient’s strength
- Increase this only if the patient improves or if there is no deterioration after 1 week
- Return to bed rest if a decrease in function or strength occurs
- Limit fatiguing exercise/ activity for 1 year
15
Q
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
A
- Closely related to GBS; considered chronic counterpoint of that acute disease
- Caused by damage to myelin sheath of PNS
- Chronically progressive or relapsing symmetric sensorimotor disorder
- Autoimmune disorder
- Weakness occurs over 2 months or more
