Guillain-Barré Syndrome❗️

Question 1

Etiology of GBS; onset; sex

Answer 1

an inflammatory disease that causes demyelination of axons in peripheral nerves

Question 2

GBS course and prognosis

Answer 2

• GBS has no cure, and the rate of recovery is variable.
  1. About 80% of clients can walk independently 6 months after diagnosis
  2. About 60% of clients fully recover motor strength 1 year after diagnosis
  3. About 5% to 10% of clients have very delayed and incomplete recovery

Question 3

Phase of GBS

Answer 3

1. Onset and acute inflammatory phase: Acute weakness that occurs in at least two extremities advances and reaches its maximum in 2 to 4 weeks; may need mechanical ventilation. Rapid progression of symptoms, typically in a symmetrical ascending pattern of flaccid paralysis that begins in the feet; paralysis may occur in respiratory muscles

2. Plateau phase: Symptoms are at their most disabling, with little or no change over a few days or weeks.

3. Progressive recovery phase: Remyelination and axonal regeneration occur over a period as long as 2 years. Recovery tends to start at the head and neck and travel distally

Question 4

Occupational performance issues

Answer 4

Pain, mostly in the lower extremities

Fatigue

Absence of deep tendon reflexes

Initial mild sensory loss in the hands and legs ; as sensation returns in the recovery phase, patients often report hypersensitivity to touch and other painful sensations

Dysfunction of cranial nerves e.g. facial palsy

Autonomic nervous system (ANS) involvement –> postural hypotension, arrhythmias心律不整, facial flushing, diarrhea, impotence, urinary retention, and increased sweating

Bladder dysfunction

Question 5

Interdisciplinary team management

Answer 5

Medications

Respiratory therapists (breathing treatments and exercises)

Speech-language pathologists (speech production or swallowing impairments)

Physical therapists (mobility needs, help prevent muscle atrophy, and aid in the prevention of contractures or skin breakdown)

Question 6

OT Ax in plateau phase, recovery phase

Answer 6

Plateau phase:
- communication
- control of the physical environment
- anxiety management
- sensory assessment
- skin integrity
- interview/observation

Recovery phase:
- mobility, self-care and ADLs
- communication
- leisure
- workplace and community reintegration

Question 7

OT Tx in plateau phase

Answer 7

Plateau phase (temporary modifications)

• use of communication tools, such as signs or picture boards
• Adjust (and train caregivers on) supine and sitting positions that optimize function and comfort and reduce risk of skin breakdown
• Position the client for trunk, head, and upper-extremity stability
• Achieve optimal muscle use at a
  tolerable pain level as nerve supply returns
• Use gentle passive range-of-motion to reduce the risk of contractures and DVT
• Support weak upper extremities with armrests, a wheelchair tray and/or pillows to prevent stretching of shoulder muscles and joint tissues
• Educate the client and family about the health condition and anxiety-reduction techniques

Question 8

OT Tx in recovery phase

Answer 8

Recovery phase (resume occupations and roles, rituals, and routines)

• functional activities
  e.g. bed mobility
  transfers
  gait and/or wheelchair mobility
  sitting and standing balance while
  reaching, dressing, feeding, bathing/toileting, writing/typing,
  leisure activities
  reintegration into the work environment.
• Design dynamic splints to help maintain range of motion, especially for the wrist, fingers, and ankle (hinged drop-foot orthosis)
• Continue to adapt modes of communication on the basis of the client’s priorities (e.g., voice- operated text messaging)
• Energy conservation
• Exercises may be progressed from passive to active-assisted ROM
• body mechanism, joint protection, pain mx
• work modification
• self mx
• support group
• sensation
  e.g. contrast baths, rice or bean buckets, vibrating massage tools with
  interchangeable heads, and position in space exercises