Guillain-Barre Syndrome

Question 1

What is Guillain-Barre Syndrome?

Answer 1

Acute inflammatory demyelinating immune-mediated polyneuropathy
Body-s immune system attacks part of peripheral nervous system

Question 2

Does Guillain-Barre affect peripheral or central nerves?

Answer 2

Peripheral

Question 3

What causes Guillain-Barre?

Answer 3

Unknown

2/3 of patients had symptoms of infections disease 2 weeks before onset such as Epstein-Barr Virus

Question 4

How does GBS present? (5)

Answer 4

Motor Weakness (progressive, develops rapidly, distal to proximal)
Mild sensory signs or symptoms
Tachycardia and arrhythmias
Absence of fever at onset
Recovery usually begins 2-4 weeks after plateau

Question 5

How is GBS diagnosed?

Answer 5

Lumbar puncture for elevated fluid protein

Abnormal nerve conduction velocities

Question 6

How fast does GBS hit?

Answer 6

Can have maximal paralysis within 1-2 days
50% within 1 week
80% greatest severity within 3 weeks
Rare cases 1-2 months

Question 7

What is the Recovery process for GBS like?

Answer 7

3-5% die
Most have gradual recovery 2-4 weeks after plateaue
Rehab starts at 4 weeks
80% become ambulatory at 6 months

Question 8

What is the most common long-term deficit with GBS?

Answer 8

Weakness of anterior tibial musculature and foot and hand intrinsic muscles

Question 9

How is GBS managed medically?

Answer 9

Respiratory monitoring (may need vent)
Monitor cardiac
Immunotherapy-based treatments (plasma exchange, immunoglobulin)
Prevent secondary complications

Question 10

What are some goals of interventions?

Answer 10

Facilitate resolution of respiratory problems
Minimize pain
Prevent contractures, ulcers, and injury to weakened muscles
Introduce graduated program of active exercise
Resume previous roles in life

Question 11

What are some ways to resolve pain in GBS patients?

Answer 11

Medications
TENS
Capsaicin (topical anesthetic)
With extreme sensitivity there are cradles that hold sheets away from body, limbs wrapped snuggly with elastic bandages

Question 12

What is the best way to stretch for preventing contractures?

Answer 12

Mild continuous stretch maintained for at least 20 minutes

Question 13

How early do you want to start ROM exercises with GBS patients?

Answer 13

Within the 1st couple of days of hospitalization
PNF patterns work well
PROM to end range TWICE daily

Question 14

How does strength usually return?

Answer 14

Returns in descending pattern; proximal to distal
No evidence that active exercise can change rate of progression of disease
May improve function though

Question 15

When do you want to start antigravity strengthening?

Answer 15

Not until strength is 3/5 MMT