Guillain-Barre Syndrome Flashcards
what is GBS
acute generalized weakness
broad group of demyelinating inflammatory polyradiculoneuropathies
- nerve roots and epripheral nerves are affected-
- LMN disorder
results in flaccid paralysis
pathophysiology
involves autoimmune reactions-> cross-reaction with neural tissue
Myelin is destroyed-> inflammation occurs
acute inflammatory lesions are present within several days of onset of sysmptom
Never conduction is slowed and may be blocked completely
Schwann cells are destroyed by AXONS are left in tack
**Schwann cells do begin to regrow after 2-3 weeks of demylennation and inflammation subsides
clinical features
rapid and progressive over 3-7 days
loss of motor function occurs: distally and then progresses to proximal
*distal extremity paraesthesia=pins and needles
dysesthesia= abnormal burning and pain sensation
pain reported as musculature=myalgia
DTR’s are absent from demyelination of peripheral nerves
Postpolio Snydrome
-late effects of poliomyelitis
viral infection which attacks some of the anterior horn cells in spinal cord=muscular paralysis
due to increased metabolic demands by giant motor units
GIANT MOTOR UNITS-PPS
formed during recovery process from the original viral infection
polio destroyed anterior horn cells
muscle fibers innervated by ant. cells that were destroyed were taken up by reinnervating them anterior horn cells not destroyed which causes giant motor units
clinical features of PPS
fatigue new weakness pain cold intolerance decreased function
Symptoms of GB
rapid 3-7 days
symmetrical extremity weakness with hyporeflexia
initially proximally, then distally
initially LE then UE and face if effected
respiration and swallowing muscles effected
neuropathic or radicular pain
tachycardia-cardiac irregularities
facial flushing
abnormalities of sweating, pulmonary dysfunction and impaired sphincter control
fever
nausea
medical management for GB
plasmapheresis w/ respiratory dysfunction
IV immunoglobulin
ICU w/ ventilator if rapid progressiveness
Rehab for GB in acute phase
pulmonary rehab
skin management
PROM with orthotics to prevent contractions
ther ex/ mobility training upon fair to good muscle grade
pain management w/ TENS
Sub acute Rehab with GB
Ther EX: ARROM within pt. tolerance, avoid overuse to prevent pain
functional mobility training
- orthotics
- ambulation devices
continue with pain management
REHABILITATION PHASE GB
continue to progress resistive exercise as tolerated
cont. functional mobility training
adaptive equipment
pain management
gradual aerobic training
OT:
- UE strength
- ADL training and adaptive equp.
Prognosis with rehabilitation phase
20% permanent physical limitation
-ankle DF
within 6 months-85% ambulatory
Bulbar palsy
facial nerve CN7 involved with bilateral facial weakness
double vision from eye muscle weakness -CN 3,4,6
what is plasmapheresis with GB
remove blood from body and seperate red and white blood cells from plasma and only blood cells are returned to patient
- body makes more plasma to replace
- it elminates some of the immune factors responsible for disease progression
- reduces length of illness
3 phases of GB
- acute
- 4 weeks
- 100% core symptoms occur - Plateau
- stabilization of symptoms
- no longer progressing
- can last 4 weeks - recovery
- patient begins to improve
- 80% of pts. recover within a year but some have residual deficits
- can last several months to years
- poor outcome for those who needed ventilation and had rapid progression of demyelination
