Guillan Bare Syndrome

Question 1

GBS

Answer 1

• Acute inflammatory demyelinating poly neuropathy

* Ascending paralysis

Question 2

Pathophysiology

Answer 2

Autoimmunity, which is preceded by a GIT/Respiratory tract infections

Demyelination only takes place in the peripheral nerves, including the cranial nerves

Recovery takes place by axonal regeneration and remyelination

Question 3

GBS clinical presentation

Answer 3

Abrupt paraesthesia
• Symmetrical muscle weakness and wasting:
arms, legs, face & chest
• Decreased tone and reflexes
• Symptoms are from distal to proximal
• Glove and stocking pattern of sensory loss
• Motor fibres - more affected than sensory fibers
Proprioception-most affected sensory modality

Disturbance in autonomic function: cardiac arrhythmias and labile/unstable blood pressure – due to involvement of the vagus nerve

Question 4

Medical management

Answer 4

Mechanical ventilation
• Plasmapheresis/Plasma filtration
• Injection with Immunoglobulins
• Anticoagulants
• Parenteral feeding if swallowing is impaired
• May also have enteral feeding (with nasogastric tube)
• Rx for potential UTI - possible cause (e.g. retention

Question 5

Physiotherapy mx: Acute management

Up to day 10

Answer 5

• Respiratory care (ACBT, PD, Manual tech, Sxn..)
Musculoskeletal
-joint protection(AFOs)
-Maintenance of joint movement (e.g. AP’s/PA’s – should know

• Skin: positioning & circulatory exercises
• Circulation: Prevent DVT & Postural hypotension
• Psychological support: family and patient

Question 6

Physio mx-plateau phase

-day10 up to 4 weeks

Answer 6

• Chest care
• Joint range
• Muscle strength – central stability (e.g. with kneeling, rhythmic stabs, crawling, ball excs….)
NB! Avoid fatigue: may lead to paradoxical weakening
• Sensory awareness & Balance re-education
• ADLs
• Orthoses (AFO, Universal cuff, etc) Motivation and support groups
-Recovery period: 6-12 months, sometimes up to 3

Question 7

Precautions

Answer 7

-Don’t overstretch
-beware of postural hypotension
-don’t exercise to a point of fatigue
-autonomic dysreflexia
-beware of decreased sensation
 DVT
 Pain

Question 8

Residual paralysis

Answer 8

Muscles are supplied by:

• median nerve
• Ulnar nerve
• Peroneal nerve
• Distal branches of tibial nerve

Question 9

What the nerves have in common

Answer 9

• Ulnar nerve – Ulnar sulcus
• median nerve -carpal tunnel
• Peroneal nerve – Fibula head
• Distal branches of tibial nerve – Tarsal tunnel