Guilliain Barre

Question 1

What is guillian-barre

Answer 1

• an autoimmune disorder of the peripheral nervous system causing progressive weakness with diminished/absent tendon reflexes.
• Acute, inflammatory, demyelinating,
  polyradiculoneuropathy presenting as rapid loss of myelin

Question 2

etiology of Guillian-Barre

Answer 2

Unknown, associated
with an autoimmune attack,
usually occurs after recovery
from an infectious illness

Question 3

GBS pathophysiology

Answer 3

• Inflammatory process affects the Schwann cells.
• Macrophages attack Schwann cells resulting in primary demyelination of the axon
  while usually leaving the axon intact.
• Affects sensory, motor and
  autonomic systems.
• Remyelination occurs rapidly.

Question 4

Patient may experience secondary….

Answer 4

axonal damage due to
lymphocytic infiltration and cyto destructive events in the axon occur resulting in Wallerian denervation of the distal axon

Question 5

GBS is the largest single cause of what?

Answer 5

acute neuromusculature paralysis

Question 6

GBS SxS

Answer 6

• Acute demyelination of both cranial and peripheral
  nerves/nerve roots
• Sensory loss, paresthesias (tingling, burning) pain; Sensory loss usually not as significant as motor loss
• Motor paresis or paralysis: relative symmetrical distribution of weakness, may produce full quadriplegia with respiratory failure if not treated
• Dysarthria, dysphagia, diplopia, and facial weakness may develop in more severe cases

Question 7

GBS Progression

Answer 7

Progression of symptoms usually over a few days or weeks, usually ascending symptoms; recovery slow (months to 2 years) but most regain function; 10-20% have severe disability, 5% mortality

Question 8

Medical management of GBS

Answer 8

plasmapheresis, IVIG

Question 9

Interventions in the acute phase of GBS

Answer 9

respiratory care, passive movements, positioning, splinting, and gentle progressive strengthening exercises

Question 10

interventions in the post-acute stage of GBS

Answer 10

more intensive strengthening and functional activities

Question 11

Factors associated with poorer outcome

Answer 11

• Requirement for respiratory support
• Abnormal peripheral nerve function
• No plasmapheresis or intravenous immune globulin performed
• Subgroup of GBS with primary axonal degeneration
• Patients with rapid onset
• Progression to quadriplegia
• Respiratory dependence
• Severe disease at presentation
• Patients showing no improvement at 3 weeks of plateau of disease.

Question 12

Treatment of fatigue

Answer 12

• central fatigue related to decreased number of remaining motor units
• management: energy conservation techniques, lifestyle changes, pacing, regular periods of naps during the day and improvement of sleep
• exercise programs

Question 13

Treatment of sensory loss

Answer 13

education of the patient and preventative program

Question 14

symptoms of autonomic dysfunction and pain

Answer 14

decreased sweating, orthostatic hypotension, gastro paresis, constipation, vomiting, diarrhea, impotence, and flaccid urinary bladder

Question 15

treatment of neurogenic bladder and bowel

Answer 15

pelvic floor training

Question 16

treating physical deconditioning

Answer 16

• Avoid overwork
• overwork may be due to several factors: due to transmission problems, there are fewer numbers of successfully recruited muscle fibers available to produce significant forces for function OR increased force production in a muscle

Question 17

excess muscle activity may occur due to:

Answer 17

• spotty/patchy demyelination
• abnormal remyelination
• partial denervation

Question 18

Overwork symptoms

Answer 18

delayed onset muscle soreness, peaking between days 1 and 5 post activity and a reduction in maximum force production that gradually recovers.
Caused by an inflammatory process resulting in a secondary muscle injury.

Question 19

When treating physical deconditioning, what type of muscle contraction should you avoid?

Answer 19

• eccentric
• greatest probability of injury
• only eccentrically train to resist muscle damage

Question 20

When training physical deconditioning, what should you do?

Answer 20

wait until the musculature is antigravity strength before stressing
- should be progressed to antigravity exercises once they are able to move the limb against a resistance equal to the mass of the limb

Question 21

when should ambulation begin?

Answer 21

when the patient has at least a fair grade in the lower extremity musculature

Question 22

Assessment of overuse weakness

Answer 22

• Rest intervals, objective testing of strength, and evaluating complaints of muscle soreness are required.
• Therapist should at minimum assess the patient’s strength and muscle soreness complaints from one day to the next or evaluate the
  patient after a weekend of no therapy.

Question 23

What type of strength training should be performed?

Answer 23

sub maximal with minimal numbers of repetitions

Question 24

Aerobic training

Answer 24

• carefully monitor for appropriate physiological responses
• patient may experience autonomic involvement
• work the patent to a moderate exercise intensity level using Borg

Question 25

What type of muscle fibers do you want to recruit for aerobic training

Answer 25

• fast-twitch muscle fibers
• push for speed or rapid rises and falls in muscle force production such as fast walking, jumping, and quick changes in direction during walking and lunges

Question 26

Multi-joint Work

Answer 26

• move in a multijoint pattern from the beginning of the disease process.
• By linking multiple joints together for a movement,
  the patient reinforces muscle synergies where prime movers
  and stabilizers are active and coordination between joints with the patient’s new neurological system will be encouraged to
  develop from the onset.

Question 27

Respiratory function

Answer 27

Concern for aspiration, weakness of muscles of inspiration, weakness of muscles of expiration, pulmonary complications
(embolism and pneumonia)