Guillian Barre Syndrome Flashcards
what is GBS
an autoimmune disease that causes acute demylination of the peripheral nerve directed towards the nerve root leading to motor and sensory neuropathy
what are the 2 subtypes of GBS
1) acute inflammatory demyelination polyneuropathy
2) acute motor and sensory axonal neuropathy
what are the causes of GBS
stomach virus: campylobecter jejuni, cytomegalovirus, epstein barr, HIV, immunizations or trauma. Person is usually sick 2 weeks before signs and symptoms of GBS.
Pathogenesis of GBS
infiltration of macrophages and T lymphocytes . macrophages attack and strip the myelin leading to reduces saltatory conduction
what is Chronic Inflammatory Demylinating Polyneyropathy
slow progressive chronic condition similar to GBS. does not involve the respiratory system. Needs constant medication/ steroids
what is the first symptom of GBS
symmetrical ascending muscular weakness distal to proximal
Clinical presentation of GBS
1) fatigue
2) symmetrical ascending weakness in the UE and LE
3) LMN S/S (hypotonia and areflexia)
4) autonomic Symptoms ( in 50%)
5) intercoastal and diaphramatic weakness
6) CN involvement (5,7,9,10,11,12)
7) urinary retention
8) sensory loss of mylinated fibers
what are the autonomic S/S
1) tachycardia
2) postural orthosistis
3) arrhythmias
4) hypertention
5) peripheral pooling of blood
what are the sensations that are carried on mylinated fibers
- vibration
- proprioception
- discriminative touch
what are the sensations that are carried on C fibers
- pain
- aching
- buring/temp
- itch
what is the progression of GBS
rapid onset 2-4 weeks to reach nadir
methods to diagnosis GBS
- increased leukocytes
- elevated CSF protein in a lumbar puncture
- abnormal nerve conduction velocity
what are the 3 phases of GBS
1) initial (1-3 weeks)
2) plateau (days- weeks)
3) recovery (4-6 mo to 2 years)
what are the functional limitations in GBS
- inability to transfer
- inability to stand
- limited by fatigue
- limited by orthostatic/autonomic issues
what are the options for medical management for GBS
1) plasmapheresis: 1st line plasma exchange
2) IV immunoglobins need to be done immediatly and reduces the risk of a second attack.
long term consequences of GBS
- > 80% ambulation at 6 mo
- 60% to PLOF within 1 year
- low death and relapse rate
- 2% develop CIDP
Special considerations for GBS
- skin integrity
- DVT use homans sign
- autonomic dysfunction
- aspiration (elevate the head of the bed)
Time to reach nadir
- 50% reach in 1 week
- 70% reach in 2 weeks
- 80% reach in 3 weeks
what are the negative prognosis indicators for GBS
- age over 40
- rapid progression <7 days
- time until nadir
- severe muscular weakness
- CN involvement
- need for vent support
- distal motor responce <20% of normal
- preceding diarrheal illness
PT assessment
1) full neuromuscluar
2) full msk
3) full CN
4) full cardiopulm
5) pain at rest and with PROM
6) sensory: proprioception and deep touch
7) sitting and standing tolerance
8) transfers and gait
things to consider with ICU management
- supported upright sitting with cardiopulm management
- prevent contractures and skin breakdown
- OOB mobility once nadir is acheived
goals for acute care
- unright sitting in chair 2-3 hrs a day
- transfer training and bed mobility
- ROM
- WB activities
exercise considerations for acute phase of GBS
- avoid fatigue or over-exertion
- STOP at first sign of fatigue
- upright tolerance is exercise
Goals for IPR
- 3 hrs of tx a day
- dysphasia refer to SLP
- strengthen
- functional rehab
