Unit 8: GBS Flashcards
What is GBS?
-aka Acute Inflammatory Demyelinating Polyneuropathy
-Autoimmune disorder
-Results in acute neuromuscular failure
-The body’s immune system attacks the myelin sheath covering the nerve, resulting in a slower signal transmission through the nerve
Etiology of GBS
-Exact etiology is unknown
-Distribution is worldwide
-1.3 – 2 per 100,000
-1.5x more likely in men
-Ages: 20–24, and 70–74
-No hereditary susceptibility or vaccinations cause GBS
-Enteritis precedes GBS in 41% of cases
-Some respiratory infections, HIV & AIDS
3 Main Types of GBS
-Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP)
-Miller Fisher Syndrome (MFS)
-Acute Motor Axonal Neuropathy (AMAN) and Acute Motor-Sensory Axonal Neuropathy (AMSAN)
Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) (Types of GBS)
-The most common form in the U.S.
-Most common sign= Muscle weakness that starts in the lower part of your body and spreads upward.
Miller Fisher Syndrome (MFS) (Types of GBS)
-In which paralysis starts in the eyes
-Also associated with
unsteady gait.
-Occurs in about 5% of people with in the U.S. but is
more common in Asia.
Acute Motor Axonal Neuropathy (AMAN) and Acute Motor-Sensory Axonal Neuropathy (AMSAN) (Types of GBS)
-Less common in the U.S.
-But AMAN and AMSAN are more frequent in China, Japan and Mexico.
Characteristics of GBS Include
-Weakness and Tingling in extremities is usually first symptom
-Cognition remains intact
-Quickly progressing, symmetrical ascending
paralysis starting with the feet
-Pain in the legs
-Absence of deep tendon reflexes
-HTN
-Tachycardia
-Fatigue
-Urinary dysfunction
-Respiratory muscle paralysis
-Possible facial palsy
3 phases of GBS
-Phase 1: Acute Inflammatory Phase: 95% of people manifests as weakness in at least 2 limbs that progresses and reaches maximum within 2 – 4 weeks with increasing symptoms (20–30% require mechanical ventilation)
-Phase 2: Plateau *NO significant changes
-Phase 3: Progressive Revery
Prognosis/ Presentation
-Full recovery can occur within as little as a few weeks to a few years
- 1–10% of people die
-50% of patients have full recovery
-40% require rehabilitation services
-35% experience some residual weakness
-15% experience some residual weakness that may not resolve
-Fatigue is the most common residual problem for 93% of patients
Common Functional Impairments in GBS
-Decreased ADL I
-Decreased IADL I
-Decreased Mobility
-Skin, Falls, possible DVT
-Decreased balance
-Decreased muscle strength
-Fatigue
-Inability to fulfill roles
-Sleep
Common Functional Impairments in GBS
-Decreased ADL I
-Decreased IADL I
-Decreased Mobility
-Skin, Falls, possible DVT
-Decreased balance
-Decreased muscle strength
-Fatigue
-Inability to fulfill roles
-Sleep
Possible Assessments for GBS
-Pain scale
-Beck Depression Scale
-FIM
-COPM
-7 point GBS disability scale
-Semmes Weinstein
-ROM/MMT
-Dynamometer
-Grip, Pincher, 3 point, Lateral pinch
Possible Assessments for GBS
-Pain scale
-Beck Depression Scale
-FIM
-COPM
-7 point GBS disability scale
-Semmes Weinstein
-ROM/MMT
-Dynamometer
-Grip, Pincher, 3 point, Lateral pinch
Acute phase: Possible Treatments
-Communication tools such as a picture board, signs or voice activated devices (if appropriate)
-Adapted: calls lights, T.V. controller, & lights (PRN)
-Hands free telephone
-Strategies to reduce anxiety
-Body positioning
Recovery Phase: Possible Treatments
-Provide/perform activities and dynamic splints to maintain ROM
-Patient & caregiver education
-Sensory stimulation or desensitization program
(PRN)
-Transfer training
-Modified self-care techniques and adapting activities
-Re-arranging routines/schedule
-Energy conservation techniques/fatigue management
-Employment modification
-Strengthening gross and fine motor, enhancing
sensation
-Complete a home assessment/modifications assessment
Possible Adaptive Equipment
-Build up utensils
-Reacher
-Built up handles
-Dycem
-Adaptive shoe laces
-Long handled sponge
-Long handled shoe horn
-Rocker knife
The Role of Occupational Therapists:
Working with patients & Caregivers
-Problems & Concerns
-Needs & Priorities
-Occupational history and experience
-Occupational Profile
-Values
-Patterns of daily living
-Interests
Person-Environment- Occupation Model
-Ideal performance results from a perfect balance between client factors, the environment, and the occupation.
-Person (intrinsic factors)
-Performance (actual act of doing)
-Occupation (structure of tasks
-Environment (extrinsic factors)
Come together for occupational performance and participation
7-Point Disability Scale
Primarily assesses ambulation and need for a ventilator
Acute Phase Interventions
-Patient may be actively involved in directing care rather than physically involved, providing the opportunity for educating the patient and others about maintaining comfort in bed, protecting against bed sores, and future therapy
-Modifications during the acute and plateau phase should be considered temporary
Recovery Phase Inteventions
Initially completed with few repetitions, punctuated with rest
-The number and complexity of task should be increased gradually
