Exam 1 Lecture 3 GBS and PPS Flashcards Preview

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Last case of Polio in US was in



Polio is transmitted how

by fecal oral
(not washing hands after going to the bathroom, etc)


Polio has spikes when



Polio has 2 types of vaccines (names and details)

~The Salk vaccine- dead virus
~The Sabin vaccine- alive/weakened virus


Is polio still in the US? Outside the US?

~No- no case since 1979
~yes- still around; middle east, etc


What are the three patterns that polio can take?

~ asymptomatic
~flu-like symptoms (GI pains and some muscular pain)
~paralytic infection that starts with flu like symptoms


where does polio attack in the body?

the virus invades and damages motor cells bodies


Polio (description)

~focal and asymmetric motor impairments
~can lead to respiratory failure
~However, most just had flu s/s and never know that they had it


Post polio syndrome occurs when

decades after the acute polio event


Why does PPS occur?

~deinnervation occurred when the pt has polio
~the pt had axonal collateral sprouting to reinnervate the muscles
~all the collateral sprouting and the nerve create the GMU unit
~the GMU will wear out over time when the collateral sprouting wear away
~causes weakness (pt will think that they have polio again)


Dos and Don'ts for to save GMU

~Do Preservation!
~Don't try and increase strength (if less than 3/5 strength)
~Do not put heat on
~Do educate the pt


How can you test to see if you need to strengthen or preserve GMU?

MMT the pt: needs to be 3/5 or better to strengthen; if less than 3/5- preserve!


Main goal with PPS is to

save the GMU (if higher then 3/5 can strengthen them, if less than 3/5 then preserve the GMU as long as possible)


Energy Conservations: 5 P's

*we are trying to maintain these pts; try to keep them below or at target heart rate; not a huge workout like we have bc they do not need to be overworked


Energy Conservation: Planning

~plan the activity in the day to be the most efficient
~think about your day and spread out your activities throughout the week (don't just do all your activities in one day)
~know what part of the day you have the most energy and plan to do activities during this time


Energy Conservation: Prioritizing

~you do not have to do EVERYTHING
~try and delegate activities/ ask for help at times


Energy Conservation: Pacing

~everything does not have to be at a fast pace= SLOW DOWN
~you can sit to brush teeth, sit in the shower, sit to cook, etc; you can then have this energy to use at a different time


Energy Conservation: Positioning

~need to be as close biomechanically correct as possible (when exercising, doing ROM, etc)
~correct position will put less stress on the joints will be less stressful on the body


Energy Conservation: Power

~eventually, they are not going to be able to ambulate anymore
~you will have to talk to them about devices for longer distances (at first)
~these devices can help them keep going for a little longer


Guillian Barre Syndrome is linked to

No one really know
~linked to bacterial and viral (epstein-barr) infections as well as vaccines
~2/3 of people reported acute infection w/in 2 months; 90% had illness (respiratory or GI) in past 30 days


GBS s/s

~motor and sensory
~starts distal and moves proximal
~"stocking and gloves"- see it in feet and hands first
~rapid onset
~symmetrical- doesn't have to be perfect, but it moves up the body at the same pace


GBS- what is happening

~demyelination of PNS
~the Schwann cells are being attacked (anti-body mediated demyelination); this occurs at the nodes of Ranvier b/c macrophages respond to the inflammation by the antibodies
*this can be motor, sensory, autonomic


When does GBS reach its peak?

~75% of people will reach their weakness in 2 weeks
~95% will get there by 4 weeks


GBS diagnosis

~lumbar puncture (protein will be evaluated in the CSF)
~nerve conduction test (slowed)
~full body scans/ EMGs, etc
~evaluate s/s


What to do with the pt with GBS?

~not going to strength muscles (they are less that 3/5), just passive move
~positioning/ splinting
~check for wounds
~educate the patient


Treatment for GBS

~this is an autoimmune disorder so we don't know the trigger
~can do a plasma transfusion- plasmaphorisis (take out the plasma) which can hopefully stop the demyelination
~may just need a massive does of plasma (don't remove yours first)

*if the pt's GBS gets high enough, will need venting, etc to keep alive


What are the 3 phases of GBS



GBS- acute phase

~2-4 weeks
~when they are getting worse- want to try and get them to slow down/ stop the process as early as possible (if possible)


GBS- plateau phase

~can take some/ can be days, weeks, months depending on how far GBS traveled
~keep them stable
~stretch, positioning, check for wounds
~should be able to reach recovery if they get to this phase


GBS- recovery phase

~will take months to years to get to 95-100%
~everything is weak so you get to have fun deciding what to help these pts with
~don't want to work them too hard when they are below 3/5, but they will need to start walking
~Form fatigue plays a role here