Guillain-Barre Syndrome

Question 1

what is GBS

Answer 1

acute generalized weakness
broad group of demyelinating inflammatory polyradiculoneuropathies

• nerve roots and epripheral nerves are affected-
• LMN disorder

results in flaccid paralysis

Question 2

pathophysiology

Answer 2

involves autoimmune reactions-> cross-reaction with neural tissue

Myelin is destroyed-> inflammation occurs

acute inflammatory lesions are present within several days of onset of sysmptom

Never conduction is slowed and may be blocked completely

Schwann cells are destroyed by AXONS are left in tack

**Schwann cells do begin to regrow after 2-3 weeks of demylennation and inflammation subsides

Question 3

clinical features

Answer 3

rapid and progressive over 3-7 days

loss of motor function occurs: distally and then progresses to proximal

*distal extremity paraesthesia=pins and needles

dysesthesia= abnormal burning and pain sensation

pain reported as musculature=myalgia

DTR’s are absent from demyelination of peripheral nerves

Question 4

Postpolio Snydrome

Answer 4

-late effects of poliomyelitis

viral infection which attacks some of the anterior horn cells in spinal cord=muscular paralysis

due to increased metabolic demands by giant motor units

Question 5

GIANT MOTOR UNITS-PPS

Answer 5

formed during recovery process from the original viral infection

polio destroyed anterior horn cells

muscle fibers innervated by ant. cells that were destroyed were taken up by reinnervating them anterior horn cells not destroyed which causes giant motor units

Question 6

clinical features of PPS

Answer 6

fatigue
new weakness
pain
cold intolerance
decreased function

Question 7

Symptoms of GB

Answer 7

rapid 3-7 days
symmetrical extremity weakness with hyporeflexia

initially proximally, then distally

initially LE then UE and face if effected

respiration and swallowing muscles effected

neuropathic or radicular pain

tachycardia-cardiac irregularities

facial flushing

abnormalities of sweating, pulmonary dysfunction and impaired sphincter control

fever

nausea

Question 8

medical management for GB

Answer 8

plasmapheresis w/ respiratory dysfunction

IV immunoglobulin

ICU w/ ventilator if rapid progressiveness

Question 9

Rehab for GB in acute phase

Answer 9

pulmonary rehab
skin management
PROM with orthotics to prevent contractions

ther ex/ mobility training upon fair to good muscle grade

pain management w/ TENS

Question 10

Sub acute Rehab with GB

Answer 10

Ther EX: ARROM within pt. tolerance, avoid overuse to prevent pain

functional mobility training

• orthotics
• ambulation devices

continue with pain management

Question 11

REHABILITATION PHASE GB

Answer 11

continue to progress resistive exercise as tolerated

cont. functional mobility training

adaptive equipment
pain management

gradual aerobic training

OT:

• UE strength
• ADL training and adaptive equp.

Question 12

Prognosis with rehabilitation phase

Answer 12

20% permanent physical limitation
-ankle DF

within 6 months-85% ambulatory

Question 13

Bulbar palsy

Answer 13

facial nerve CN7 involved with bilateral facial weakness

double vision from eye muscle weakness -CN 3,4,6

Question 14

what is plasmapheresis with GB

Answer 14

remove blood from body and seperate red and white blood cells from plasma and only blood cells are returned to patient

• body makes more plasma to replace
• it elminates some of the immune factors responsible for disease progression
• reduces length of illness

Question 15

3 phases of GB

Answer 15

1. acute
   - 4 weeks
   - 100% core symptoms occur
2. Plateau
   - stabilization of symptoms
   - no longer progressing
   - can last 4 weeks
3. recovery
   - patient begins to improve
   - 80% of pts. recover within a year but some have residual deficits
   - can last several months to years
   - poor outcome for those who needed ventilation and had rapid progression of demyelination