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Guillian-Barre' Syndrome (GBS):
- a demyelinating inflammatory polyradiculoneuropathy
- -affects nerve roots
- -affects peripheral nn
- -leads to motor neuropathy and flaccid paralysis
GBS destroys the protective covering of the peripheral nerves (myelin sheath), disabling the nerves from...
- transmitting signals to the mm
- If the myelin sheath doesn't recover, the nerve itself may become affected and die, causing permanent damage and disability
How does it happen?
- 2 infections have been implicated
- -campylobacter jejuni
- -cytomegalovirus infection
- -diabetes, alcohol abuse, exposure to heavy metals, and toxins
- We really don't know!
- Perhaps autoimmune reaction
How does it progress?
- a rapidly evolving, symmetrical onset of weakness or flaccid paralysis
- decreased DTRs
- 20-30% become so weak they require respiratory support
- 5% die from respiratory distress or organ system failure
- 50% develop cranial nerve weakness primarily in the facial nerve
- hyperesthesia, paresthesias (tingling or burning), numbness and decreased vibratory or position sense are common
- sensory distribution loss is frequently stocking/glove patterns as opposed to dermatomes
- 55% report pain preceding the onset of GBS
- 72% have pain at some point during the onset and recovery
- pain is a muscle aching, symmetrical, and in larger muscle groups
- 50% of pts reach their full extent of paralysis in 1 week, 70% by two weeks, and 80% by three weeks
- recovery most often starts at 2-4 weeks after progression of the symptoms stops
- 80% become ambulatory w/in 6 months of onset of symptoms
Long term deficits?
- weakness in the anterior tibialis
- weakness in the hand and foot intrinsics
- weakness in the quadriceps
- weakness in the gluteal musculature
What to do?
- watch for respiratory complications including respiratory failure
- watch for aspiration from oral muscle weakness or paralysis
- plasma exchange demonstrates promise as an intervention b/c of the autoimmune nature of the illness
- IV immunoglobin has also shown promise
What to do?
- chest PT
- oral-motor eval and intervention by OT or speech
- Pain (TENS)
- ROM/stretching to prevent contractures
- positioning w/ good skin care
- splints, casting, positioning devices
- tolerance to upright
- progressive program of active exercise while monitoring for overuse and fatigue
What to do?
Rule: exercise will NOT hasten or improve nerve regeneration, not will it influence the reinnervation rate during rehab
With exercise, the goal is:
- to maintain the pt's musculosketletal system in a ready state to prevent overwork, and to pace the recovery process to obtain maximal function as reinnervation occurs
- avoid muscle fatigue
- provide rest
- short periods of exercise appropriate to the pt's strength
- increase this only if the pt improves or if there is no deterioration after 1 week
- return to bed rest if a decrease in function or strength occurs
- direct exercise at strengthening for function, not for strengthening itself
- limit fatiguing exercise for 1 year