Card Set Information
review of Guillian-Barre' Syndrome lecture 4-23
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
-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
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?
oral-motor eval and intervention by OT or speech
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
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