Gullian-Barre' Syndrome

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Gullian-Barre' Syndrome
2014-05-03 18:18:04

review of Guillian-Barre' Syndrome lecture 4-23
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  1. Guillian-Barre' Syndrome (GBS):
    • a demyelinating inflammatory polyradiculoneuropathy
    • -affects nerve roots
    • -affects peripheral nn
    • -leads to motor neuropathy and flaccid paralysis
  2. 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
  3. 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
  4. 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
  5. Sensory problems?
    • 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
  6. Pain
    • 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
  7. Prognosis:
    • 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
  8. Long term deficits?
    • weakness in the anterior tibialis
    • weakness in the hand and foot intrinsics
    • weakness in the quadriceps
    • weakness in the gluteal musculature
  9. 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
  10. 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
  11. What to do?
    Rule: exercise will NOT hasten or improve nerve regeneration, not will it influence the reinnervation rate during rehab
  12. 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
  13. Progression
    • 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