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Definition
- Polyneuritis with progressive muscular weakness that develops rapidly
- Involves acute demyelination of both cranial and peripheral nerves (LMN disease)
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Etiology
- Unknown, associated with an autoimmune attack
- Usually occurs after recovery from an infectious illness (respiratory or GI)
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Sensory and Motor Loss
- Sensory loss and paresthesias (typically less than motor loss)
- Motor paresis or paralysis (relative symmetrical distribution of weakness)
- Motor loss rogresses from lower extremities to upper (ascending pattern) and distal to proximal
- May produce full tetraplegia with respitatory failure
- Dysarthria, dysphagia, dipolia and facial weakness may develop in severe cases
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Prognosis
- Progression evolves over a few days or weeks
- Recovery usually slow (6 months → 2 years) and usually complete (85% of cases)
- Some mild weakness may persist
- 3% mortality
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Complications
- Respiratory impairment and failure
- Autonomic instability: tachycardia, arrhythmias, BP fluctuations
- Pain: myalgia
- Risk of pneumonia
- Prolonged hospitalizations and immobility: DVT, skin breakdown, contracture
- Relapse: if treatment is inadequate
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Examine
- Cardiac and respiratory status, vital signs
- CN function (VII, IX, X, XI, XII)
- Motor strength
- Reflexes: decreased or absent tendon reflexes
- Sensation: paresthesias, anethesias, hyperesthesias, pain (muscle aching, burning); May have stocking and clove distribution
- Functional status
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Medical Treatment
- Good nursing care
- Plasmapheresis
- IVIG
- Analgesics for relief of pain
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PT Goals, Outcomes, and Interventions
- Maintain respiratory function (may require endotracheal intubation, intubation, tracheotomy, and ventilation)
- Prevent indirection impairments: PROM, positioning, and skin care
- Prevent injury to denervated muscles
- Muscle re-ed, moderate exercise program
- Functional training as recovery progresses
- Energy conservation techniques (overuse and fatigue prolong recover)
- Cardiovascular fitness
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