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102 Cards in this Set
- Front
- Back
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What are myopathies?
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Actual damage to the muscle structure itself with intact nervous system
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What is a disease at the NMJ that has a similar onset to GBS?
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Myoasthenia Gravis--autoimmune problem with pts often fatiguing themselves
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What is ALS and what is often targeted?
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Motor neuron disease that is progressive, multifocal and neurodegenerative
Target alpha motor neurons and pyramidal tract neurons |
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What is GBS and what does it target?
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A peripheral nerve problem targeting the myelin sheath or axon itself
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What is GBS considered a syndrome?
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Named syndrome because it is a collection of symptoms, not a disease process
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What other syndrome is similar to GBS?
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Post polio syndrome
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What is post polio syndrome?
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A rapid onset of alpha motor neuron damage resulting in new onset of weakness later in life
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Why is GBS considered acute?
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Rapid onset of bottom of functional losses within 2-4 weeks
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What becomes inflammed with GBS?
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Either the myelin sheath or axon itself is damaged due to autoimmune attack
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How is GBS a polyneuropathy or polyradiculopathy?
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GBS will affect multiple nerve roots in an organized manner
(proximal to distal, ascending to descending nerves) |
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What is charcot-marie tooth?
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An inherited, progressive, slow onset of damage to the myelin or axon itself with symptoms of peripheral nerve denervation of distal limb muscles, loss of sensation and atrophy in hands
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When does charcot-marie tooth present?
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Starts in adolescents or early adulthood
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Where does charcot-marie tooth usually start?
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Starts in the feet where the longest nerve axons reside
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Describe the feet of pt with charcot-marie tooth?
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Normal arch changes to high arch and clawed toes
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How is charcot-marie tooth and GBS different from each other?
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The onset of charcot-marie tooth is a slow onset compared to GBS which is rapid.
Mechanism of CMT is denervation starting in the feet with the longest axons, while GBS affects multiple nerve roots in an organized manner |
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What gender is more likely to develop GBS?
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Equal between men and women
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What are 2 neuropathologies of GBS?
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1) Myelin as a target
2) Axon as a target (either sensory or motor) |
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What specific nerve fibers with myelin sheath will GBS affect?
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1) Alpha motor
2) Ia 3) Betas 4) Deltas |
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What is the cause for GBS?
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Unknown cause
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What are 2 possible molecular mimicries to GBS?
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1) Precursor infection (GI or respiratory within a month)
2) Vaccinations |
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What is molecular mimicry?
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A virus did something to change the myelin to look different to the immune system or did something to the immune system?
*Can't confirm b/c whatever the virus was is gone |
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When did vaccines increase the chance for GBS and what was the outbreak?
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1976 swine flu
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What other possible etiology is there for GBS
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Environmental causes like chickens in China with GBS (in their pooh)
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What are 4 forms of GBS by neuropathology?
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1) AIDP (acute inflammatory demyelinating polyneuropathy)
2) AMAN (acute motor axonal neuropathy) 3) AMSAN (acute motor and sensory axonal neuropathy) 4) CIDP (chronic inflammatory demyelinating polyneuropathy) |
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What is AIDP and what does it attack?
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Acute Inflammatory Demyelinating Polyneuropathy
Attacks myelin of motor and/or sensory |
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What variant of GBS is most common in the US?
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AIDP
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What are AIDP pts at risk for?
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Secondary axonal damage (AKA Wallerian Degeneration)
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What is AMAN and what does it affect?
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Acute Motor Axonal Neuropathy
Affects motor with axonal damage |
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What is AMSAN?
What does it attack? |
Acute Motor and Sensory Axonal Neuropathy
Attacks both axons of motor and sensory |
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What is CIDP
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Chronic Inflammatory Demyelinating Polyneuropathy
Recurring GBS with slower onset to hit rock bottom (at 8 weeks rather than 2-4 weeks) and may not recover as well |
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What are 4 consequences or features of GBS?
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1) Somatic motor
2) Somatic sensory 3) Cranial nerves 4) Autonomic |
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What somatic motor areas are usually affected by GBS? (4)
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Skeletal muscles
CNs Trunk Limbs |
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How would you measure the effects of GBS within somatic areas?
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Electrodiagnostic testing
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How does GBS affect somatic sensory? (4)
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Changes in:
Sensation Paresthesis Allodynia Anesthesia |
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What types of sensory changes are there with GBS? (3)
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1) Touch--pain/temp which is fast A-delta fibers
2) Proprioception 3) Light touch to hand and skin--textures, size |
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What type of fibers are often left in tact with GBS and why?
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C-fibers left intact due to no myelination
So pt can feel the slow "ouch" fibers |
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What cranial nerves can be attacked by GBS?
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Anything myelinated such as eye movements, hearing, dyarthria (swallowing and facial muscles)
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What are GBS pts at risk for?
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Dysautonomia
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What are 4 types of dysautonomic outcomes can occur with GBS pts?
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1) Increase/decrease BP
2) Orthostatic Hypertension 3) Cardiac arrhythmia 4) Bowel/bladder function |
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What is the # 1 GBS presentation?
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Weakness in legs (95%)
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What is Miller Fisher Syndrome?
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Variant syndrome of GBS that presents with ataxia and problems with the eyes
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What is a common and mostly like #1 symptoms of GBS?
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Pain
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What kind of distribution does GBS tend to have?
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Bilateral and symmetrical distribution
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What is the # 1 presentation of GBS?
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Weakness (starts in the legs and works up or starts in the arms and works down)
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What is the first clinical sign of GBS and what is it followed with?
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Pain and changes in sensation
Followed with bilateral and symmetrical loss of motor function |
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How is a definitive dx of GBS given?
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Usually a clinical dx based on history of symptoms with precursor of an infection with clinical signs (ex. weakness in legs, arms, areflexia, paresthesia, etc)
Do NCVS |
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What occurs with a GBS pt's reflexes if there is motor and sensory input?
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Areflexia even though their motor and sensory are intact
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Why would a spinal tap be performed on a GBS pt?
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Could have elevated levels of protein in their SC
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What are 6 differential diagnoses to GBS?
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1) Spinal cord compression
2) Transverse myelitis 3) Myasthenia gravis 4) Neoplastic meningitis 5) Vasculitis neuropathy 6) Paraneoplastic neuropathy |
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What is meant by Nadir?
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Person starts from normal to their lowest function for GBS and CDIP
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What is a 1 on Hughes clinical impairment scale for GBS?
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Minor signs or symptoms, can run
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What is a 2 on Hughes clinical impairment scale for GBS?
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Walk independently
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What is a 3 on Hughes clinical impairment scale for GBS?
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Walk 5m with an AD
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What is a 4 on Hughes clinical impairment scale for GBS?
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Bed or chair bound
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What is a 5 on Hughes clinical impairment scale for GBS?
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Requires assisted ventilation
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What is a 6 on Hughes clinical impairment scale for GBS?
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Death
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What are the 3 phases of GBS?
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1) Acute/inflammation/demyelination
2) Nadir/Plateau 3) Recovery |
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Describe the plateau phase of GBS
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Hits low point and doesn't improve or get worse
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What are the 3 components to the recovery phase of GBS?
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1) Regenerate myelin
2) Regenerate axons 3) Reinervation of muscle |
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What are 2 recovery mechanisms in the peripheral nerve?
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1) Regenerate myelin
2) Regenerate axons |
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What is a compensatory mechanism in the recovery of a peripheral nerve?
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Reinnervate muscle
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What does "full functional recovery" mean for GBS pts?
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90% of pts will achieve a full functional recovery according to their FIM score of 7 (ambulates 150ft without an AD) but not back to their original self
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According to Forsberg study, what do GBS pts have difficulty with 2 yrs post? (3)
And what does this suggest? |
1) IADLs
2) Leisure activities 3) Return to work with 17% not able to return to work Suggests there are life long changes/consequences of not returning to former lifestyle due to residual symptoms |
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What is the evidence of residual neuropathy in those considered "fully functionally recovered?"
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Problem with nerve conduction or reinnervation of nerve to a muscle that now different
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What did the military study indicate with GBS pts? What was their criteria?
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4 survivors were unable to pass the fitness test to return to work.
Tested speed, endurance and amount of force required (MMT can't measure these) |
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What is clinical weakness due to with GBS pts?
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Residual neuropathy consistent with axon loss/damage
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What are 4 long term muscle impairments with GBS pts?
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1) Anterior tibialis
2) Foot and hand instrinsics 3) Quads 4) Gluts |
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What are the goals with a GBS pt in ICU or step down unit? (3)
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1) Ensure medical stability
2) Prevent secondary complications 3) Prepare for rehab |
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What are 5 systems needing to be addressed with GBS pts in ICU or step down unit?
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1) Musculoskeletal
2) Respiratory 3) Sensory 4) Autonomic 5) Cranial Nerves |
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What respiratory goals are needed for GBS pts in acute or step down unit? (2)
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Ventilator support to prevent respiratory complications
--Positioning program for secretions and optimal breathing |
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What musculoskeletal goal is needed to be addressed for GBS pts in acute or step down unit?
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Prevention of contractures
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What are 5 ways to combat contractures in GBS pts in acute or step down unit?
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1) Positioning program
2) Preventive splinting 3) PROM program 4) Joint mobs (grade 1) 5) Family education of ROM techniques and positioning |
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What are 2 sensory goals to address with GBS pt in acute or step down unit?
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1) Pain management
2) Neurogenic pain |
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How do you manage pain for GBS pt in acute or step down unit?
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If musculoskeletal in nature:
Mobilize PROM Positioning |
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How does neurogenic pain progress for GBS pts?
How does it affect PT? |
From pins and needles to burning greatest at the feet/toes
Pain may prevent any form of tactile inputs tolerated and therefore attempts for PROM |
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What are some symptoms of neurogenic pain? (3)
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Allodynia
Hyperexthesia Hyperalgesia |
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What pharmacological treatments can be given to manage pain for GBS pts? (6)
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1) Ibuprofen
2) Codeine 3) Opiates (morphine) 4) Oxycontin 5) Tri-cyclic antidepressants (Elavil) 6) Antiseizure meds (Neurontin) |
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What PT interventions can be done to manage neurogenic pain in GBS pts? (2)
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1) Prep the bedding so random acts of light touch does not occur
2) Bandaging for low load, constant pressure that will also prevent random light touch |
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What is the dosage for preventing contractures with GBS pts in acute care?
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PROM 15/min x day whole body to treat muscles, tendons and joint mobs (grade 1s) to keep joints nourished
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What 2 considerations are needed for managing autonomic system in GBS pts?
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1) Monitor vital signs
2) Manage orthostasis as needed |
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What 3 cranial nerve areas need to be addressed for GBS pts in acute or step down units?
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1) Swallowing (CN IX, XI, XII) augmented feeding
2) Dysarthria--communication boards (CN XI, XII) 3) Visual changes--difficult with convergence (CN VI) |
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What are 5 respiratory potential problems with GBS pts in the recovery phase?
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1) Changes in inspiratory/expiratory capacity
2) Strength 3) Immobility 4) Coughing 5) Breathing patterns |
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What is an autonomic potential problem with GBS pt in the recovery phase?
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Not building enough tolerance for upright (OH)
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What are 4 sensory potential problems with GBS pts in the recovery phase?
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1) Pain/dyesthesias
2) Positioning 3) Careful ROM 4) Proprioception which may affect balance |
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What are 6 pharmacological treatments that can help with careful ROM in GBS pts?
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1) NSAIDs
2) Tricyclics 3) Anticonvulsants 4) Opiates 5) Capsaisin 6) TENS |
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What are 2 musculoskeletal potential problems with GBS pts in acute care?
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1) ROM (joint mobs, splinting, prolonged positioning)
2) Weakness (progress from PROM to AAROM to AROM to resistance) |
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What is the key point with the intensity of rehab for GBS pts during active recovery period?
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The intensity must not put the pt at risk for overuse injury during active recovery phase (not work to the point of muscle fatigue)
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What will not improve remyelination, axon outgrowth or speed up regneration/reinnervation process?
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Exercise and functional training
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What 4 things do most GBS pts post recovery frequently report (those "functionally recovered")?
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1) Chronic fatigue
2) Pain 3) Weakness 4) ROM and connective tissue limitations |
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What is the cause of chronic fatigue for GBS pts post recovery?
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Cause unknown, but related to decrease quality of life and is independent of muscle strength, sensory deficits, functional capacity and duration of symptoms
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What is one of the most disabling symptoms post GBS recovery?
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Chronic fatigue
80% complain of no second wind |
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What types of pain do post GBS recovery pts complain of? (3)
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Paresthesisa
Muscle pain Joint pain |
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What type of weaknesses do post GBS recovery pts complain of? (2)
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1) Endurance activities
2) Power activities Demands that require large amounts of muscle force and repetitions |
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What are some predictors for respiratory failure in GBS pts?
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1) If the pt no longer is able to lift head from pillow
2) Lost neck flexion or extension strength (C3, C4, C5 close to being hit) 3) Difficulty breathing in supine b/c diaphragm is weak and can't move without gravity assisting |
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What are 2 drugs usually combined used for acute GBS?
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1) Plasmaphoresis (AKA plasma exchange)
2) IVIG infusion |
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What is plasmaphoresis or plasma exchange?
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Removing RBC and WBC while discarding all the plasma only to give back the blood while the body remakes plasma
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What is IVIG infusion?
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IGg injected into the immune system to help regenerate nerves (expensive)
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Why are corticosteroids not used for acute GBS (AIDP) as a tx?
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They can be harmful rather than beneficial and are used for CIDP
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What consists of a nerve conduction velocity study?
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2 needles in 2 different locations on the same nerve stimulated to measure how long until a response occurs
Compare velocity in order to decide if there is a latency |
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How is a conduction block tested?
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Distal and proximal message from e-stim (travel in both ways) looking at F-wave, M-wave and S-wave
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What GBS variant pt tends to not have changes in NCVS?
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Axonal variant GBS
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What GBS variant pt tends to have changes in NCVS?
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Demyelinating variant GBS
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