Monday, October 8, 2018

PT Pathologies: Guillain-Barre Syndrome

Guillain-Barre Syndrome (GBS) or acute polyneuropathy is a temporary inflammation and demyelination of the peripheral nerves myelin sheaths, potentially resulting in axonal degeneration.  Motor weakness results in a distal to proximal progression as well as sensory impairment and possible respiratory paralysis.  The cause of Guillain-Barre Syndrome is not exactly known, but, according to the National Institute of Neurological Disorders and Stroke, scientists do know that "the body's immune system begins to attack the body itself, causing what is known as an autoimmune disease."  It is not fully understood why it strikes some people but not others or what it is that sets the disease in motion.

Guillain-Barre Syndrome can occur in individuals at any age, but it tends to have the highest frequency in young adults and adults 50-80 years old.  Also males typically have a higher incidence of GBS than females.  Those affected by GBS initially present with "distal symmetrical motor weakness and will likely experience mild distal sensory impairment and transient paresthesias."  Weakness eventually progresses proximally toward the upper extremities and to the head.  Along with motor weakness, the patient could present with muscle and respiratory paralysis, the absence of deep tendon reflexes, and the inability to speak or swallow.  If there is respiratory involvement GBS can be life threatening.  Laboratory and imaging studies can be done to confirm GBS as well as the use of additional information such as a physical and neurological examination, strength testing, and a review of the patients relevant medical history.

In order to medically manage GBS, hospitalization may be required.  Pharmacological interventions are used to treat the symptoms, as well as PT, OT, and SLP.  Each of these different types of therapies facilitate neurological rehabilitation.  As soon as the patient is admitted to the hospital, physical therapy treatment should be initiated.  The focus of the physical therapy should be PROM, positioning, and some light exercise.  While the patient is in the acute phase of GBS, the PT should ensure they are not overexerting or causing too much fatigue for the patient.  This could cause exacerbations of the patients symptoms. "As the patient progresses, intervention may include orthotic, wheelchair or assistive device prescription, exercise and endurance activities, family teaching, functional mobility and gait training, and progressive respiratory therapy".  A therapeutic swimming pool may also be indicated for the patient.  This allows initiation of movement without the effects of gravity.  Once the patient goes home, he/she should continue therapeutic exercise, functional mobility training, endurance activities, and other breathing activities.  Physical therapy can assist in the recovery of GBS but cannot alter the course of the disease.

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