1
Loss in GBS is from:
Distal to proximal
- Ascending, symmetrical weakness
- Areflexia
- Atrophy
- Ataxia
Motor s/s of GBS
- Acute inflammatory demyelinating polyneuropathy (AIDP)
- Acute motor axonal neuropathy (AMAN)
- Rare: acute motor and sensory axonal neuropathy (AMSAN), Miller Fisher syndrome (MFS), Pure autonomic, pure sensory, Bickerstaff brainstem encephalitis
Subtypes of GBS
- Numbness, paresthesias
- Loss of kinesthesia, vibration, and touch
- Paresthesia of the toes is often the first neurologic symptom
Sensory s/s of GBS
- Variable blood pressure and HR
Autonomic dysfunction s/s in GBS
- Affects PNS (myelin damage of schwann cells and axon destruction)
- LMN disorder
- Often preceded by an infection 1-3 weeks prior
- Most common respiratory infection or GI
- Lymphocyte-mediated autoimmune reaction
- Rare: 1-2 cases per 100,000, (adult) males more affected
- Acute demyelination
Overview of GBS
- Oculomotor
- Bulbar (speech and swallowing - lower CN)
Cranial nerve palsies s/s of GBS
Return of function from GBS is from:
Proximal to distal
GBS disability scale:
Able to walk without assistance for 5 meters
3
- 30% of cases need vent
Respiratory failure in GBS
GBS disability scale:
Able to walk without assistance
2
- Urinary retention
- Constipation
- Urinary sphincter problems
Bowel and bladder issues in GBS
GBS disability scale:
Normal
GBS disability scale:
Requires ventilator support
5
GBS disability scale:
Minimal signs and symptoms
1
- "Good" with high likelihood of recovery
- Requiring mechanical ventilation increases mortality and complications --> poor prognosis
- Fastest recovery: children
- Demyelination process stops (remyelination begins) after a few weeks
- Weeks to years to fully recovery
Prognosis of GBS
GBS disability scale:
Bed or chair bound
4
Phase of prognosis:
Patients condition begins to improve; lasts few weeks to 2 years
Recovery
Phase of prognosis:
Onset of symptoms with rapid progression until no more deterioration occurs, lasting up to 4 weeks
Acute
GBS disability scale:
Death
6
IVIg, plasmapheresis, corticosteroids
Medical treatment of GBS
- Older than 40-50 years of age, rapidly progressive disease, axonal loss and extended mechanical ventilation
- A longer period before recovery begins (longer plateau)
- 5-10% patients die in acute phase (especially old age, cardiac disease, PE, or respiratory infection)
Factors of poor outcome for GBS
- Begin neuromuscular facilitation techniques, endurance and strength training, functional training
- RPE scales to monitor exertion
- cardiac monitoring (BP, HR)
PT treatment - Descending phase
- Prevent complications with immobilization - PROM, DVT prevention, repositioning, prevention of skin breakdown, prevention of orthostatic hypotension, cardiopulmonary monitoring
PT treatment - acute/ascending phase
Phase of prognosis:
Symptoms constant from acute phase and do not change; days to weeks
Plateau