Guillain-Barre Syndrome is also known as
-AIDP: acute inflammatory demyelinating polyradiculoneuropathy
-Landry's syndrome
What is Guillain-Barre Syndrome
Auto-immune.
Characterized by lesions of the peripheral nervous system:
-myelin is stripped from nerve
-most cases also include axonal degeneration
->slower or absent action potential in axon
Pathology
Ages:
young adulthood and > 50 years of age
Incidence: 1 - 2 person per 100,000 in US
Cause: unknown, speculated to be viral in nature in most cases
(most clients experienced illness w/in 2 months of onset).
Symptoms
First symptom often toe parasthesias that progress up the LE w/in hours/days. Paralysis
quickly progresses from distal extremities and ascends symmetrically, resulting in:
Flaccid paralysis, symmetrical, proximal to distal
Absent deep tendon reflexes
Pain
Mild sensory loss 'glove & stocking'
Possible facial palsy
Possible ANS disruption - tachycardia, BP changes, vasomotor symptoms, respiratory
muscle paralysis
30% of cases require mechanical ventilation
Compromised verbal ability and swallowing
Ocular muscles may be preserved
Prognosis
50 - 75% fully recover, primarily w/in one-two years.
20 - 45% experience residual neurological deficits which can include weakness, fatigue,
and mild cog. impairment.
Fatal in 5%+ of cases.
Stages
Acute = 2-4 weeks: rapid onset of symptoms as above
Plateau = a few days-weeks: symptoms remain constant
Recovery = months to years: remyelination & axonal
regeneration occurs, proximal to distal
Dx
Office exam: history, neurological assessment
Nerve conduction studies
Lumbar puncture - assess CSF for elevated albumin
Treatment
No cure
Plasmapheresis - plasma is filtered to remove/dilute excess anti-bodies (plasma
removed from blood - pt receives own blood back without plasma)
High dose IV immunoglobulin (injections of high doses of proteins to aid the body in
fighting off invading ogranisms)
Steroids
Symptom management and Time
Rehabilitation for Acute & Plateau Phases
Education to pt and family addressing psychosocial needs, expectations of disease
Prevent loss of ROM and joint contracture
Daily ROM programs self/staff/family
Positioning programs (bed/chair/orthoses) -> neutral positions to prevent soft tissue &
contracture
Environmental controls (nurse call bell)
Passive activities - audio books, fav music, access different technology
Rehabilitation for Recovery Phase
1. RESPECT PAIN
2. PREVENT FATIGUE
Gentle stretching
Progressing PROM to AROM/AAROM
Gradually increase challenge to ROM & resistance tasks
Joint protection techniques
Pain management
Compensatory strategies- emergency conservation, work simplification techniques
Assistive equipment
Assistive Equipment
Environmental Controls
Supportive orthoses
Lightweight, enlarged handled tools
Mobile Arm Support
Increasing recognition for managing long term
CIDP - Chronic Inflammatory Demyelinating Polyneuropathy
Despite much recovery, residual symptoms remain for some needs OT can address:
Community reintegration
Psychosocial management
Education: client, family, friends, and health care team
Down-grading of tasks to enhance function despite residual weakness and fatigue
Maintaining function over the long run recently covered under new Medicare guidelines
- expanding role for OT
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