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NPT Gullian Barre and Acute Transverse Myelitis
Terms in this set (26)
What is Guillian Barre Syndrome?
- an acute autoimmune disorder that attacks the peripheral nervous system
What pathology is associated with GB?
- respiratory or GI viral infection
- other infections
What is the pathology of GB?
- macrophages and lymphocytes migrate to the node of Ranvier
- they attack the Schwann cells, and myelin disappears
- there is a loss of nerve impulse before the signal gets to the muscle fibers
What structures are affected in GB?
- peripheral nerves and nerve roots
What are the onset of symptoms like in GB?
- occur a few days to weeks following respiratory or GI viral infections, of influenza immunization
What are the symptoms like in GB?
- tingling sensation in the legs
- rapidly evolving relatively symmetrical ascending weakness or flaccid paralysis
What are the phases of GB?
1. Progression phase- constant deterioration of function, 1-4 weeks
2. Plateau phase- no changes or improvement, duration unknown
3. Recovery phase- nerves begin to remyelinate, lasts average of 4 years
What do you need to consider to diagnose GB?
- subjective history (ask about history of illness)
- clinical presentation (pain and weakness)
- nerve conduction velocity
- spinal tap (detects proteins in the spinal cord)
What is the prognosis like for GB?
- the sooner it is detected, the better prognosis
- by 4 weeks, most show improvement
- by 6 months, 80% are walking
What is the most common deficit of GB?
- foot drop
What is the medical intervention for GB?
- ICU/Acute care- especially for possible respiratory failure
- Plasmaphoresis- remove blood, separate it, and put it back in without plasma
- Immunoglobulin therapy- injects proteins which help immune system to attack foreign objects instead of itself
How should you treat someone with GB in the clinic?
- same as any other neuro eval
- history, motor function, sensory, autonomic, family training
- motor testing- should be specific to monitor progression, test a few muscles weekly
What kind of PT treatment should you do during the Progressive phase of GB?
- prevent secondary impairments
What kind of PT treatment should you do during the Plateau phase of GB?
- positioning and PROM continued
- light AROM
What kind of PT treatment should you do during the Recovery phase of GB?
- gentle progressive program
- low resistance, low repetition (10), high sets (5-6) spread throughout the day
- functional activities as tolerated
- frequent rest periods
- AVOID muscle fatigue
What is fatigue related relapse?
- a prolonged weakness in strength and endurance of a muscle due to excessive activity
What is the pathologic process of fatigue related relapse? What does the pt feel like?
- motor units are overworked, leads to elevated creatine kinase levels
- muscle soreness, weakness, and abnormal sensation for 1-5 days
- pt may state they feel weaker and less stable than previous days
What should the pt do if fatigue related relapse occurs?
STOP THERAPY until medically cleared to start again
How can we prevent fatigue related relapse?
- monitor CK levels
- constantly evaluate for weakness
- use caution with eccentric strengthening
- strengthen in antigravity until pt can tolerate gravity positions without overwork
What is acute transverse myelitis?
- inflammation of one segment of the spinal cord across both sides
What is the pathology of acute transverse myelitis?
- autoimmune response following exposure to a virus or bacteria
-leads to inflammation that can damage
What are the 4 classic signs/symptoms of acute transverse myelitis?
- UE/LE weakness (varying degrees, coordination is off, etc)
- pain- localized in LB, sharp shooting sensation, may radiate
- sensory alterations- numbness, tingling, or burning sensation, hypersensitivity to light touch
- bowel and bladder dysfunction, increase frequency and the urge to go
How is Acute Transverse Myelitis diagnosed?
- MRI/CT- look for obstructions/blockages
- blood tests- for lupus, HIV, vitamin deficiency
What is the prognosis for Acute Transverse Myelitis?
- recovery typical in 2-12 weeks
- rapid onset= poor prognosis
- 3-6 months no improvement, recovery is unlikely
- by 2 years, recovery is typically maximized
How is Acute Transverse Myelitis managed medically?
- Muscle relaxants
What should we do for the therapeutic management of Acute Transverse Myelitis?
- strength, endurance, and coordination
- spasticity management
- assistive devices/bracing
- prevention of secondary impairments
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