Neuro Week 2: GBS

GBS affects the _____ nervous system

peripheral

GBS is an autoimmune, neurological disorder that is usually triggered by

a recent infection (food poisoning, herpes)

3 most common presenting sx of GBS

numbness/paresthesia, weakness (distal to proximal), pain

What are the three phases of GBS?

acute, plateau, recovery

Timeframe for GBS: Acute

2-4 weeks

Timeframe for GBS: plateau

3 days- months, within 2-4 weeks of sx onset

Timeframe for GBS: recovery

typically within 4 weeks of sx onset, could last several years

Which form of GBS is most common?

acute inflammatory demyelinating polyradiculopathy (AIDP)

GBS is more frequent in males or females?

males

What is the typical age range for developing GBS?

30-50 years old

What are the 2 required features that support a diagnosis of GBS?

progressive weakness that is symmetric and progressive, in an ascending pattern, reflexes are areflexic or hyporeflexic

What are some other supportive features that lead to a hypothesis of GBS?

progressive sx of < 4 weeks, sensory findings, cranial nerve involvement, impaired autonomic function, recovery signs/sx, increased CSF protein, demyelination on EMG

True or false: GBS is a diagnosis of exclusion

true

What two pharmacologic interventions are used most frequently to treat GBS?

intravenous immunoglobulin, phalsmapheresis

TRUE or FALSE: Most patients demonstrate extensive recovery within 3 months after disease onset. 

false: usually within the first year

True or false: most patients do not regain the ability to walk independently within 6 months

false: 80% of patients do regain this ability

Which two factors most commonly lead to death in GBS?

cardiovascular and respiratory compromise

What factors lead to a poor prognosis in GBS?

severe limb weakness, > 60 years old, autonomic dysfunction, preceding diarrhea, rapid disease progression of < 7 days, need for mechanical ventilation

What is the name of the primary outcome measure used to predict functional outcome of GBS patients? 

modified erasmus GBS outcome score

What are the 3 factors considered in the scoring of the modified erasmus GBS outcome score?

age, diarrhea at onset of sx, sum of muscle strength bilaterally

A (HIGHER vs LOWER) score on the tool indicates a more positive prognosis for the ability to recover independent walking.  

lower

TRUE or FALSE: Long-term residual complaints including neuropathic pain, weakness, and fatigue are common in GBS. 

true

2 signs of autonomic dysfunction in GBS

arrhythmias, BP hypotension

Which arrhythmia is most common with GBS?

sinus tachycardia (>100bpm w/ normal sinus rhythm)

What value of PaO2 (partial pressure of oxygen dissolved in blood) is a red flag for impaired respiratory function?  

<70mmHg (normal is 75-100) 

Explain the 20 / 30 / 40 Rule for risk of respiratory failure: 

• 20 = vital capacity (should be 60-70) 

• 30 =  maximum inspiratory pressure < 30cmH2o 

• 40 =  maximum expiratory pressure < 40cmH2O

Which test/tool is commonly used to assess RISK of developing pressure sores?  

braden scale

Which tests / measures should be utilized to track changes over time in order to track progression of disease? 

• Joint ROM and muscle flexibility 

• Muscle strength (MMT, dynamometry, pinch gauge) 

• Muscle endurance (5xSTS, 30 sec STS, 2min step test) 

TRUE or FALSE: Cognition can be impacted in persons with GBS, particularly during the acute phase and for those that require extended stay in ICU. 

true

Which outcome measure is the MOST appropriate tool to utilize to assess for neurocognitive impairment in persons that required ICU stay?  

MoCA

Which 3 cranial nerves are MOST commonly affected in severe cases of GBS? 

• Facial nerve 

• Glossopharyngeal nerve 

• Vagus nerve 

What are the expected findings for reflexes, tone, muscle observation, and sensation for GBS?

hypo/areflexia, hypotonia, fasciculations, sensory loss/paresthesia/anesthesia/hyperesthesia

TRUE or FALSE: Fatigue is not a major concern or symptom for people with GBS. 

false

What berg balance score correlates with the ability for a person with GBS to walk without an assistive device? 

>49/56

GBS disability scale

• 0 =  healthy 

• 1 = minor sx of neuropathy 

• 2 =  able to walk without assistance but incapable of manual work or running 

• 3 =  able to walk with stick, appliance, or support 5m across open space 

• 4 = confined to bed or chair  

• 5 =  requiring assisted ventilation 

• 6 = death 

TRUE or FALSE: There is strong evidence for use of transcutaneous electrical stimulation (TENS) to manage pain in persons with GBS. 

false: Poor but positive results in those with neuropathy 

TRUE or FALSE: denervated muscles are more vulnerable to injury than innervated muscles.  

true

What is the most appropriate action to take if a person reports any of these symptoms (fatigue, muscle ache, increased weakness, paresthesia) for a period beyond the 48-hour window? 

Eliminate activity for several days, then reinitiate at lower level of resistance and reps 

True or false: you should initiate high intensity exercise during the early stages of GBS

false: avoid high intensity exercise during early stages as it can make GBS worse

Acute Phase exercise recommendations

• ROM —> How many times per day should ROM be completed?: 2x 

  Strength training 

• Frequency: <3 days per week 

• Intensity: non fatiguing 

• Type: AAROM and functional task training 

Subacute phase exercise recommendations

Strength Training 

• Frequency: 2-3x per week per each muscle group 

• Intensity:  >1 set of 10-15 reps at 60-70% 1 RM 

• Type:  functional task practice, low resistance theraband, light free weights, aquatic therapy 

  Aerobic

• Frequency: 3-5x per week 

• Intensity: 40-60% HR max or low-mod intensity RPE 12-13/20,  

• TIME:20-30 min per session 

• Type: walking, stationary bike, arm ergometer 

Chronic phase exercise recommendations

Strength Training 

• Frequency: 2-3x per week 

• Intensity: 60-80% 1RM 

• Type: free weights, machines, theraband 

 

Aerobic Training 

• Frequency:4-5x per week 

• Intensity: 60-80% HR max, mod-high RPE 

• TIME: at least 30 min 

• Type: treadmill, or other