A 78-year-old male was admitted to a rehabilitation facility with the diagnosis of Guillain-Barré syndrome. He initially developed numbness and tingling in bilateral feet and lower legs that progressed to his hands and arms over a 3-day period. Upon visiting his primary care physician, he was transferred directly to the hospital for further monitoring. He underwent a spinal tap and nerve conduction velocity test, ultimately leading to a diagnosis of Guillain-Barré syndrome. While in the hospital for 3 weeks, he developed complete bilateral lower extremity paralysis with decreased sensation. He developed some upper extremity weakness, but maintained at least a grade of 3/5 for all upper extremity muscles. His pulmonary and respiratory function remained adequate and he did not require mechanical ventilation. After the third week, his signs and symptoms began to plateau and he started to regain minimal motor function. The patient was then transferred to an inpatient rehabilitation facility (IRF). At admission to the IRF, the physical therapist is asked to evaluate and treat the patient to improve functional mobility and independence to enable a discharge home with his wife to a one-story home with level-entry access.
What are possible complications interfering with physical therapy?
What precautions should be taken during the physical therapy examination and interventions?
What are the most appropriate physical therapy interventions?
What are the most appropriate physical therapy goals?
- GUILLAIN-BARRE SYNDROME (GBS): Disorder in which the body's immune system attacks the peripheral nervous system, resulting in progressive weakness of the limbs, trunk, and possibly respiratory muscles
- NERVE CONDUCTION VELOCITY: Diagnostic test to measure how nerves and muscles respond to electrical stimuli; aids in diagnosis of GBS
- SPINAL TAP: Procedure in which a small amount of cerebrospinal fluid is removed from the spinal canal for examination; high levels of protein aid in diagnosis of GBS
Describe the pathophysiology of GBS.
List lab values that should be checked frequently during the patient's disease course.
Describe overwork weakness and its negative impact on recovery.
Discuss an appropriate progression of treatment strategies to improve function and independence in the patient with GBS.
PT considerations for management of the patient recovering from an episode of GBS:
- General physical therapy goals: Improve bilateral lower extremity strength and functional activity tolerance; improve ankle and hip strategies for balance reactions; normalize gait pattern; improve functional mobility and independence
- Physical therapy interventions: Patient education regarding energy conservation techniques and GBS-related fatigue; muscle strengthening, balance activities, gait training, functional training
- Precautions during physical therapy: GBS-related fatigue; physical supervision to decrease fall risk; frequent skin assessments to decrease risk of skin breakdown (due to sensory impairments); frequent monitoring of lab values to decrease risk of overwork weakness resulting from denervated muscles
- Complications interfering with physical therapy: Deep vein thrombosis (due to immobility), compromised ...