GB syndrome (Full Version)

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anurag_iph -> GB syndrome (November 29, 2006 6:59:00 AM)

Hi all

I am currently looking after a no. of patients recovering from Guillaine Barre syndrome.Does anyone have some idea of some stndardised guidelines for its rehab?
I havnt had much exposure to this condition and would love to learn from the experiences of the group.

Thanks

Anurag



ehanso -> Re: GB syndrome (November 29, 2006 3:40:00 PM)

Treat them gently. They fatigue very easily, and if you over work them, they may have a bit of a set back. Most of the ones i have seen had tight hamstrings. Aggressive stretching of hamstrings is very painful and of little value. As the disease improves the tightness will decrease. Progress from PROM to AAROM to AROM to strenthening. Light weight increased reps. Coordination activities. If you have a number of these patients, it would make a great case study or presentation.



anurag_iph -> Re: GB syndrome (November 30, 2006 6:50:00 AM)

Hi

Thanks fallsPT for the reply.yeah i do have a no of patients at the moment.Will follow your advice and definitely collect data to make a presentation.I guess i will introduce more frequent yet shorter therapy sessions.

Cheers

Anurag



FLAOrthoPT -> Re: GB syndrome (November 30, 2006 3:12:00 PM)

wow, one of those diseases you read about but never see nor never know anyone to have, but to have a number of them at once? Makes me think the CDC should be out there checking for environmental causes. any idea on the incidence in India? The prevalance?



ehanso -> Re: GB syndrome (November 30, 2006 5:03:00 PM)

We had quite a number of GB pts following the Swine flu vacination fiasco in the 70's. A very bad reaction to the particular vacine that was distributed. The Rehab center that i worked at must have had at least 6-8 pts or more for months of rehab. If there are that many in one facility, there must be a reason. Interesting case for a public health or epidemiology study.



anurag_iph -> Re: GB syndrome (December 1, 2006 6:27:00 AM)

Well,we've got 5-6 at different stages of recoveryand with very varied presentations.Since all were admitted at different times so doesnt seem to be a pattern.And now that i come to think of it,they are from different localities.One of them still in the ICU,dependant on mechanical ventilation since approx 5 months .Both me and the anasthetist are at our wits' ends to try and wean him off.Any ideas? The anasthetist says that the pressure given is insignificant and the patient is psychologically dependant on the ventilator.Any help would be greatly appreciated.We have to get him out of the ICU asap



anurag_iph -> Re: GB syndrome (December 1, 2006 6:30:00 AM)

That vaccination reaction was interesting,never thought about it as a possible cause.Thanks for the info



tucker -> Re: GB syndrome (December 12, 2006 11:47:00 AM)

"The anasthetist says that the pressure given is insignificant and the patient is psychologically dependant on the ventilator."

What mode of vent support is he currently tolerating...assist control, SIMV, CPAP? Can he tolerate trach collar trials?

I have seen a number of these patients with GBS in the ICU and aquiring GBS shortly after the flu vaccination has been something I have heard several times. There is a study in JAMA about it as well. I agree with the previous post...progressive mobilization and avoid overworking.

Darin

Reference:
Guillain-Barre syndrome following influenza vaccination. JAMA. 2004 Nov 24;292(20):2478-81.



anurag_iph -> Re: GB syndrome (December 15, 2006 5:46:00 AM)

Hi Darin

Thanks a lot for the referance.

He is currently on CPAP,and is given hourly 5 min trials,toleration is variable.Sometimes well tolerated,sometimes not.
Now we had an anasthesia consultant who thought that he might be on the vent indefinitely.Talk of encouragement..
Its been over 5 months now.Any idea about the likely prognosis?Muscle power is zero at the moment almost all over

Anurag



nari -> Re: GB syndrome (December 15, 2006 9:19:00 AM)

We had a GB patient for 11 months in ICU. After about four months she had tiny flickers distally.
At 12 months she was independently mobile, but with very patchy recovery. At about 18 months she did fairly well, totally independent with a gait like a duck, but very happy.
Nothing at 5 months sounds ominous to me.

Nari



tucker -> Re: GB syndrome (December 16, 2006 11:03:00 AM)

Me too Nari. Five months and still no trace of motor is strange. I have not seen that before...taking 2 or 3 months to see a trace maybe, but not five.

Anurag...how did this patient present at onset? Did he come in with the typical GBS signs and progress to resp. failure...or was he admitted with resp failure and GBS was later diagnosed? My question is because this sounds like critical illness polyneuropathy or myopathy (CIP/CIM)?

Thanks.

Darin Trees, PT, DPT



tucker -> Re: GB syndrome (December 16, 2006 3:35:00 PM)

Some References:

Green, Deborah; Weakness in the ICU: Guillain-Barre Syndrome, Myasthenia Gravis, and Critical Illness Polyneuropathy/Myopathy. Neurologist, Vol 11(6) November 2005 pp 338-347.

Hsiang-Cheng et al: Acute quadriplegia complicating critical illness polyneuropathy in a patient with infective endocarditis: A case report. Journal of Infection. 2005, Vol. 50,153-157.

Lorin S and Nierman DM: Critical illness neuromuscular abnormalities. Crit Care Clin 2002 Jul 18 (3) 553-568.

Darin



tucker -> Re: GB syndrome (December 16, 2006 4:00:00 PM)

One more question...did the patient undergo IVIg or plasma exchange for the treatment of GBS? Both?

We had a patient with GBS recently that was recovering rather slowly after plasmaphoresis (not as slow as this patient though) and neurology opted for the high-dose immunoglobulin (IVIg) a few weeks later. It seemed to help. I just didn't know they could do multiple treatments of it if the patient was not responding.

Neurology involved? Pulmonary?

Darin



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