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Joseph- Guillain Barre Syndromg (Stage 3: OUTPATIENT CARE (Problem 1: Poor…
Joseph- Guillain Barre Syndromg
Problem 1:UE Muscle Weakness
Stage 1:
ACUTE CARE
ROM SCREEN
Decreased ABduction
105/180 degrees
3-/5 MMT
Decreased Flexion
85/180 Degrees
3/5 MMT
Goniometry for weakened extremities
MMT weakened extremities
Intervention
: Functional reaches such as pulling up covers in hospital bed as well as grabbing water from tray and reaching upwards
Problem 2: Sensation deficits in hands
Cottonball/ monofilament sensation screen
Dorsal/Palmar sensation impairment
Decreased gross motor of fingers, hands, arms
Intervention
: Sensory immersion/Desensitization by leaving client with multiple different sensory fabric sheets to rub on hands every hour
Stage 2:
INPATIENT CARE
Problem 1: ADL/IADL impairment
FIM Assessment
Unable to complete bathing without SOB/rest break and Mod A
Toilet and shower transfer require Mod A
Intervention
: Increase standing endurance by completing 2 sets 10 reps of sit to stands, and engage client in functional activities to increase dynamic standing balance and endurance.
Scored 80/126 on FIM
Cognitive comprehension, expression, social interaction, problem solving and memory WFL
B UB/LB dressing require setup
Intervention
: Educate client on AE in order to increase independence dressing at EOB, and AE for transfers such as grab bars.
Problem 2: Mobility/Balance
BERG Balance
Unable to pick up objects and needs SBA
40% confident in picking slipper up from floor
Intervention
: Educate client on AE such as reacher in order to pick objects up from ground without bending over.
The Activities-specific Balance Confidence (ABC) Scale
55%/100% confident in performing activities without LOB
Intervention
: Therapeutic Exercise/Activity to increase mobility/balance such as sit to stands, attending to functional activities at table while standing,
Reaches forward but needs supervision
Deficits in sit to stand without assistance
Problem 3: Sensation deficits in hands
GRASSP Assessment
Decreased prehension performance
Decreased Pinch/Grip strength
Intervention
: Have client retrieve beads from hard thera-putty in order to increase hand/grip strength. Have client engage in functional activities such as opening bottles/jars/using clothespins.
Palmar/dorsal sensation impaired
Stage 3:
OUTPATIENT CARE
Problem 1: Poor Fine Motor due to UE Muscle Weakness and sensation deficits
MMDT assessment
Decreased dexterity
Decreased rapid hand-eye coordination (gross motor)
Intervention:
Fine motor interventions such as using tweezers to pick up beads and place them in jars/operation game
Problem 2: Mobility/Balance Deficits due to generalized muscle weakness
Tinetti Balance Assessment
Standing balance is unsteady
Hesitancy in gait along with stopping/discontinuity
Intervention
: Increase endurance through therapeutic exercise such as leg pumps
Intervention
: Attending to functional activities such as a card game while standing to improve dynamic standing balance
SOB and fatigue noted during ambulation
Intervention
: Educate client on energy conservation techniques and AE for ambulation
Problem 3: Pain
Numeric Pain Scale
Client is experiencing 5/10 pain
Overall body aches due to immobility
Intervention
: Education on bed positioning to decrease pain during immobility
Intervention
: Educate client on hot/cold modalities for pain management
DISCHARGE
: Prior to discharge, client must be able to demonstrate functional ambulation with AE and no LOB. Client should be able to UB/LB dress with MI utilizing AE. Client should continue home exercises such as leg pumps and sit to stands to increase endurance and strength for balance and ambulation deficits. Client should have learned understanding of pain management.