A patient diagnosed with Guillain-Barre Syndrome 3 days ago has been admitted to an inpatient rehab facility. The patient is ventilated and has muscle weakness at Poor Minus in the upper arms and paralysis of the lower extremities. What would be the focus of treatment at this time?
In the acute stage, the focus is positioning to prevent muscle shortening and decubiti and basic functional activities as the person is able to as regaining function (such as communicating needs) is expected for 70% of cases for persons with Guillain-Barre Syndrome. During the acute phase of GBS, the patient may not tolerate, or may not be able to participate in active movements. Although their condition may be worsening at this point, and care may be more medical than rehabilitative, occupational therapy still plays an important role. Initially, your treatment plan will likely be more consultative in nature, with patient participation being mostly passive. The role of the occupational therapist typically includes providing patient and caregiver education and training for the prevention of contractures, DVTs and bedsores. Proper positioning, avoiding prolonged hip and knee flexion; frequently changing their position in bed; supporting weak upper extremities with pillows to prevent stretching of the shoulder muscles and ligaments/tendons, and gentle passive range-of-motion to reduce the risk of contractures and DVTs, are included in your treatment plan. Educating yourself about the patient’s home life, work demands, recreational interests and support system is important at this stage so that you can adapt your treatment plan to meet their needs. Anticipating the need for assistive devices and other adaptive equipment/technology is recommended, as well as training the patient and caregivers in their use. https://www.gbs-cidp.org/wp-content/uploads/2012/01/PTOTGuidelines.pdf (pg 13) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5462706/
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