Definition: Immune system attacks part of the PNS – myelin sheath and axons of peripheral nerves. Results are extreme muscle weakness, mild distal sensory loss, and tetraplegic-like paralysis. Differs from Multiple Sclerosis which affects the Central Nervous System.
Progression: 1st S/S are tingling sensations in the legs with different degrees of weakness – weakness and sensations spread to the arms and upper body and can increase in intensity. If diaphragmatic breathing affected, put on a ventilator. Good recovery even in the most severe cases.
Rate of recovery is very slow and variable
May take up to 2 years for full recovery for most, some residual weakness
**Note: This syndrome is extremely emotionally distressful ** Provide positive encouragement and instruct on disease course to ↓ fear and anxiety
Etiology: youngest age of onset 20-24 y.o., commonly between 30-50 y.o.
Signs & Symptoms: Acute, rapidly non-progressive polyneuropathy with symmetrical muscle weakness (vs ALS asymmetrical) and mild, distal sensory loss and paresthesias
Hallmark sign: muscle belly tenderness
Other: Weakness more apparent than sensory – begins in feet and ascends symmetrically, pain in LE, fatigue, edema (elevate feet), absent DTR, stocking-glove pattern (mild sensory loss pattern), possible facial palsy, some autonomic – check vitals for hypotension, diaphoresis, urinary retention
Onset & Acute Inflammatory Phase – Symptoms are worse 2-3 weeks: no OT until patient is stable.
Plateau – Symptoms are stabilized, 2-4 weeks **Diabling**
Anxiety mgt focus on comfort and positioning, comm w/call button
Positioning trunk, head, and UE: stability
Adjust in supine and sitting positions to optimize fxn and comfort
PROM when at or below FAIR
Recovery Phase – Starts 6-12 mos
Head and neck, then recovers distally – i.e. use MAS for FM tasks
Resume occupations and roles
Gradually increase the number and complexity of tasks
*OT Implications: Functional levels may change; determine their current functional level and work from there, i.e. have them sit for grooming, then move to dressing and bathing as strength and endurance↑
OT Interventions in line with the 3 phases above including…E Conservation, Work Simplification, fine motor Q: Should we provide AD/AE during early stages?__
Watch for signs of fatigue and discontinue activity to prevent overexertion
Watch for signs of substitution – use suspension slings or MAS to allow hand activities to continue without fatigue to shoulder and upper arms
Definition: A disorder of neuromuscular transmission. It’s characterized by abnormal fatigue of voluntary muscle, mostly targeting the areas innervated by cranial nerves, such as that for the eyelids, eyes, and oropharyngeal muscles.
Onset: occurs at any age, more in women than men
Progression: Prognosis varies, but it’s usually a progressive, disabling process
Proximal > distal, sometimes asymmetric distribution
Intensity of the disease fluctuates, and its course is unpredictable
Death usually occurs due to respiratory failure
Signs & Symptoms
Muscle progressively weak during activity, improves with rest
Impaired facial muscles – dysphagia, dysarthria
Proximal limb weakness
Hallmark signs: Fatigue, ptosis
DTR intact (vs Parkinson’s which is not)
OT Intervention – FOCUS…**
Primary goal: regain muscle power and endurance
Lifestyle Mod: light weight dishes, place objects within easy reach, graded activities gentle/non-resist, E Conserv/Work Simplication/Pacing, Sit vs stand
Self-assess & monitor fatigue and drooling – mirror to check
Best after a period of rest and worst after activity; compensate
Self-feeding: small bites, food/liquid consistency
Educate on disease process
If UE are too weak: overhead slings, electronic aids, MAS, stress management
Respect the pt’s activity tolerance levels
Educate on Borg Level – have them use a scale to rate their perceived exertion (6-20 scale: 6=no exertion, 20=max””), i.e. How do you feel sitting in a chair relaxed? 8 = requires little effort, 13 = somewhat hard
Watch changes in respiration and watch for emotional distress
**TIPS ON WORK SIMPLIFICATION AND ENERGY CONSERVATION: Rest breaks throughout the day, plan, delegate or omit part of an activity, change body position when performing certain activities and identify ergonomically poor work heights.
The Benefits of Group Occupational Therapy for Patients with Parkinson’s Disease. American Journal of Occupational Therapy, June 1987, Vol. 41, 360-365. doi:10.5014/ajot.41.6.360
Cooper, C. (2007) Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity. St. Louis, MO: Mosby/Elsevier.
Physical Dysfunction Practice Skills for the Occupational Therapy Assistant, 3rd Edition – Mary Beth Early
Quick Reference to Occupational Therapy, 2nd Edition – Kathlyn L. Reed