Guillain-Barre Syndrome, Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), Miller Fisher Syndrome – Occupational Therapy Intervention

Background

  • Guillain-Barre Syndrome (GBS/AIDP), Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), and Miller Fisher Syndrome are a group of inflammatory diseases that causes demyelination of axons in peripheral nerves.
  • Cause is uncertain, possible causes include: genetic, vaccination (infrequently), viral infection, enteritis, respiratory tract infection, HIV/AIDS may precede GBS.
  • 2/3 of people develop GBS days or weeks after diarrhea or a respiratory illness.
  • Bacterial infection is the most common risk factor, but also after having the flu or other infections.

GBS

  • Also called acute inflammatory demyelinating polyneuropathy (AIDP).
  • 3000-6000 people in the US are diagnosed with GBS (CDC, 2012).
  • Disability occurs over the course of a few days to 4 weeks.
  • Starts distally and ascends.
  • 50% develop abnormal sensations (tingling in feet/fingers).
  • 25% develop muscle weakness.
    • Flaccid paralysis of nearly all skeletal muscles
    • Speech/swallow
    • Breathing – possible intubation or ventilator use
  • Pain is a common symptom (deep aching, cramping in buttocks/thighs/between shoulders).
  • Minor cognitive impairment (executive, short-term memory, decision making)

GBS Stages

  • Onset & acute inflammation: weakness occurs in at least 2 extremities
  • Plateau: most debilitating, with little change over days to weeks.
  • Recovery: remyelination and axonal regeneration.

GBS Recovery

  • Most reach full or nearly full recovery.
  • Many will walk without aid after 3 months.
  • Recovery can be slow – 6 months to 2 years+.
  • 5-20% are left with significant residual symptoms on long-term disability.
  • Recovery typically begins at the head & neck.

Miller Fisher Syndrome

  • An uncommon variant of GBS
  • Clinical features often accompany GBS
  • Triad:
    • Areflexia
    • External ophthalmoplegia (weak eye muscles that cause diplopia)
    • Ataxia (ataxic gait)

CIDP (Chronic Inflammatory Demyelinating Polyneuropathy)

  • Chronic counterpart to GBS.
  • Rare compared to GBS.
  • Can persist for years.
  • Disability develops slowly compared to GBS (over the course of 2 months+)
  • Recurrent relapses & remissions of ascending weakness (over the course of years) or slow progressive deteriorating course without improvement.
  • If left untreated, CIDP can lead to irreversible and severe nerve damage.
  • Characterized by symmetrical weakness and sensory changes.
  • Unlike GBS, breathing, swallowing, speech is rarely affected.

Occupational Therapy

Therapists should be encouraging and hopeful regarding the patient’s recovery, but not make promises about the degree of recovery or time frame.

Address:

  • Occupational profile
  • Safety (falls & injury)
  • Psychosocial (fear, anxiety, depression, stress)
  • Communication (A/E & environmental modifications if needed)
  • Pain (TENS, heat, sensory desensitization)
  • Autonomic Nervous System
    • Postural hypotension
    • Arrhythmias
  • Positioning & comfort (all stages)
  • Splinting (wrist, fingers, ankle)
  • Edema
  • Sensation (legs, hands, cranial nerves – face)
  • Skin
  • ROM & MMT – Strengthening
    • Progressed from PROM to AAROM to AROM
    • Progress from low repetitions & resistance with frequent rest breaks
    • Consider gravity eliminated, low friction
    • Consider PNF techniques
  • Function (ADLs)
    • Bladder dysfunction (urinary retention)
  • Mobility
  • Respiration
  • Endurance / Fatigue / Energy conservation
  • Discharge: home environment, return to function, prior occupations
  • Prevention: Pressure sores, DVT

Sources:

https://www.ncbi.nlm.nih.gov/pubmed/18848313

https://www.gbs-cidp.org/wp-content/uploads/2012/01/PTOTGuidelines.pdf

Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, sociology, and philosophy. Become a Patreon Supporter or Buy me a Coffee on Venmo.