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Guillain-Barre Syndrome, Case Study Example

Pages: 6

Words: 1521

Case Study
Source (Full Citation): Level of Evidence: Findings: Relationship to Case:
Hughes, R.A., Wijdicks, E.F., Benson, E., Cornblath, D.R., Hahn, A.F., Meythaler,  J.M., Sladky JT, Barohn, R.J. & Stevens, J.C. (2005). Supportive care for patients with Guillain-Barre syndrome. Archives of Neurology, 62(8):1194-8. The level of evidence in this article is a basic literature review taken from MEDLINE (1966 to May 2003); afterwards relevant references were extracted primarily based on observation studies.  While there is a basic level of evidence presented via the literature, the lack of randomized control studies is disconcerting meaning that, in many cases, specific recommendations cannot be issued. The main findings of the paper focus on how to respond to specific issues during the course of Guillian-Bare syndrome (hereafter “GBS”); such as the issuance of heparin and pressure stockings to deal with problems related to deep vein thrombosis.  In addition, the paper mentions, but doesn’t explicitly relate an evidence-based approach to respiratory monitoring, tracheostomy, and pain management. The patient in this case seems to be recovering from the acute phases of GBS. This article addresses many areas relevant to the current clinical treatment of the patient including: 1) Rehabilitation; 2) Fatigue Management; 3) Pain management. Recommendations in those areas include a light exercise regimen and the proper positioning of limbs.  In addition, the patient might also have existing issues related to pain management which could be managed based on the patient’s pain level.  There is not enough specific information in the clinical case to make specific recommendations.
Source (Full Citation): Level of Evidence: Findings: Relationship to Case:
Meythaler, J. (1997).  Rehabilitation of Guillain-Barre Syndrome. Archives of Physical Medicine and Rehabilitation, 78, 872-879. The level of evidence in this article is heavily dependent on the existing medical literature; however, the purpose of the research is slightly different from the article above.  That is, the article essentially breaks down the clinical elements of the disease , ultimately focusing on issues related to rehabilitation towards the end.  While there is some reference to randomized control trials, evidence is also heavily dependent on observational studies arising from treatment related to GBS patients. The article’s main findings focus on describing how rehabilitation serves as the key bridge to recovery once the acute stages of  GBS have receded.  While the author doesn’t conduct a study or provide novel insights, he does provide a compendium for how medical professional should approach the issue of patient rehabilitation. The article deals with two sets of issues relevant to the patient.  First, the author outlines a number of short-term “rehabilitation therapeutics” that can be used to aid recovery: 1) motor recovery; 2) sensory dysfunction and pain; 3) psychosocial issues; 4) respiratory issues.  At the same time, the author also introduces long-term rehabilitative follow-up including the use of outpatient services to help in these areas.  The bifurcation between short- and long-term rehabilitative strategies is quite useful in managing the patient’s recovery and expectations for future activity.
Source (Full Citation): Level of Evidence: Findings: Relationship to Case:
Garssen, M.P., Bussmann, J.B., Schmitz, P.I., Zandbergen, A., Welter T.G., Merkies,  I.S., Stam,  H.J. & van Doorn, P.A. (2004). Physical training and fatigue, fitness, and quality of life in Guillain-Barre syndrome and CIDP.  Neurology, 28(63), 2393-5. The article details a 12-week, prospective observational study carried out with three different populations: 1) severe fatigue (n=20); 2) moderately recovered patients (n=16); 3) normal CIP patients (n=4).  Although the study was a prospective observational study, it lacked l the rigor of a randomized control study. The findings appeared to be statistically significant and robust to patients recovering from GSB. Overall, there was a 20% reduction in measured fatigue (p<.001) in study participants; the training was well received by almost all previously affected by GSB.  Physical fitness, functional outcome, and overall quality of life were improved (both mental and physical).

 

 

 

 

 

 

 

 

 

 

 

This article is quite relevant in addressing the next phase of the patient’s treatment. That is, the article details how light exercise can play a key role in helping to relieve fatigue, one of the patient’s current symptoms.  In addition, the introduction of a light exercise program is likely  to accelerate the accomplishment of many of the patient’s future goals including increasing quality of life.
Source (Full Citation): Level of Evidence: Findings: Relationship to Case:
Bersano, A., Carpo,  M., Allaria, S., Franciotta, D., Citterio, A. & Nobile-Orazio, E. (2006). Long-term disability and social status change after Guillain-Baire syndrome. Journal of Neurology, 253(2), 214-8. The article details a case-control study performed in an Italian province over a 3-5 year time frame.  The same individuals (previously those with GBS) served as both the case and controls in the study.  As an observational study, there are obviously concerns over potential bias impacting results; however, there seems to be highly useful information based on robust evidence in this study. The main findings of the study were although many individuals have a “good” prognosis after recovering from the acute phases of  GBS, the residual symptoms after the acute stage can last longer than most expect and can impact both a patient’s physical disability and social life. As in the case of the previous article, this article provides an interesting perspective on what elements in a patient’s rehabilitative process  should be focused on. Although this patient has a long way to go to achieve functional mobility (just recovering from the acute symptoms), a lot of the residual symptoms will linger for many years and can be dealt with now proactively in helping her to assess her recovery goals.  Indeed, although 90% of individuals with GSB recover from the acute stage, 27% needed to make changes in his/her daily life, with 19% reducing their activity level due to residual symptoms.
Source (Full Citation): Level of Evidence: Findings: Relationship to Case:
Bernsen, R,A.,  de Jager, A.E., Schmitz,  P.I. & van der Meché,  F.G. (2002). Long-term impact on work and private life after Guillain-Barre syndrome.  Journal of the Neurological Sciences, 201(1-2),13-17. The article details a case-control study conducted in  the Netherlands on 122 individuals who previously participated in the Dutch Guillain-Barre study.   The same individuals (previously those with GBS) served as both the case and controls in the study.  As an observational study, there are obviously concerns over potential bias impacting results; however, there seems to be highly useful information based on robust and statistically significant evidence in this study. The paper’s main findings were that GSB has a serious long-term impact on patients’s work and private life of their partners.  This study expands on results from previous sources in the case study focusing on how individuals recovering from GSB perform in the work arena and vis-à-vis their partners.  Nearly 38% of those surveyed needed to change their jobs and 44% had altered interactions with their partner.

 

 

This article allows one to put the patient’s long-term goals in a more realistic context moving forward.  In particular, one can see that the ability of this woman to take care of her husband with COPD and grandchildren will likely be altered, perhaps dramatically, over the long-term. While the recommendations concerning work may not be all that relevant- the article gives further credence to the need to manage the patient’s long-term expectations and rehabilitation goals.
Source (Full Citation): Level of Evidence: Findings: Relationship to Case:
Clark, G.F., Avery-Smith, W., Wold, L,S., Anthony, P. & Holm, S.E. (2007). Specialized knowledge and skills in feeding, eating, and swallowing for occupational therapy practice. American  Journal of Occupational Therapy, 61(6), 686-699. The article details standards for occupational therapists and occupational along a number of important issues including: feeding, eating, swallowing, supervision, etc.  The guidelines are based on established practices distilled from medical literature. The main findings of the articles are to establish new guidelines for the proper roles and methods for occupational therapists and occupational therapist assistants. This article, while not directly addressing the patient’s case, does apply to the care she will receive in rehabilitation as best practice in a number of areas including feeding, eating, swallowing, supervision, and knowledge skills.
Source (Full Citation): Level of Evidence: Findings: Relationship to Case:
Holberg, C. &  Finlayson, M. (2007). Factors influencing the use of energy conservation strategies by persons with multiple sclerosis.   American Journal of Occupational Therapy. 61(1), 96-107. The level of evidence in this article is perhaps the least robust of all. The study is qualitative in nature, based on interaction with only eight patients with MS- some use of scales and interviews are used to assess patients’ outcomes. The article’s main finding was energy conservation is not simply a variable determined by physical inputs, but has a complex interaction of several factors including the management of scheduling of activities ahead of time. This article addresses the patient’s present and future concern of energy conservation via analogy with a similar central nervous disease: MS.  Overall, the lessons learned from this qualitative study would be applicable to the patient of our study.  In particular, the lessons of developing a strategy early to deal with issues of energy as well as planning should be introduced to the patient- particularly with her ambitious long-term goals vis-à-vis her future lifestyle.
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