Andrew's Story: Guillain-Barré Syndrome

I watched a YouTube video titled, “Andrew’s Story: Guillain-Barré Syndrome.” The video describes Andrew’s story of Guillain-Barré Syndrome (GBS), along with mentioning Andrew’s symptoms, prognosis, and diagnostic process. To further my learning on GBS, I researched other cases and experiences. Also, I compared Andrew’s story with other evidence online to gain a better understanding of the diagnosis.

To begin, Andrew enjoyed playing his guitar, working out, outdoor activities, and spending time with his girlfriend. He went to EMT school and became a firefighter. Shortly after this, he experienced symptoms of severe weakness and numbness in his feet, which led to no longer being able to walk normally. To confirm the GBS diagnosis, he had a spinal tap at Saint Thomas Rutherford Hospital. Within four days, he could no longer walk. Then, he began treatments of intravenous immunoglobulin (IVIG) and plasmapheresis, which are special blood treatments. Soon after this, he was placed in ICU and experienced symptoms of pain, blurred vision, facial paralysis, numbness in the arms, and continued weakness in breathing and swallowing. Next, he had a femoral catheter placed and was sent to the ER. Then, he lost his ability to swallow and had a nasogastric intubation (NG) tube inserted. Next, he realized that it became difficult for him to digest his new liquid diet. The drugs given to stimulate his digestive system caused major abdominal pain, and he had to constantly use a suction cup to breathe.

It was difficult and exhausting for Andrew to sleep. One night, he began aspirating and suffocating. He was placed on a Bilevel Positive Airway Pressure (BiPAP) machine and put back in ICU. Soon after, he decided to be intubated and to be on life support. During intubation, he went into cardiac arrest after being given succinylcholine; this medication is contraindicated for GBS patients. He was in cardiac arrest for seven minutes, and he was shocked three times before returning to a life supporting heart rhythm. At this point, he was paralyzed from the neck down and experienced migraines, blurred vision, and a burning sensation in his bones. For communication, he used a communication board, since he was unable to speak at the time. After being intubated for 10 days, he decided to have a tracheostomy and peg tube placed. He declared that the trach tube malfunctioned sometimes and was very uncomfortable. Next, he used a Passy-Muir valve (PMV) and received speech therapy, which allowed him to smile again. At this time, he experienced painful wound care. He needed help repositioning and constant mouth and bathroom care. 

After being weaned off of the ventilator, he began breathing on his own, and his arm movement began to come back. About 10 days after his first signs of recovery, he was throwing a football from his hospital bed. Soon after that, he was feeding himself with little assistance, playing the guitar again, and was reunited with his girlfriend. Next, he went to Shepard Center; one of the top ten best rehabilitation hospitals in the nation ranked by U.S. News & World Report. Here, he worked with parallel bars, tilt tables, and participated in five hours a day of intense therapy; Andrew began to gain his independence back. After he was fully recovered, he did outpatient therapy for two months and resumed his job as a firefighter. 

Throughout this video, I noticed that Andrew had a great support system: his family, friends, girlfriend, and healthcare staff. Whether it is a family, a friend, or a healthcare provider, I think that it is important to have support during a situation like this. I chose this video as part of my assignment because I think that Andrew’s story was a great example of never losing hope when faced with a difficult situation. Also, I was interested in learning more about GBS, and I thought that Andrew’s story was an informative and inspiring chance to learn more about it. 

As a future occupational therapist, I think that it is important to remember that one has the opportunity to positively change many lives, and to always go the extra mile to help someone reach independence. After viewing this video, I learned about the value and importance of one’s independence in everyday life. Andrew said, “It felt like I was trapped in my own body.” This statement really stood out to me. Occupational therapists have the ability to help others regain lost abilities and reach their goals. Thus, this assignment and video helped me gain imperative insight on the lasting, positive impacts therapy can have on an individual. In addition to the positivity of therapy for GBS, I gained knowledge on the different types of interventions and treatments used during Andrew’s therapy sessions. Overall, I highly recommend this video to anyone that would like to learn more about GBS and Andrew’s story.

Franek, A. J. (2017, August 1). Andrew’s Story: Guillain-Barré Syndrome. YouTube. https://www.youtube.com/watch?v=VWvrHhs2jps

Locomotion and Adaptive Devices

In order to appropriately fit a patient for the use of an assistive device, it is important to look at the whole person, while keeping safety as the primary concern. Proper measurements for the assistive device are important to ensure safety and stability. From a physical standpoint, consider the patient’s weight bearing status, and if they have any limitations on fully putting weight on both upper and lower extremities. Also, consider if the patient has any weight bearing restrictions that can occur after a surgery or a fracture. Additionally, think about the client’s endurance, speed of fatigue, and the number of breaks needed. Next, age is an important factor when fitting client’s because different recommendations will be given for a younger client compared to an older client. From a psychological standpoint, it is important to consider the client’s degree of confidence, fear, or apprehension. If a client is nervous about using a device, they are more likely to get injured. Also, look at the client’s cognitive status, and if they understand the safety features of the device.

For fitting a cane, the hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter of the femur. The elbow will be relaxed and slightly flexed to 20-30 degrees. The shoulders should be relaxed and not elevated. The cane is the least stable assistive device because it only has one point of contact with the ground. Thus, in order to use the cane, the client must have good stability. I would inform the client that the cane will be used on the opposite side of their weak leg. When walking, the cane will move in sync with their weak leg. There are different types of canes to consider for clients. For example, the standard cane allows the most freedom of movement, and the quad cane provides additional stability with four points of contact.

For fitting axillary crutches, the hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter of the femur. The elbow should be relaxed and flexed to 20-30 degrees. The axillary rest should be about 4 fingers width or 5 centimeters below the floor of the axilla. The shoulders should be relaxed, not elevated, to prevent increased pressure, which would lead to damage of the brachial plexus.

The Lofstrand crutches are fit similar to the axillary crutches. The hand grip should be at the level of the ulnar styloid, wrist crease, or greater trochanter of the femur. The shoulder should be relaxed, not elevated, and the elbow should be flexed to 20-30 degrees. Lofstrand crutches offer more stability than canes, but less stability than axillary crutches. Also, Lofstrand crutches are for clients with long-term disabilities. These crutches have an arm cuff that wraps around the client’s proximal forearm. Lastly, these crutches allow for more dynamic movement and control in small spaces.

The same measurements should be taken when fitting a client to a walker, just as when fitting a client to a cane. For fitting a platform walker, the forearms should be supported and in a neutral position. In order to prevent falls, it is important for the platform walker to be fitted correctly to the client. Likewise, the client’s height should be measured appropriately to ensure proper weight distribution. The platform itself is the steering device and is used for people with fractures of the upper extremities, wrists, or those who can’t grip onto the handles.

For fitting a rolling walker, it is still measured the same as fitting canes and standard walkers. This walker should be measured appropriately by the client’s height (while standing) to ensure adequate weight distribution for their arms. This walker is for individuals who can’t lift a walker due to upper extremity weakness or individuals who have impaired balance.

Social Determinants of Health

Social determinants of health (SDoH) are factors that include socioeconomic status, money, employment, education, social support, physical environment, and access to healthcare. SDoH are influenced by where people are born, live, and work. Some people are born into situations at a disadvantage and don’t have access to these factors. When these factors are linked to a lack of opportunity, health risks can occur. SDoH affects the nervous system by development and the ability to function. When a person has stress, they experience allostasis; a process of adapting to stress. As the body adapts, one may experience an increase of blood pressure, headaches, and GI problems. Additionally, the allostatic load influences the nervous system, which influences biobehavioral factors. Next, behavioral factors include things like physical activity, diet, and alcohol use. For example, a poor diet leads to the development of blood pressure problems, which leads to long-term consequences and an increased risk of stroke. Lastly, a social factor is no access to the gym, which leads to risky behaviors.

When someone is stressed, their adrenal glands produce high levels of cortisol, which leads to health issues. These health issues could include high blood pressure, obesity, or diabetes. Specifically, high levels of cortisol diminishes the function of the PFC and reduces the number of connections in the hippocampus, causes memory problems. UTHSC’s OT program requires students to complete service and professional development hours, which serves to facilitate career preparedness. UTHSC prepares students to think from an upstream approach, one that considers a client’s living and working conditions, instead of just the diagnosis. Moreover, students learn how to ask important questions, break barriers, work together, and contribute to building health in the community. Now, I understand the importance of the context of a client’s life and can provide the best standard of care.

Transfers

The hierarchy of mobility skills goes in the following order: bed mobility, mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADLs, toilet and tub transfer, car transfer, functional ambulation for community mobility, and community mobility and driving. I think that this hierarchy is in this particular sequence because skills are built sequentially. Moreover, it is important that the client is able to perform the steps that are at the bottom of the hierarchy and then progress to the more challenging skills at the next level. The order of the hierarchy is mostly what I would expect because of my observations at Covington Care Nursing and Rehabilitation. Here at this skilled nursing facility, I observed occupational therapists help clients move up the hierarchy order from wheelchair transfers to bed transfers. I agree to the order of this hierarchy, but I do think that all clients are unique. Thus, not all clients progress at the same rate or order. I believe that occupational therapists are great at adapting to the situation and should encourage clients based on their unique improvements. Furthermore, I believe that safety should be of the highest importance at all times, especially if the client is progressing in a different order.

Posture and Body Mechanics

It is important to teach proper posture and body mechanics to a client who has faulty posture for several reasons. Most back pain is a result of faulty posture and poor body mechanics. By teaching proper posture and body mechanics, the therapist is educating the client on preventing back pain. Clients need to understand proper posture and body mechanics to avoid possible injury, thus, hindering their careers, increasing the time that the client is away from work, and pain. In 2016, the back was reported as being the most frequent injury. Therefore, work related injuries can be costly, leading to expensive medical and lawyers bills. If the client understands proper posture and body mechanics, they are less likely to face injury, miss work, and face expensive medical costs. Back pain could also be from lack of exercise, poor nutrition, stressful situations, smoking, and lack of proper rest. Thus, it is important for occupational therapists to teach their clients on proper posture and body mechanics before injury occurs. An example of a way that I might teach proper posture and body mechanics in an intervention would be teaching my client the slouch-overcorrect technique. This technique is used to improve someone’s posture while sitting. After learning the procedure, the client can practice the slouch-overcorrect technique in the comfort of their own home. Another way that I would teach my client would be instructing them on the golfer’s lift. The golfer’s lift reduces strain on the back and allows the spine to stay straight. The golfer’s lift is used to pick up light objects off of the floor, while still maintaining correct posture and preventing injury.

Advertisements and the Human Nervous System

An advertisement that I have seen that really stuck out to me was one involving two patients at St. Jude. The advertisement asked for donations to help fight childhood cancer, which would contribute to helping the two children with cancer on the advertisement. In order to remember this advertisement, I used my episodic memory, which helped me identify personal illustrations of my life experiences. One aspect of the human nervous system that is primarily involved in my response to this advertisement is my amygdala. The amygdala is a small, almond-shaped part of the brain that is responsible for the emotional implication behind my memories. Additionally, located in the temporal lobe, the hippocampus is another part of the brain where long-term memories are stored and also connect with emotion. Moreover, the hippocampus is involved in the “what” implication of my episodic memory. Both the hippocampus and amygdala are a part of the limbic system, which would motivate me to donate to St. Jude. Next, I would use my prefrontal cortex (PFC), located in the frontal lobe, to make the decision to donate money towards the advertisement. The prefrontal cortex is responsible for executive functions, planning, problem solving, and decision-making. Moreover, the prefrontal cortex takes in emotional and sensory information in order to make a decision and plan of action. After I make a donation and receive a reward (receiving a letter that displayed how my donation helped fight cancer and an item from the St. Jude gift shop) the positive impact on my contribution motivates me to donate again. Dopamine influences the synapses in the reward pathway, so I anticipate a reward and continue to donate. Now, I have a reward pathway that activates the neurotransmitter, dopamine, each time I see a St. Jude advertisement.

"Man from the South"

I enjoyed reading a portion of “Man from the South” by Roald Dahl. During this literary segment, a man made a bet with an American solider. The bet was whether or not the soldier could light his lighter ten times running. The man told the solider that if the soldier won the bet, he would gain the man’s Cadillac. At the end of the story, the audience understood that the Cadillac was not really the man’s car, it was his wife’s car. However, if the soldier lost, the soldier’s little finger on his left hand would be cut off with a chopping knife. Moreover, losing the bet would change the soldier’s daily routine and occupations.

The soldier’s grasp would be negatively affected, and he would lose the majority of strength in his left hand. He would not be able to achieve intrinsic plus, and he would not have deep functioning of the ulnar nerve. More specifically, the soldier’s lateral grip would be affected when he holds a cigarette. In this case, smoking would be a leisure occupation that would be greatly affected by the loss of the little finger. Based on the reading, the soldier seemed to enjoy the leisure occupation of swimming as well. If the soldier lost the bet, swimming would also be affected. His ulnar nerve would be majorly impacted and would affect the pull and strength of his swimming strokes. The soldier would need to make modifications to his daily routine in order to compensate for the loss. Also, he may need to learn new ways to engage in the occupations that he needs or wants to do. As a solider, his daily routine may include shooting guns. In this case, his grip would also be affected by the loss of his little finger, while stabilizing and holding a gun.

After reading the article, “Occupation-based Hand Therapy and the Occupational Therapy Practice Framework” by Deborah Amini, one strategy to help the soldier regain his independence for swimming would be physical agent modalities (PAMs). The outcome that this would support would be returning to functional movement by providing pain management.

As for the wife of the man betting against the solider, she had already lost some of her fingers. In fact, she only had two fingers on one of her hands. Daily occupations that would be affected by the loss of her fingers would include driving her Cadillac, washing her hair, and preparing meals. Specifically, the occupation of driving would be affected by the loss of her fingers. Equipment that would help the wife regain independence would be adaptive driving aids such as hand controls. The outcome that this IADL would address would be the modification for functional independence.