Orris

Create a presentation on Guillain–Barré Syndrome related with rehabilitation just 5 slides

Reading File
Reading File
Reading File
Finding Sources
Searching Images

Guillain-Barré syndrome rehabilitation physical therapy

Reading File
Finding Sources
Reading File
Reading File
Reading File
Running Command

ls /home/daytona/workspace/ 2>/dev/null || echo "workspace empty or not found"

Running Command

mkdir -p /home/daytona/workspace/gbs-rehab-pptx && node /home/daytona/skills/sha…

Writing File

~/gbs-rehab-pptx/gbs_rehab.js

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Guillain-Barré Syndrome & Rehabilitation";
pres.author = "Medical Education";

// ── COLOR PALETTE ──────────────────────────────────────────────────────────
const C = {
  navy:    "0D2B55",   // dominant dark bg
  teal:    "1A7F8E",   // accent
  sky:     "4DB8C8",   // light accent
  white:   "FFFFFF",
  offwhite:"EEF4F7",
  orange:  "E8773C",   // highlight/warning
  ltgray:  "CFE0E8",
};

// ─── HELPER: rounded rect background ──────────────────────────────────────
function addCard(slide, x, y, w, h, fill, radius = 0.12) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w, h,
    fill: { color: fill },
    line: { color: fill },
    rectRadius: radius,
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();

  // Full dark bg
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625,
    fill:{ color: C.navy }, line:{ color: C.navy } });

  // Teal accent bar left
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:0.18, h:5.625,
    fill:{ color: C.teal }, line:{ color: C.teal } });

  // Teal horizontal stripe
  s.addShape(pres.ShapeType.rect, { x:0, y:2.55, w:10, h:0.06,
    fill:{ color: C.teal }, line:{ color: C.teal } });

  // Title
  s.addText("Guillain–Barré Syndrome", {
    x:0.5, y:0.7, w:9, h:1.1,
    fontSize:42, bold:true, color:C.white,
    fontFace:"Calibri", align:"center", margin:0,
  });

  // Subtitle
  s.addText("Rehabilitation: Assessment, Goals & Evidence-Based Interventions", {
    x:0.5, y:1.9, w:9, h:0.55,
    fontSize:17, color:C.sky, fontFace:"Calibri",
    align:"center", italic:true, margin:0,
  });

  // Three stat boxes
  const stats = [
    { icon:"1.8", lbl:"per 100,000 incidence / yr" },
    { icon:"9–30%", lbl:"require mechanical ventilation" },
    { icon:"~80%", lbl:"walk independently at 6 months" },
  ];
  stats.forEach((st, i) => {
    const bx = 0.9 + i * 3.1;
    addCard(s, bx, 2.85, 2.6, 1.65, "1A2E47");
    s.addShape(pres.ShapeType.rect, { x:bx, y:2.85, w:2.6, h:0.06,
      fill:{ color: C.teal }, line:{ color: C.teal } });
    s.addText(st.icon, { x:bx, y:2.92, w:2.6, h:0.72,
      fontSize:26, bold:true, color:C.sky, align:"center", fontFace:"Calibri", margin:0 });
    s.addText(st.lbl, { x:bx+0.08, y:3.64, w:2.44, h:0.72,
      fontSize:10.5, color:C.offwhite, align:"center", fontFace:"Calibri", margin:0 });
  });

  // Footer
  s.addText("Bradley & Daroff's Neurology in Clinical Practice  |  Medical Education", {
    x:0, y:5.28, w:10, h:0.3,
    fontSize:8, color:"4A6B82", align:"center", fontFace:"Calibri", margin:0,
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 2 – OVERVIEW: PATHOPHYSIOLOGY & CLINICAL FEATURES
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();

  // Header bar
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.72,
    fill:{ color: C.navy }, line:{ color: C.navy } });
  s.addShape(pres.ShapeType.rect, { x:0, y:0.72, w:10, h:0.06,
    fill:{ color: C.teal }, line:{ color: C.teal } });
  s.addText("Overview: Pathophysiology & Clinical Features", {
    x:0.3, y:0.08, w:9.4, h:0.56,
    fontSize:22, bold:true, color:C.white, fontFace:"Calibri", valign:"middle", margin:0,
  });

  // LEFT column – pathophysiology
  addCard(s, 0.25, 0.9, 4.4, 4.1, "EEF4F7");
  s.addShape(pres.ShapeType.rect, { x:0.25, y:0.9, w:4.4, h:0.44,
    fill:{ color: C.teal }, line:{ color: C.teal } });
  s.addText("PATHOPHYSIOLOGY", { x:0.25, y:0.9, w:4.4, h:0.44,
    fontSize:12, bold:true, color:C.white, align:"center", fontFace:"Calibri", valign:"middle", margin:0 });

  const pathoBullets = [
    "Post-infectious immune attack on myelin & Schwann cells",
    "Multifocal inflammatory demyelination of spinal roots & peripheral nerves",
    "Macrophages strip myelin lamellae → conduction block & slowing",
    "Axonal subtypes (AMAN, AMSAN): direct axonal damage → poorer prognosis",
    "Molecular mimicry: anti-ganglioside antibodies (anti-GQ1b in Miller-Fisher)",
    "Triggers: C. jejuni (most common), CMV, EBV, COVID-19",
  ];
  s.addText(pathoBullets.map((t,i) => ({
    text: t,
    options: { bullet:{code:"2022"}, fontSize:10.5, color:"0D2B55",
               fontFace:"Calibri", breakLine: i < pathoBullets.length-1 }
  })), { x:0.4, y:1.4, w:4.1, h:3.5, valign:"top", margin:4 });

  // RIGHT column – clinical features
  addCard(s, 5.05, 0.9, 4.7, 4.1, "EEF4F7");
  s.addShape(pres.ShapeType.rect, { x:5.05, y:0.9, w:4.7, h:0.44,
    fill:{ color: C.orange }, line:{ color: C.orange } });
  s.addText("CLINICAL FEATURES", { x:5.05, y:0.9, w:4.7, h:0.44,
    fontSize:12, bold:true, color:C.white, align:"center", fontFace:"Calibri", valign:"middle", margin:0 });

  const clinBullets = [
    "Ascending flaccid paralysis, areflexia (hallmark)",
    "Symmetric weakness legs → arms → face/bulbar muscles",
    "Cranial nerve involvement: 45–75% (facial paresis most common)",
    "Autonomic dysfunction: 65% (arrhythmia, BP lability, urinary retention)",
    "Pain: 70% in acute phase (back, limb, dysesthesia)",
    "Respiratory failure requiring ventilation: 9–30%",
    "Peak disability at 2–4 weeks; recovery begins 2–4 wks after plateau",
  ];
  s.addText(clinBullets.map((t,i) => ({
    text: t,
    options: { bullet:{code:"2022"}, fontSize:10.5, color:"0D2B55",
               fontFace:"Calibri", breakLine: i < clinBullets.length-1 }
  })), { x:5.2, y:1.4, w:4.4, h:3.5, valign:"top", margin:4 });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 3 – REHABILITATION PHASES
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();

  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.72,
    fill:{ color: C.navy }, line:{ color: C.navy } });
  s.addShape(pres.ShapeType.rect, { x:0, y:0.72, w:10, h:0.06,
    fill:{ color: C.teal }, line:{ color: C.teal } });
  s.addText("Rehabilitation Across Disease Phases", {
    x:0.3, y:0.08, w:9.4, h:0.56,
    fontSize:22, bold:true, color:C.white, fontFace:"Calibri", valign:"middle", margin:0,
  });

  const phases = [
    {
      label:"ACUTE / ICU PHASE",
      color: C.orange,
      items: [
        "Positioning: prevent pressure injuries & contractures",
        "Passive ROM all joints BID",
        "Chest physiotherapy: secretion clearance, ventilator weaning support",
        "DVT prophylaxis: compression stockings + early mobilization",
        "Splinting to maintain wrist & ankle neutral",
        "Swallowing screen → modified diet / NGT if dysphagia present",
      ],
    },
    {
      label:"SUBACUTE / INPATIENT REHAB",
      color: C.teal,
      items: [
        "Progressive resistance: elastic bands, gravity-resisted movements",
        "Active-assisted → active ROM as strength returns",
        "Gait training: parallel bars → walker → independent ambulation",
        "Balance & proprioception retraining (sensory deficits persist)",
        "ADL retraining: occupational therapy for fine-motor tasks",
        "Orthoses: AFOs for foot drop; wrist splints if needed",
      ],
    },
    {
      label:"OUTPATIENT / COMMUNITY PHASE",
      color: "2E7D6F",
      items: [
        "Aerobic conditioning: swimming, cycling (low-impact preferred)",
        "Fatigue management strategies — energy conservation",
        "Neuropsychological support for depression & anxiety (~67%)",
        "Pain management: gabapentin / TENS for neuropathic pain",
        "Return-to-work / school vocational rehabilitation",
        "Long-term follow-up: up to 3 yrs for residual weakness / fatigue",
      ],
    },
  ];

  phases.forEach((ph, col) => {
    const bx = 0.18 + col * 3.3;
    addCard(s, bx, 0.88, 3.1, 4.62, "EEF4F7");
    s.addShape(pres.ShapeType.rect, { x:bx, y:0.88, w:3.1, h:0.5,
      fill:{ color: ph.color }, line:{ color: ph.color } });
    s.addText(`PHASE ${col+1}`, { x:bx, y:0.88, w:3.1, h:0.24,
      fontSize:8, bold:true, color:C.white, align:"center", fontFace:"Calibri", valign:"middle", margin:0 });
    s.addText(ph.label, { x:bx, y:1.11, w:3.1, h:0.27,
      fontSize:9.5, bold:true, color:C.white, align:"center", fontFace:"Calibri", valign:"middle", margin:0 });
    s.addText(ph.items.map((t,i) => ({
      text: t,
      options: { bullet:{code:"2022"}, fontSize:9.8, color:"0D2B55",
                 fontFace:"Calibri", breakLine: i < ph.items.length-1 }
    })), { x:bx+0.1, y:1.44, w:2.9, h:4.0, valign:"top", margin:3 });
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 4 – KEY INTERVENTIONS & OUTCOME MEASURES
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();

  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.72,
    fill:{ color: C.navy }, line:{ color: C.navy } });
  s.addShape(pres.ShapeType.rect, { x:0, y:0.72, w:10, h:0.06,
    fill:{ color: C.teal }, line:{ color: C.teal } });
  s.addText("Key Interventions & Outcome Measures", {
    x:0.3, y:0.08, w:9.4, h:0.56,
    fontSize:22, bold:true, color:C.white, fontFace:"Calibri", valign:"middle", margin:0,
  });

  // LEFT – interventions table
  const interventions = [
    ["Intervention", "Rationale / Evidence"],
    ["IVIg or Plasma Exchange", "First-line immunotherapy; shorten ventilator time & time to walk"],
    ["Progressive Resistance Training", "Restores MRC grade; start when medically stable"],
    ["Treadmill / Body-Weight Support", "Promotes central pattern generator reactivation"],
    ["Hydrotherapy / Aquatic PT", "Buoyancy reduces load; early active exercise possible"],
    ["Neuromuscular Electrical Stim (NMES)", "Delays atrophy; improves muscle recruitment in flaccid limbs"],
    ["Respiratory Muscle Training", "Improves FVC; supports ventilator weaning"],
    ["Splinting & Orthotics (AFO)", "Prevents contracture; enables safe ambulation with foot drop"],
    ["Cognitive-Behavioral Therapy", "Addresses depression, anxiety, fatigue — common sequelae"],
  ];

  // Draw table manually
  const tx = 0.25, ty = 0.88, tw = 5.7, rowH = 0.44;
  interventions.forEach((row, ri) => {
    const rowY = ty + ri * rowH;
    const bg = ri === 0 ? C.navy : ri % 2 === 0 ? "EEF4F7" : C.white;
    const fg = ri === 0 ? C.white : C.navy;
    const fs = ri === 0 ? 10 : 9.5;

    [row[0], row[1]].forEach((cell, ci) => {
      const colW = ci === 0 ? 1.9 : 3.8;
      const colX = tx + (ci === 0 ? 0 : 1.9);
      s.addShape(pres.ShapeType.rect, { x:colX, y:rowY, w:colW, h:rowH,
        fill:{ color: bg }, line:{ color: "C8D9E4" } });
      s.addText(cell, { x:colX+0.06, y:rowY+0.02, w:colW-0.1, h:rowH-0.04,
        fontSize:fs, color:fg, fontFace:"Calibri", bold: ri===0,
        valign:"middle", margin:2, wrap:true });
    });
  });

  // RIGHT – outcome measures
  addCard(s, 6.15, 0.88, 3.6, 4.62, "EEF4F7");
  s.addShape(pres.ShapeType.rect, { x:6.15, y:0.88, w:3.6, h:0.44,
    fill:{ color: C.teal }, line:{ color: C.teal } });
  s.addText("OUTCOME MEASURES", { x:6.15, y:0.88, w:3.6, h:0.44,
    fontSize:12, bold:true, color:C.white, align:"center", fontFace:"Calibri", valign:"middle", margin:0 });

  const outcomes = [
    { m:"GBS Disability Scale", d:"0–6; primary functional staging tool" },
    { m:"MRC Sum Score", d:"60-point motor strength scale (6 muscle groups × 2 sides)" },
    { m:"Erasmus GBS Outcome Score (EGOS)", d:"Predicts walking ability at 6 months" },
    { m:"Fatigue Severity Scale (FSS)", d:"Critical — fatigue persists in 60–80%" },
    { m:"Berg Balance Scale", d:"Balance & fall risk during gait retraining" },
    { m:"10-Meter Walk Test / TUG", d:"Ambulation speed & functional mobility" },
    { m:"SF-36 / RAND-36", d:"HRQoL — physical & mental component scores" },
    { m:"VAS / NRS Pain", d:"Neuropathic pain monitoring throughout rehab" },
  ];
  outcomes.forEach((o, i) => {
    const ry = 1.38 + i * 0.51;
    s.addText(o.m, { x:6.25, y:ry, w:3.4, h:0.23,
      fontSize:9.8, bold:true, color:C.teal, fontFace:"Calibri", margin:0 });
    s.addText(o.d, { x:6.25, y:ry+0.22, w:3.4, h:0.24,
      fontSize:8.8, color:"333333", fontFace:"Calibri", margin:0 });
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 5 – PROGNOSIS & MULTIDISCIPLINARY TEAM
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();

  // Dark bg
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:5.625,
    fill:{ color: C.navy }, line:{ color: C.navy } });

  // Header
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.78,
    fill:{ color: "0A2240" }, line:{ color: "0A2240" } });
  s.addShape(pres.ShapeType.rect, { x:0, y:0.78, w:10, h:0.06,
    fill:{ color: C.orange }, line:{ color: C.orange } });
  s.addText("Prognosis & Multidisciplinary Team", {
    x:0.3, y:0.1, w:9.4, h:0.62,
    fontSize:22, bold:true, color:C.white, fontFace:"Calibri", valign:"middle", margin:0,
  });

  // Prognosis boxes
  const progData = [
    { pct:"~80%", label:"Walk independently by 6 months", col: C.teal },
    { pct:"5–10%", label:"Non-ambulatory at 1 year", col: C.orange },
    { pct:"1–5%", label:"Mortality (modern ICU era)", col: "C0392B" },
    { pct:"67%", label:"Psychiatric sequelae (depression/anxiety)", col: "7D5BA6" },
  ];
  progData.forEach((pd, i) => {
    const bx = 0.3 + i * 2.4;
    addCard(s, bx, 0.96, 2.1, 1.45, "112D4A");
    s.addShape(pres.ShapeType.rect, { x:bx, y:0.96, w:2.1, h:0.07,
      fill:{ color: pd.col }, line:{ color: pd.col } });
    s.addText(pd.pct, { x:bx, y:1.05, w:2.1, h:0.72,
      fontSize:28, bold:true, color:pd.col, align:"center", fontFace:"Calibri", margin:0 });
    s.addText(pd.label, { x:bx+0.06, y:1.74, w:1.98, h:0.6,
      fontSize:9, color:C.offwhite, align:"center", fontFace:"Calibri", margin:0 });
  });

  // MDT wheel layout – text boxes
  s.addText("MULTIDISCIPLINARY REHABILITATION TEAM", {
    x:0.3, y:2.55, w:9.4, h:0.35,
    fontSize:12, bold:true, color:C.sky, align:"center", fontFace:"Calibri",
    charSpacing:2, margin:0,
  });

  const roles = [
    { role:"Neurologist", tasks:"Disease monitoring, IVIg/PE decisions, relapse detection" },
    { role:"Physiatrist (PM&R)", tasks:"Rehabilitation plan, disability assessment, functional goals" },
    { role:"Physiotherapist", tasks:"Strength, gait, balance, respiratory, exercise prescription" },
    { role:"Occupational Therapist", tasks:"ADL training, orthotics, home adaptations, return-to-work" },
    { role:"Speech-Language Pathologist", tasks:"Dysphagia, communication, AAC devices if needed" },
    { role:"Respiratory Therapist / ICU Nurse", tasks:"Ventilator weaning, secretion clearance, monitoring" },
    { role:"Psychologist / Psychiatrist", tasks:"Depression, anxiety, PTSD — CBT, mindfulness, medication" },
    { role:"Social Worker", tasks:"Discharge planning, caregiver training, community resources" },
  ];

  const cols = [[0,1,2,3], [4,5,6,7]];
  cols.forEach((idxs, ci) => {
    idxs.forEach((idx, ri) => {
      const rx = 0.25 + ci * 5.0;
      const ry = 2.98 + ri * 0.62;
      // teal dot
      s.addShape(pres.ShapeType.ellipse, { x:rx, y:ry+0.14, w:0.16, h:0.16,
        fill:{ color: C.teal }, line:{ color: C.teal } });
      s.addText(roles[idx].role, { x:rx+0.24, y:ry, w:4.55, h:0.28,
        fontSize:10.5, bold:true, color:C.sky, fontFace:"Calibri", margin:0 });
      s.addText(roles[idx].tasks, { x:rx+0.24, y:ry+0.27, w:4.55, h:0.28,
        fontSize:9, color:C.offwhite, fontFace:"Calibri", margin:0 });
    });
  });

  // Footer source
  s.addText("Sources: Bradley & Daroff's Neurology in Clinical Practice | Miller's Anesthesia | Robbins Pathology", {
    x:0, y:5.32, w:10, h:0.26,
    fontSize:7.5, color:"3A6080", align:"center", fontFace:"Calibri", margin:0,
  });
}

// ── WRITE ─────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/gbs-rehab-pptx/GBS_Rehabilitation.pptx" })
  .then(() => console.log("DONE"))
  .catch(e => console.error(e));
Running Command

cd /home/daytona/workspace/gbs-rehab-pptx && node gbs_rehab.js

Running Command

ls -lh /home/daytona/workspace/gbs-rehab-pptx/GBS_Rehabilitation.pptx

Your presentation is ready — 173 KB, 5 slides:

GBS Rehabilitation

Presentation · PPTX

Slide-by-slide summary

#SlideContent
1TitleNavy/teal design with 3 key stats: incidence (1.8/100k), ventilation rate (9–30%), recovery rate (~80%)
2Overview: Pathophysiology & Clinical FeaturesTwo-column layout — demyelination mechanism, macrophage role, ganglioside antibodies (left); ascending paralysis, autonomic dysfunction, cranial nerve involvement, pain (right)
3Rehabilitation Across Disease PhasesThree-phase column layout: Acute/ICU (positioning, passive ROM, chest PT), Subacute/Inpatient (progressive resistance, gait training, AFOs), Outpatient/Community (aerobic conditioning, fatigue management, psychosocial support)
4Key Interventions & Outcome MeasuresTable of 8 evidence-based interventions (IVIg/PE, NMES, aquatic PT, CBT…) + outcome tool panel (GBS Disability Scale, MRC Sum Score, EGOS, FSS, Berg Balance)
5Prognosis & MDT4 prognosis stat boxes + full multidisciplinary team roles (Neurologist, PM&R, PT, OT, SLP, RT, Psychologist, Social Worker)
All content is sourced from Bradley & Daroff's Neurology in Clinical Practice, Miller's Anesthesia, and Robbins Pathology.

According to the patient

Asking for Preferences
Your message appears to be incomplete — it ended with "According to the patient" without finishing the thought.
Could you share the rest? For example:
  • "According to the patient's clinical profile…" — and then describe the patient (age, symptoms, phase of illness, current function)
  • "According to the patient's presentation, what rehab interventions apply?"
  • Or paste the patient case/clinical data you'd like me to work with

Create 5 slides of presentation related with rehabilitation topic is Guillain–Barré Syndrome and present it with a clinical case

Reading File
Finding Sources
Searching Images

Guillain-Barré syndrome clinical rehabilitation physiotherapy patient

Running Command

node /home/daytona/skills/shared/scripts/fetch_images.js \ "https://cdn.orris.…

Writing File

~/gbs-rehab-pptx/gbs_case.js

const pptxgen = require("pptxgenjs");
const images = require("./images.json");

// images[0] = pelvic bridge PT session (rehab)
// images[1] = wheelchair → full recovery comparison (COVID GBS)
// images[2] = Achilles stretch / ROM
// images[3] = diaphragmatic breathing / chest PT

const pres = new pptxgen();
pres.layout  = "LAYOUT_16x9";
pres.title   = "GBS & Rehabilitation – Clinical Case";
pres.author  = "Medical Education";

// ── PALETTE ────────────────────────────────────────────────────────────────
const C = {
  navy:    "0B2545",
  teal:    "13808E",
  sky:     "56C6D4",
  orange:  "E87040",
  amber:   "F5A623",
  white:   "FFFFFF",
  offwhite:"EDF4F7",
  card:    "142E4A",
  mid:     "1B4060",
  gray:    "334E68",
};

function rect(s, x,y,w,h, fill, line) {
  s.addShape(pres.ShapeType.rect, { x,y,w,h,
    fill:{color: fill||"FFFFFF"}, line:{color: line||fill||"FFFFFF"} });
}
function rRect(s, x,y,w,h, fill, r=0.1) {
  s.addShape(pres.ShapeType.roundRect, { x,y,w,h,
    fill:{color:fill}, line:{color:fill}, rectRadius:r });
}
function hdr(s, title) {
  rect(s, 0,0,10,0.72, C.navy);
  rect(s, 0,0.72,10,0.055, C.teal);
  s.addText(title, { x:0.3,y:0.05,w:9.4,h:0.62,
    fontSize:21, bold:true, color:C.white, fontFace:"Calibri", valign:"middle", margin:0 });
}
function footer(s, txt) {
  s.addText(txt, { x:0,y:5.35,w:10,h:0.26,
    fontSize:7.5, color:"3A6080", align:"center", fontFace:"Calibri", margin:0 });
}
function bullets(s, items, x,y,w,h, fs=10, color="0B2545") {
  s.addText(items.map((t,i)=>({
    text:t,
    options:{ bullet:{code:"2022"}, fontSize:fs, color:color,
              fontFace:"Calibri", breakLine: i<items.length-1 }
  })), { x,y,w,h, valign:"top", margin:3 });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE + CLINICAL CASE VIGNETTE
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();

  // Full dark background
  rect(s, 0,0,10,5.625, C.navy);
  // Left accent bar
  rect(s, 0,0,0.2,5.625, C.teal);
  // Divider stripe
  rect(s, 0.2,2.58,9.8,0.055, C.teal);

  // Title block
  s.addText("Guillain–Barré Syndrome", {
    x:0.45,y:0.55,w:9.1,h:1.0,
    fontSize:40, bold:true, color:C.white,
    fontFace:"Calibri", align:"center", margin:0,
  });
  s.addText("Rehabilitation & Clinical Case Presentation", {
    x:0.45,y:1.6,w:9.1,h:0.5,
    fontSize:18, italic:true, color:C.sky,
    fontFace:"Calibri", align:"center", margin:0,
  });

  // ── CLINICAL CASE VIGNETTE BOX ─────────────────────────────────────
  rRect(s, 0.35,2.75,9.3,2.58, C.card, 0.14);
  rect(s, 0.35,2.75,9.3,0.055, C.orange);

  s.addText("CLINICAL CASE VIGNETTE", {
    x:0.45,y:2.79,w:9.1,h:0.38,
    fontSize:11, bold:true, color:C.orange,
    fontFace:"Calibri", charSpacing:2, margin:0,
  });

  // Case text – rich formatting
  s.addText([
    { text:"Patient: ", options:{ bold:true, color:C.amber } },
    { text:"Carlos M., 34-year-old male, previously healthy.\n", options:{ color:C.offwhite } },
    { text:"History: ", options:{ bold:true, color:C.amber } },
    { text:"10 days after an episode of gastroenteritis (", options:{ color:C.offwhite } },
    { text:"C. jejuni", options:{ color:C.offwhite, italic:true } },
    { text:"), he developed bilateral lower extremity weakness, gait instability, and tingling in his feet and hands.\n", options:{ color:C.offwhite } },
    { text:"Progression: ", options:{ bold:true, color:C.amber } },
    { text:"Over 5 days, weakness ascended to the upper limbs and trunk; facial weakness developed. Referred to ICU on day 3 due to respiratory compromise (FVC < 20 mL/kg).\n", options:{ color:C.offwhite } },
    { text:"Exam: ", options:{ bold:true, color:C.amber } },
    { text:"MRC sum score 28/60 | Areflexia | Dysautonomia (HR fluctuations, BP lability) | Pain VAS 7/10\n", options:{ color:C.offwhite } },
    { text:"Workup: ", options:{ bold:true, color:C.amber } },
    { text:"CSF albuminocytological dissociation · NCS: diffuse demyelinating pattern · Anti-ganglioside: GQ1b negative → AIDP subtype", options:{ color:C.offwhite } },
  ], { x:0.5,y:3.18,w:9.0,h:2.1, fontSize:10.2, fontFace:"Calibri", valign:"top", margin:3 });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 2 – ACUTE PHASE: ICU REHABILITATION
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  hdr(s, "Phase 1 – Acute ICU Management & Early Rehabilitation");

  // Left content column
  rRect(s, 0.2,0.88,5.3,4.5, C.offwhite);
  rect(s, 0.2,0.88,5.3,0.44, C.orange);
  s.addText("CARLOS IN THE ICU  •  Days 1–14", {
    x:0.2,y:0.88,w:5.3,h:0.44,
    fontSize:11, bold:true, color:C.white, align:"center",
    fontFace:"Calibri", valign:"middle", margin:0,
  });

  const icuItems = [
    "Intubated Day 3 (FVC < 20 mL/kg) → mechanical ventilation",
    "IVIg initiated: 0.4 g/kg/day × 5 days (first-line immunotherapy)",
    "Cardiac monitoring: continuous ECG (vagal spells risk → asystole)",
    "DVT prophylaxis: LMWH + pneumatic compression stockings",
    "NGT feeding: dysphagia + absent gag reflex",
    "Pain management: pregabalin 75 mg BID for neuropathic pain",
    "Urinary catheter: autonomic retention",
    "Nursing repositioning every 2 h: pressure injury prevention",
  ];
  bullets(s, icuItems, 0.35,1.38,5.0,2.2, 10, C.navy);

  // Rehab sub-box
  rRect(s, 0.25,3.62,5.2,1.65, "D6E8EE", 0.08);
  rect(s, 0.25,3.62,5.2,0.35, C.teal);
  s.addText("EARLY REHAB (bedside)", {
    x:0.25,y:3.62,w:5.2,h:0.35,
    fontSize:10, bold:true, color:C.white, align:"center",
    fontFace:"Calibri", valign:"middle", margin:0,
  });
  const earlyRehab = [
    "Passive ROM all joints BID (prevent contracture)",
    "Chest PT: manual vibration, positioning for secretion clearance",
    "Splinting: wrist neutral + AFO to prevent foot drop",
    "Verbal / sensory stimulation; family education",
  ];
  bullets(s, earlyRehab, 0.38,4.0,5.0,1.2, 9.8, C.navy);

  // Right image column
  s.addImage({ data: images[3].base64, x:5.7,y:0.9,w:4.05,h:2.7,
    sizing:{type:"contain",w:4.05,h:2.7} });

  // Caption
  rRect(s, 5.7,3.65,4.05,0.7, C.card, 0.08);
  s.addText("Respiratory physiotherapy & diaphragmatic breathing exercises in the acute/ICU phase of GBS — critical for ventilator weaning.", {
    x:5.78,y:3.68,w:3.9,h:0.64,
    fontSize:8.5, color:C.sky, fontFace:"Calibri",
    italic:true, valign:"middle", margin:2,
  });

  // GBS Disability scale box
  rRect(s, 5.7,4.42,4.05,0.9, C.mid, 0.08);
  s.addText("GBS Disability Scale – Carlos at admission", {
    x:5.78,y:4.44,w:3.88,h:0.3,
    fontSize:9.5, bold:true, color:C.amber, fontFace:"Calibri", margin:0,
  });
  s.addText("Score: 4 / 6  →  Bedridden, requires assisted ventilation", {
    x:5.78,y:4.74,w:3.88,h:0.52,
    fontSize:9.5, color:C.offwhite, fontFace:"Calibri", valign:"middle", margin:0,
  });

  footer(s, "Bradley & Daroff's Neurology in Clinical Practice | Medical Microbiology 9e");
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 3 – SUBACUTE PHASE: INPATIENT REHABILITATION
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  hdr(s, "Phase 2 – Subacute: Inpatient Rehabilitation  (Weeks 3–8)");

  // Image – pelvic bridge PT session
  s.addImage({ data: images[0].base64, x:0.2,y:0.9,w:3.4,h:2.5,
    sizing:{type:"contain",w:3.4,h:2.5} });
  rRect(s, 0.2,3.42,3.4,0.72, C.card, 0.08);
  s.addText("Supervised pelvic bridging exercise — core & lower limb strengthening during inpatient GBS rehabilitation.", {
    x:0.3,y:3.44,w:3.2,h:0.68,
    fontSize:8.5, color:C.sky, italic:true, fontFace:"Calibri", valign:"middle", margin:2,
  });

  // Image – Achilles stretch
  s.addImage({ data: images[2].base64, x:0.2,y:4.18,w:3.4,h:1.3,
    sizing:{type:"contain",w:3.4,h:1.3} });

  // Right content
  rRect(s, 3.82,0.88,5.95,4.62, C.offwhite);
  rect(s, 3.82,0.88,5.95,0.44, C.teal);
  s.addText("CARLOS: Transferred to Neurorehabilitation Ward  (Day 18)", {
    x:3.82,y:0.88,w:5.95,h:0.44,
    fontSize:10.5, bold:true, color:C.white, align:"center",
    fontFace:"Calibri", valign:"middle", margin:0,
  });
  s.addText("Status: Extubated Day 15 | MRC 36/60 | Pain VAS 5/10", {
    x:3.92,y:1.36,w:5.75,h:0.3,
    fontSize:10, color:C.teal, bold:true, fontFace:"Calibri", margin:0,
  });

  const rehab2 = [
    ["Physiotherapy", [
      "Active-assisted ROM → progressive resistance (elastic bands)",
      "Pelvic bridging, supine leg lifts, seated balance training",
      "Parallel bars ambulation → walking frame → forearm crutches",
      "Achilles / wrist stretching BID; proprioception retraining",
    ]],
    ["Occupational Therapy", [
      "Fine motor retraining: grip, pinch, writing, fastening",
      "ADL retraining: dressing, grooming, meal preparation",
      "Wrist splints for residual weakness; adaptive devices",
    ]],
    ["Speech-Language Pathology", [
      "Swallowing reassessment → upgrade to soft diet",
      "Vocal exercises for residual facial/bulbar weakness",
    ]],
    ["Psychology", [
      "CBT sessions: anxiety, helplessness, fear of relapse",
      "Sleep hygiene; fatigue education",
    ]],
  ];

  let cy = 1.72;
  rehab2.forEach(([sect, items]) => {
    s.addText(sect, { x:3.95,y:cy,w:5.7,h:0.26,
      fontSize:10, bold:true, color:C.orange, fontFace:"Calibri", margin:0 });
    cy += 0.27;
    items.forEach(item => {
      s.addText([{ text:"• ", options:{bold:true, color:C.teal}},{text:item, options:{color:C.navy}}],
        { x:4.1,y:cy,w:5.55,h:0.28, fontSize:9.5, fontFace:"Calibri", valign:"middle", margin:0 });
      cy += 0.28;
    });
    cy += 0.04;
  });

  footer(s, "Bradley & Daroff's Neurology in Clinical Practice");
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 4 – OUTPATIENT PHASE + OUTCOME MEASURES
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  hdr(s, "Phase 3 – Outpatient Rehabilitation & Outcome Measures  (Month 2–6+)");

  // Left column – outpatient program
  rRect(s, 0.2,0.9,4.55,4.48, C.offwhite);
  rect(s, 0.2,0.9,4.55,0.44, "2E7D6F");
  s.addText("OUTPATIENT PROGRAM  –  Carlos at Week 10", {
    x:0.2,y:0.9,w:4.55,h:0.44,
    fontSize:10.5, bold:true, color:C.white, align:"center",
    fontFace:"Calibri", valign:"middle", margin:0,
  });
  s.addText("Ambulating with lAFO (right foot drop) | MRC 48/60 | VAS 3/10", {
    x:0.32,y:1.38,w:4.3,h:0.28,
    fontSize:9.5, color:"2E7D6F", bold:true, fontFace:"Calibri", margin:0,
  });

  const outpt = [
    "3× weekly physiotherapy: treadmill, cycling, balance board",
    "Aquatic physiotherapy 2× weekly (buoyancy reduces load)",
    "Progressive resistance training: MRC-guided grading",
    "Fatigue management: energy conservation, pacing strategies",
    "TENS for residual neuropathic burning in feet",
    "Occupational therapy: return-to-work simulation, driving eval",
    "Neuropsychology: adjustment disorder counseling; group support",
    "Orthotics review at 3 months: AFO weaning if dorsiflexion MRC ≥ 3",
    "Nutritional support: protein for muscle re-synthesis",
    "Follow-up at 6 months, 1 year, 2 years: residual fatigue in ~60%",
  ];
  bullets(s, outpt, 0.32,1.72,4.28,3.55, 9.8, C.navy);

  // Right column – outcome measures table
  rRect(s, 4.95,0.9,4.85,4.48, C.offwhite);
  rect(s, 4.95,0.9,4.85,0.44, C.navy);
  s.addText("OUTCOME MEASURES – Carlos's Progress", {
    x:4.95,y:0.9,w:4.85,h:0.44,
    fontSize:10.5, bold:true, color:C.white, align:"center",
    fontFace:"Calibri", valign:"middle", margin:0,
  });

  const measures = [
    { tool:"GBS Disability Scale", admission:"4 / 6", wk4:"3 / 6", wk10:"1 / 6", goal:"0" },
    { tool:"MRC Sum Score /60", admission:"28", wk4:"36", wk10:"48", goal:"55+" },
    { tool:"Berg Balance Scale /56", admission:"0", wk4:"18", wk10:"38", goal:"50+" },
    { tool:"10m Walk Test (s)", admission:"—", wk4:"—", wk10:"14.2s", goal:"< 10s" },
    { tool:"Fatigue Severity Scale /7", admission:"6.8", wk4:"6.2", wk10:"5.1", goal:"< 4" },
    { tool:"VAS Pain /10", admission:"7", wk4:"5", wk10:"3", goal:"< 2" },
    { tool:"SF-36 Physical /100", admission:"12", wk4:"28", wk10:"54", goal:"70+" },
  ];

  // Header row
  const cols = ["Tool", "Admission", "Wk 4", "Wk 10", "Goal"];
  const colW = [2.05, 0.68, 0.55, 0.68, 0.62];
  const colX = [4.97, 7.03, 7.72, 8.27, 8.95];

  colX.forEach((cx,ci) => {
    rect(s, cx, 1.38, colW[ci], 0.36, C.navy);
    s.addText(cols[ci], { x:cx+0.03,y:1.38,w:colW[ci]-0.06,h:0.36,
      fontSize:8.5, bold:true, color:C.white, fontFace:"Calibri",
      align:"center", valign:"middle", margin:0 });
  });

  measures.forEach((row, ri) => {
    const ry = 1.74 + ri * 0.46;
    const bg = ri%2===0 ? "EDF4F7" : C.white;
    const vals = [row.tool, row.admission, row.wk4, row.wk10, row.goal];
    colX.forEach((cx,ci) => {
      rect(s, cx, ry, colW[ci], 0.46, bg, "C8D9E4");
      const isGoal = ci===4;
      s.addText(vals[ci], { x:cx+0.03,y:ry+0.02,w:colW[ci]-0.06,h:0.42,
        fontSize:ci===0?9:9, color: isGoal?"2E7D6F":C.navy,
        bold: isGoal||false, fontFace:"Calibri",
        align: ci===0?"left":"center", valign:"middle", margin:1, wrap:true });
    });
  });

  footer(s, "Outcome tools: GBS Disability Scale · MRC Sum Score · Berg Balance · FSS · SF-36");
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 5 – PROGNOSIS, MDT & CARLOS'S 3-MONTH RECOVERY
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  rect(s, 0,0,10,5.625, C.navy);
  rect(s, 0,0,10,0.78, "08192E");
  rect(s, 0,0.78,10,0.055, C.orange);
  s.addText("Prognosis, Multidisciplinary Team & Carlos's Recovery", {
    x:0.3,y:0.08,w:9.4,h:0.65,
    fontSize:20, bold:true, color:C.white, fontFace:"Calibri", valign:"middle", margin:0,
  });

  // Recovery comparison image
  s.addImage({ data: images[1].base64, x:0.2,y:0.95,w:3.9,h:2.85,
    sizing:{type:"contain",w:3.9,h:2.85} });
  rRect(s, 0.2,3.82,3.9,0.7, C.card, 0.08);
  s.addText("Carlos: wheelchair at discharge (GBS score 3) → full independent ambulation at 3 months (MRC 55/60).", {
    x:0.3,y:3.84,w:3.7,h:0.65,
    fontSize:8.8, color:C.sky, italic:true, fontFace:"Calibri", valign:"middle", margin:2,
  });

  // Prognosis stats row
  const stats = [
    { v:"~80%",  l:"walk independently by 6 months", col:C.teal },
    { v:"1–5%",  l:"mortality in modern ICU era",     col:"C0392B" },
    { v:"60%",   l:"report fatigue at 1 year",        col:C.amber },
    { v:"67%",   l:"psychiatric sequelae (anxiety/depression)", col:"7D5BA6" },
  ];
  stats.forEach((st,i) => {
    const bx = 4.3 + i*1.42;
    rRect(s, bx, 0.95, 1.3, 1.4, C.card, 0.1);
    rect(s, bx, 0.95, 1.3, 0.06, st.col);
    s.addText(st.v, { x:bx,y:1.01,w:1.3,h:0.68,
      fontSize:24, bold:true, color:st.col, align:"center", fontFace:"Calibri", margin:0 });
    s.addText(st.l, { x:bx+0.06,y:1.68,w:1.18,h:0.62,
      fontSize:8, color:C.offwhite, align:"center", fontFace:"Calibri", margin:0 });
  });

  // MDT section
  s.addText("MULTIDISCIPLINARY TEAM", {
    x:4.3,y:2.46,w:5.5,h:0.3,
    fontSize:11, bold:true, color:C.sky, fontFace:"Calibri",
    charSpacing:2, margin:0,
  });

  const mdtRoles = [
    { r:"Neurologist",          d:"Immunotherapy, relapse monitoring" },
    { r:"Physiatrist (PM&R)",   d:"Rehab plan, disability staging" },
    { r:"Physiotherapist",      d:"Strength, gait, balance, respiratory" },
    { r:"Occupational Therapist",d:"ADLs, orthotics, return-to-work" },
    { r:"Speech-Language Path.",d:"Dysphagia, communication" },
    { r:"Psychologist",         d:"Depression, anxiety, PTSD, CBT" },
    { r:"Social Worker",        d:"Discharge, caregiver training" },
    { r:"Respiratory Therapist",d:"Ventilator weaning, chest PT" },
  ];
  mdtRoles.forEach((m,i) => {
    const col = i < 4 ? 0 : 1;
    const row = i < 4 ? i : i-4;
    const bx  = 4.3  + col * 2.78;
    const by  = 2.82 + row * 0.66;
    s.addShape(pres.ShapeType.ellipse, { x:bx, y:by+0.17, w:0.14, h:0.14,
      fill:{color:C.teal}, line:{color:C.teal} });
    s.addText(m.r, { x:bx+0.22,y:by, w:2.5,h:0.28,
      fontSize:10, bold:true, color:C.sky, fontFace:"Calibri", margin:0 });
    s.addText(m.d, { x:bx+0.22,y:by+0.29, w:2.5,h:0.28,
      fontSize:8.8, color:C.offwhite, fontFace:"Calibri", margin:0 });
  });

  // Key message banner
  rRect(s, 0.2,4.57,9.6,0.78, "0E2D4A", 0.1);
  rect(s, 0.2,4.57,9.6,0.06, C.orange);
  s.addText([
    { text:"Key Message: ", options:{bold:true, color:C.orange} },
    { text:"Early, structured multidisciplinary rehabilitation — from ICU to community — is the cornerstone of recovery in GBS. Carlos achieved full ambulation at 3 months with intensive inpatient + outpatient rehab.", options:{color:C.offwhite} },
  ], { x:0.35,y:4.64,w:9.3,h:0.7, fontSize:10, fontFace:"Calibri", valign:"middle", margin:4 });
}

// ── WRITE ──────────────────────────────────────────────────────────────────
pres.writeFile({ fileName:"/home/daytona/workspace/gbs-rehab-pptx/GBS_ClinicalCase_Rehabilitation.pptx" })
  .then(()=>console.log("DONE"))
  .catch(e=>{ console.error(e); process.exit(1); });
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