Guillain-Barre syndrome rehabilitation physical therapy

ls /home/daytona/workspace/ 2>/dev/null || echo "workspace empty"

~/gbs-rehab-ppt/gbs_rehab.js

const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// ─── Colour palette ────────────────────────────────────────────────────────
const DARK_BG   = "0D1F2D";   // deep navy  (dominant ~65%)
const MID_BG    = "1A3247";   // slightly lighter navy panel
const ACCENT    = "3ABFBF";   // teal accent
const ACCENT2   = "F4A261";   // warm amber highlight
const WHITE     = "FFFFFF";
const LTGRAY    = "D4E4EF";
const DIMGRAY   = "8BAFC7";

// ─── Image URLs ────────────────────────────────────────────────────────────
const imgUrls = [
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_3fc0b5f32487a3ddb44fdfcd0ab805e4dda970c46b4410fc976276f4e2166f98.jpg",  // early rehab / upper limb exercise
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_dd524c501db31e1fb1646f3dfc56be3328bce5179ef6a686f74588d8de88a195.jpg",  // pelvic bridging PT session
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_60a6ca2d41197bf5ee33d1c54758ad76ae6b406b84a8448274d18254b28958c5.jpg"   // recovery wheelchair → standing
];

// Fetch images as base64
let imgs;
try {
  const raw = execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ` +
    imgUrls.map(u => `"${u}"`).join(" ")
  ).toString();
  imgs = JSON.parse(raw);
} catch(e) {
  imgs = imgUrls.map(() => ({ base64: null, error: "fetch failed" }));
}

// ─── Presentation setup ────────────────────────────────────────────────────
const pres = new pptxgen();
pres.layout  = "LAYOUT_16x9";
pres.title   = "Guillain-Barré Syndrome – Rehabilitation";
pres.author  = "Orris Medical";
pres.subject = "Neurology / Rehabilitation Medicine";

// ─── Helper: dark navy background ─────────────────────────────────────────
function navyBg(slide) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: DARK_BG } });
}

// ─── Helper: accent top bar ────────────────────────────────────────────────
function topBar(slide, color = ACCENT) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.08, fill: { color: color } });
}

// ─── Helper: section heading pill ─────────────────────────────────────────
function pill(slide, text, x, y, w = 3.2, bgColor = ACCENT) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w, h: 0.38,
    fill: { color: bgColor }, rectRadius: 0.05
  });
  slide.addText(text, {
    x, y, w, h: 0.38,
    fontSize: 11, bold: true, color: DARK_BG,
    align: "center", valign: "middle", margin: 0
  });
}

// ─── Helper: divider line ─────────────────────────────────────────────────
function hLine(slide, x, y, w, color = ACCENT) {
  slide.addShape(pres.ShapeType.line, {
    x, y, w, h: 0,
    line: { color, width: 1.5 }
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 1 – Title slide
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);

  // Left teal panel
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: ACCENT } });

  // Large hero title
  s.addText("Guillain–Barré", {
    x: 0.45, y: 0.8, w: 9.1, h: 1.1,
    fontSize: 54, bold: true, color: WHITE,
    fontFace: "Calibri", charSpacing: 2
  });
  s.addText("Syndrome", {
    x: 0.45, y: 1.85, w: 9.1, h: 0.9,
    fontSize: 54, bold: true, color: ACCENT,
    fontFace: "Calibri", charSpacing: 2
  });

  // Subtitle bar
  s.addShape(pres.ShapeType.rect, { x: 0.45, y: 2.88, w: 5.5, h: 0.5, fill: { color: MID_BG } });
  s.addText("Rehabilitation: Assessment, Interventions & Recovery", {
    x: 0.45, y: 2.88, w: 5.5, h: 0.5,
    fontSize: 13, color: LTGRAY, italic: true, align: "center", valign: "middle", margin: 0
  });

  // Key fact box (bottom right)
  s.addShape(pres.ShapeType.roundRect, {
    x: 6.3, y: 3.5, w: 3.4, h: 1.8,
    fill: { color: MID_BG }, rectRadius: 0.1,
    line: { color: ACCENT, width: 1 }
  });
  s.addText([
    { text: "Key Facts\n", options: { bold: true, color: ACCENT, fontSize: 12 } },
    { text: "Incidence: ", options: { bold: true, color: LTGRAY, fontSize: 10 } },
    { text: "1–2 per 100,000/yr\n", options: { color: WHITE, fontSize: 10 } },
    { text: "Mortality: ", options: { bold: true, color: LTGRAY, fontSize: 10 } },
    { text: "~1–5% (modern ICU)\n", options: { color: WHITE, fontSize: 10 } },
    { text: "Recovery: ", options: { bold: true, color: LTGRAY, fontSize: 10 } },
    { text: "80% walk by 6 months", options: { color: WHITE, fontSize: 10 } },
  ], { x: 6.35, y: 3.55, w: 3.3, h: 1.7, valign: "middle", margin: 8 });

  // Image (early rehab patient)
  if (imgs[0] && !imgs[0].error) {
    s.addImage({ data: imgs[0].base64, x: 0.45, y: 3.5, w: 2.0, h: 1.8 });
  }

  // Bottom caption
  s.addText("Bradley & Daroff's Neurology in Clinical Practice | Rehabilitation Medicine", {
    x: 0, y: 5.4, w: 10, h: 0.22,
    fontSize: 7.5, color: DIMGRAY, align: "center", italic: true
  });

  topBar(s, ACCENT);
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 2 – Pathophysiology & Clinical Features
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);
  topBar(s);

  // Title
  s.addText("Pathophysiology & Clinical Features", {
    x: 0.4, y: 0.15, w: 9.2, h: 0.55,
    fontSize: 24, bold: true, color: WHITE, fontFace: "Calibri"
  });
  hLine(s, 0.4, 0.73, 9.2);

  // LEFT column – Pathophysiology
  pill(s, "PATHOPHYSIOLOGY", 0.35, 0.85, 2.7, ACCENT);
  const path_items = [
    "Autoimmune demyelination of peripheral nerves & spinal roots",
    "Molecular mimicry (post-infectious: Campylobacter, CMV, EBV)",
    "Axonal subtypes: AMAN & AMSAN (more severe, poor recovery)",
    "Complement-fixing Abs to peripheral nerve myelin (acute phase)",
    "Miller-Fisher variant: anti-GQ1b Ab (95–98% sensitivity)",
  ];
  s.addText(path_items.map((t,i) => ({
    text: t,
    options: { bullet: { indent: 15 }, color: i===0 ? WHITE : LTGRAY, fontSize: 10.5, breakLine: true }
  })), { x: 0.35, y: 1.3, w: 4.4, h: 2.5, valign: "top" });

  // RIGHT column – Clinical
  pill(s, "CLINICAL FEATURES", 5.0, 0.85, 2.7, ACCENT2);
  const clin = [
    { label:"Motor:",   val:"Progressive bilateral weakness (legs→arms)" },
    { label:"Reflexes:",val:"Areflexia / hyporeflexia (universal)" },
    { label:"Sensory:", val:"Paresthesias, mild sensory loss" },
    { label:"Cranial:", val:"Bifacial palsies; bulbar weakness" },
    { label:"Autonomic:",val:"Dysautonomia (BP swings, arrhythmias)" },
    { label:"CSF:",     val:"↑Protein, <10 cells/μL (albumino-cytologic dissociation)" },
  ];
  clin.forEach((c, i) => {
    s.addText([
      { text: c.label + " ", options: { bold: true, color: ACCENT2, fontSize: 10.5 } },
      { text: c.val,         options: { color: WHITE, fontSize: 10.5 } }
    ], { x: 5.0, y: 1.3 + i * 0.43, w: 4.65, h: 0.4 });
  });

  // Diagnostic criteria box at bottom
  s.addShape(pres.ShapeType.roundRect, {
    x: 0.35, y: 3.95, w: 9.3, h: 1.4,
    fill: { color: MID_BG }, rectRadius: 0.08,
    line: { color: ACCENT, width: 1 }
  });
  s.addText("DIAGNOSIS REQUIRES: ", {
    x: 0.5, y: 4.05, w: 9.0, h: 0.28,
    fontSize: 10, bold: true, color: ACCENT
  });
  s.addText(
    "Progressive weakness of both legs & arms  ·  Areflexia or hyporeflexia  ·  Supported by NCS (demyelination / conduction block)  ·  CSF albumino-cytologic dissociation",
    { x: 0.5, y: 4.32, w: 9.0, h: 0.9, fontSize: 10, color: LTGRAY, wrap: true }
  );

  // footer
  s.addText("Source: Bradley & Daroff's Neurology in Clinical Practice, Box 106.10", {
    x: 0, y: 5.48, w: 10, h: 0.14, fontSize: 7, color: DIMGRAY, align: "center", italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 3 – Acute Management & ICU Phase
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);
  topBar(s, ACCENT2);

  s.addText("Acute Management & ICU Phase", {
    x: 0.4, y: 0.15, w: 9.2, h: 0.55,
    fontSize: 24, bold: true, color: WHITE, fontFace: "Calibri"
  });
  hLine(s, 0.4, 0.73, 9.2, ACCENT2);

  // Three columns
  const cols = [
    {
      title: "IMMUNOTHERAPY",
      color: ACCENT,
      items: [
        "IVIg: 0.4 g/kg/day × 5 days (= PE efficacy)",
        "Plasma Exchange (PE): 4–6 sessions over 8–13 days",
        "NOT combined: no added benefit",
        "Steroids: no proven benefit in GBS",
        "Start within 2–4 weeks of symptom onset",
      ]
    },
    {
      title: "RESPIRATORY CARE",
      color: ACCENT2,
      items: [
        "Monitor FVC q4–8h; intubate if FVC <20 mL/kg",
        "25% of GBS patients require mechanical ventilation",
        "\"20-30-40 rule\": FVC<20, MIP<-30, MEP<40 cmH₂O",
        "Tracheostomy if ventilation expected >2 weeks",
        "Aggressive pulmonary toilet & positioning",
      ]
    },
    {
      title: "SUPPORTIVE CARE",
      color: "9B59B6",
      items: [
        "Cardiac monitoring (dysautonomia risk)",
        "DVT prophylaxis (LMWH + compression)",
        "Pain management (neuropathic: gabapentin/opioids)",
        "Nutrition (NG/PEG if dysphagic)",
        "Bladder/bowel care; pressure ulcer prevention",
      ]
    },
  ];

  cols.forEach((col, ci) => {
    const x = 0.25 + ci * 3.28;
    // header pill
    s.addShape(pres.ShapeType.roundRect, {
      x, y: 0.9, w: 3.1, h: 0.38,
      fill: { color: col.color }, rectRadius: 0.05
    });
    s.addText(col.title, {
      x, y: 0.9, w: 3.1, h: 0.38,
      fontSize: 10, bold: true, color: DARK_BG,
      align: "center", valign: "middle", margin: 0
    });

    col.items.forEach((item, ii) => {
      s.addShape(pres.ShapeType.rect, {
        x: x + 0.02, y: 1.38 + ii * 0.73, w: 3.06, h: 0.65,
        fill: { color: ii % 2 === 0 ? MID_BG : DARK_BG },
        line: { color: col.color, width: 0.5 }
      });
      s.addText(item, {
        x: x + 0.08, y: 1.42 + ii * 0.73, w: 2.94, h: 0.58,
        fontSize: 9.5, color: WHITE, wrap: true, valign: "middle"
      });
    });
  });

  s.addText("Source: Bradley & Daroff's Neurology in Clinical Practice | Miller's Anesthesia 10e", {
    x: 0, y: 5.48, w: 10, h: 0.14, fontSize: 7, color: DIMGRAY, align: "center", italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 4 – Rehabilitation Programme
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);
  topBar(s);

  s.addText("Rehabilitation Programme", {
    x: 0.4, y: 0.15, w: 9.2, h: 0.55,
    fontSize: 24, bold: true, color: WHITE, fontFace: "Calibri"
  });
  hLine(s, 0.4, 0.73, 9.2);

  // Phase timeline strip
  const phases = [
    { label: "PHASE 1\nAcute/ICU",     color: "C0392B", x: 0.3 },
    { label: "PHASE 2\nSubacute",       color: ACCENT2, x: 2.7 },
    { label: "PHASE 3\nInpatient Rehab",color: ACCENT,  x: 5.1 },
    { label: "PHASE 4\nCommunity/Home", color: "27AE60", x: 7.5 },
  ];
  phases.forEach(p => {
    s.addShape(pres.ShapeType.roundRect, {
      x: p.x, y: 0.82, w: 2.2, h: 0.52,
      fill: { color: p.color }, rectRadius: 0.06
    });
    s.addText(p.label, {
      x: p.x, y: 0.82, w: 2.2, h: 0.52,
      fontSize: 9, bold: true, color: WHITE,
      align: "center", valign: "middle", margin: 0
    });
  });

  // Rehab components – left panel
  const rehabRows = [
    { cat: "Physiotherapy",  items: "Passive ROM → active-assisted → progressive resistance exercises; breathing exercises; chest PT; gait re-training with parallel bars / walking aids" },
    { cat: "Occupational Tx",items: "ADL retraining (dressing, feeding, hygiene); splinting for foot-drop / wrist-drop; adaptive equipment; fatigue management strategies" },
    { cat: "Speech & Language",items:"Dysphagia screen → videofluoroscopy; modified textures; vocal cord exercises; AAC devices if severe bulbar involvement" },
    { cat: "Pain & Sensory", items: "TENS, hydrotherapy, mirror therapy; neuropathic pain meds (gabapentin, duloxetine); desensitisation programme" },
  ];

  rehabRows.forEach((r, i) => {
    const yBase = 1.5 + i * 0.88;
    s.addShape(pres.ShapeType.roundRect, {
      x: 0.3, y: yBase, w: 9.4, h: 0.8,
      fill: { color: i % 2 === 0 ? MID_BG : "152535" },
      rectRadius: 0.06
    });
    s.addText(r.cat, {
      x: 0.4, y: yBase + 0.05, w: 2.0, h: 0.7,
      fontSize: 10.5, bold: true, color: ACCENT, valign: "middle"
    });
    s.addShape(pres.ShapeType.line, {
      x: 2.45, y: yBase + 0.15, w: 0, h: 0.5,
      line: { color: ACCENT, width: 1 }
    });
    s.addText(r.items, {
      x: 2.6, y: yBase + 0.05, w: 7.0, h: 0.7,
      fontSize: 9.8, color: LTGRAY, wrap: true, valign: "middle"
    });
  });

  // PT image
  if (imgs[1] && !imgs[1].error) {
    // overlay small image top-right
    s.addImage({ data: imgs[1].base64, x: 8.0, y: 0.85, w: 1.7, h: 1.3 });
  }

  s.addText("Source: Bradley & Daroff's Neurology in Clinical Practice, Rehabilitation Chapter", {
    x: 0, y: 5.48, w: 10, h: 0.14, fontSize: 7, color: DIMGRAY, align: "center", italic: true
  });
}

// ═══════════════════════════════════════════════════════════════════════════
// SLIDE 5 – Outcomes, Prognosis & Key Take-aways
// ═══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  navyBg(s);
  topBar(s, ACCENT);

  s.addText("Outcomes, Prognosis & Key Take-aways", {
    x: 0.4, y: 0.15, w: 9.2, h: 0.55,
    fontSize: 24, bold: true, color: WHITE, fontFace: "Calibri"
  });
  hLine(s, 0.4, 0.73, 9.2);

  // Outcome stats – 4 tiles
  const stats = [
    { num: "~80%",   desc: "walk independently\nby 6 months",   col: ACCENT  },
    { num: "1–5%",   desc: "mortality (modern\nICU care)",       col: "C0392B"},
    { num: "~20%",   desc: "persist. disability\nat 1 year",     col: ACCENT2 },
    { num: "5–10%",  desc: "relapse (CIDP\noverlap)",            col: "27AE60"},
  ];
  stats.forEach((st, i) => {
    const x = 0.3 + i * 2.38;
    s.addShape(pres.ShapeType.roundRect, {
      x, y: 0.88, w: 2.15, h: 1.5,
      fill: { color: MID_BG }, rectRadius: 0.1,
      line: { color: st.col, width: 2 }
    });
    s.addText(st.num, {
      x, y: 0.95, w: 2.15, h: 0.75,
      fontSize: 32, bold: true, color: st.col,
      align: "center", valign: "middle"
    });
    s.addText(st.desc, {
      x, y: 1.7, w: 2.15, h: 0.65,
      fontSize: 9.5, color: LTGRAY,
      align: "center", valign: "middle", wrap: true
    });
  });

  // Prognostic factors
  s.addShape(pres.ShapeType.roundRect, {
    x: 0.3, y: 2.52, w: 4.4, h: 2.8,
    fill: { color: MID_BG }, rectRadius: 0.08,
    line: { color: ACCENT, width: 1 }
  });
  pill(s, "POOR PROGNOSTIC FACTORS", 0.3, 2.52, 4.4, ACCENT);
  const poorProg = [
    "Rapid onset (<7 days to nadir)",
    "Preceding Campylobacter jejuni infection",
    "AMSAN / axonal subtype",
    "Advanced age (>60 years)",
    "Mechanical ventilation required",
    "MRC sum score <40 at nadir",
    "Absent sural nerve SNAP",
  ];
  s.addText(poorProg.map((t,i) => ({
    text: "▸  " + t,
    options: { color: i < 2 ? "FF6B6B" : LTGRAY, fontSize: 10, breakLine: true }
  })), { x: 0.45, y: 3.0, w: 4.15, h: 2.2, valign: "top" });

  // Key take-aways
  s.addShape(pres.ShapeType.roundRect, {
    x: 4.9, y: 2.52, w: 4.8, h: 2.8,
    fill: { color: MID_BG }, rectRadius: 0.08,
    line: { color: ACCENT2, width: 1 }
  });
  pill(s, "REHABILITATION TAKE-AWAYS", 4.9, 2.52, 4.8, ACCENT2);
  const takeaways = [
    "Early mobilisation (even in ICU) prevents deconditioning",
    "Multidisciplinary team: physio + OT + SLP + psychology",
    "Progressive resistance bands q1h even while bed-resting",
    "Fatigue is prominent — pace activities; energy conservation",
    "Community re-integration & driving assessment at discharge",
    "Long-term follow-up: CIDP exclusion, pain, mental health",
  ];
  s.addText(takeaways.map((t,i) => ({
    text: "✓  " + t,
    options: { color: i % 2 === 0 ? WHITE : LTGRAY, fontSize: 9.8, breakLine: true }
  })), { x: 5.05, y: 3.0, w: 4.55, h: 2.25, valign: "top" });

  // Recovery image
  if (imgs[2] && !imgs[2].error) {
    s.addImage({ data: imgs[2].base64, x: 8.2, y: 0.88, w: 1.5, h: 1.5 });
  } else if (imgs[0] && !imgs[0].error) {
    s.addImage({ data: imgs[0].base64, x: 8.2, y: 0.88, w: 1.5, h: 1.5 });
  }

  s.addText("Sources: Bradley & Daroff's Neurology | Robbins & Kumar Basic Pathology | Medical Microbiology 9e", {
    x: 0, y: 5.48, w: 10, h: 0.14, fontSize: 7, color: DIMGRAY, align: "center", italic: true
  });
}

// ─── Write file ────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/gbs-rehab-ppt/GBS_Rehabilitation.pptx" })
  .then(() => console.log("✅  Saved: /home/daytona/workspace/gbs-rehab-ppt/GBS_Rehabilitation.pptx"))
  .catch(e => { console.error("❌ Error:", e); process.exit(1); });