Guillain-Barré syndrome physical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Abhishek Singh, B.P.T [2]

Overview

Following the acute phase, the patient may also need rehabilitation to regain lost functions. This treatment will focus on improving ADL (activities of daily living) functions such as brushing teeth, washing and getting dressed. Depending on the local structuring on health care, there will be established a team of different therapists and nurses according to patient needs. An occupational therapist can offer equipment (such as wheel chair and cutlery) to help the patient achieve ADL independence. A physiotherapist would plan a progressive training programme, and guide the patient to correct, functional movement, avoiding harmful compensations which might have a negative effect in the long run. There would also be a doctor, nurse and perhaps a speech trainer involved, depending on the needs of the patient. This team contribute with their knowledge to guide the patient towards his or her goals, and it is important that all goals set by the separate team members are relevant for the patient's own priorities. After rehabilitation the patient should be able to function in his or her own home and attend necessary training as needed.

Physical Therapy

• The main aim of rehabilitation is to restore and maintain person's functional independence.

• Rehabilitation utilises a multidisciplinary team approach including physiotherapist,occupational therapist,nurse,social worker.

• Encouraging active patient & family education & participation using a time based,goal focused,functional approach to minimize disability & maximize function & community participation.

• A common scenario for a patient with severe Guillain-Barre syndrome(GBS)would be inpatient rehabilitation for 3-4 weeks followed by home based rehabilitation for 3-4 months.

Respiratory Complications

• Physical Therapist(PT) work are to clear respiratory secretions to reduce the work of breathing & this is attained by breathing exercise,chest percussion,shaking,vibration,resistive inspiratory training & postural drainage.

Deep Vein Thrombosis

• Pulmonary Embolism has been reported in 1/3rd of patients with GBS.

• In rehabilitation setting, patients are encouraged to wear compression stockings.

• Encouraged to perform active movements as much as possible.

• Progressive mobilisation protocols such as improving bed mobility,safe transfer technique like bed to chair & chair to commode with or without adaptive equipment.

• Patients lie in Trendelenburg Position-body is laid in supine position with feet higher than head by 15º-30º.

Dysautonomia

• Toning muscles especially in the legs does help in increasing blood flow to the heart.Leg exercises involving ankle weights & bands should be done.

• Do isometric or active exercises in your bed or on floor.

• Hydrotherapy can be effective.The water helps blood flow & allow body to be in a balanced state.

• Use of Compression stockings.

• Dysautonomia can cause early lower motor bladder & bowel involvement.So strengthning of muscles around bladder & pelvic floor muscle exercise or Kegel Exercises.

Immobilization

• A tilt table for immobilised patients can be effectively used in rehabilitation units.
• PT includes a graduated mobility program which includes:
  • Maintenance of posture & alignment.
  • Maintenance of joint range of movement by doing active,passive or active assisted exercises.
  • Prevention of plantar contracture with the help of ankle foot orthosis.
  • Improving endurance by giving low resistance exercises(few repetition).
  • Strengthning different muscle groups & improving flexibilty with progressive ambulation program that starts with bed mobility techniques,use of wheelchair & ends with patients walking independently(if possible) or using adaptive gait aids like crutches,frames etc.
  • Pressure sores-Patient/partner/carer education in skin care & continuous posture changes to release body pressure is essential.
  • Heterotopic ossification can be prevented by early aggresive joint range of motion exercise & mobilisation.