Guillain-Barré syndrome physical therapy

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

Overview

Guillain-Barré syndrome (GBS) is an acute, autoimmune, polyradiculoneuropathy affecting the peripheral nervous system, usually triggered by an acute infectious process. It is included in the wider group of peripheral neuropathies.

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Physical therapy

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• 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 minimise disability & maximise 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.

Immobilisation

• 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.