GUILLAIN-BARRE SYNDROME

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Guillain-Barré syndrome (GBS) is an acute, frequently severe, and fulminant polyradiculoneuropathy that is autoimmune in nature. Several subtypes of GBS are recognized, as determined primarily by electrodiagnostic (Edx) and pathologic distinctions. The most common variant is acute inflammatory demyelinating polyneuropathy (AIDP). Additionally, there are two axonal variants, which are often clinically severe—the acute motor axonal neuropathy (AMAN) and acute motor sensory axonal neuropathy (AMSAN) subtypes. In addition, a range of limited or regional GBS syndromes are also encountered. Notable among these is the Miller Fisher syndrome (MFS), which presents as rapidly evolving ataxia and areflexia of limbs without weakness, and ophthalmoplegia, often with pupillary paralysis.

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IMPAIRMENTS

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BODY STRUCTURES

1. Demyelination of peripheral nerves

2. Damage to the axons

3. Denervation of the muscles

 

BODY FUNCTIONS

1. Pain​

2. Weakness/Paralysis

3. Fatigue

4. Paraesthesia

5. Dysesthesia

6. Reduced range of motion

7. Reduced nerve conduction velocity

8. Dysphagia

9. Impaired respiratory functioning

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GOALS

• Short Term

1. To maintain bronchial hygiene

2. Facilitate in resolution of dysphagia

3. To reduce pain

4. To prevent bed sores, contractures, injury to weakened or denervated muscles.

5. To make the patient functionally independent

6. To help prevent fatigue

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• Long Term​

1. To maintain all short term goals.

2. To improve strength, endurance(Musculoskeletal and Cardiopulmonary)

3. To improve sensory functioning

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MANAGEMENT

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To maintain bronchial hygiene

• Airway Clearance techniques

  • ACBT

  • Autogenic drainage

  • Postural Drainage with Chest PT

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Facilitate in resolution of Dysphagia

• Refer to a speech therapist

• Refer to a occupational therapist​

• Treatment is focused on positioning, head control, and oral-motor coordination (e.g., sucking an ice cube. stimulating the gag response. facilitating swallowing with pressure on neck and thyroid notch timed with intent to swallow).

  • Thick liquids with conscious swallowing

  • Followed by thin liquids

  • Followed by semi solid food

  • Crumbly or stringy food to be avoided. No talking or distracting the patient during​ eating.

  • Therapist should be prepared to use Heimlich Maneuver

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To reduce pain

• Transcutaneous Electrical Nerve Stimulaton​

• Phonophoresis with Capsaicin

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To prevent bed sores, contractures, injury to weakened or denervated muscles.

• Positioning program

  • Spread pressure over wide surfaces.

  • Sheepskin-type protection for pressure relief​

• Sustained Passive Stretch​

• Ankle Foot Orthosis

• Ankle Toe Movements

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To make patient functionally independent

• Improve range of motion

  • Stretching​

  • Continuous Passive Motion​

• Improve strength​

  • Passive range of motion exercises till remyelination starts​

  • Active exercises after remyelination occurs​​

• Proprioceptive Neuromuscular Facilitation with resistance​

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To help prevent fatigue

• Activity Pacing

• Energy conservation exercises

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To improve strength, endurance(Musculoskeletal and Cardiopulmonary)

• Low Intesity Aerobic exercises

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To improve sensory functioning

• Sensory Integration therapy

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REFERENCES

Neurological Rehabilitation-Darcy Umphred
Harrison's Principles of Internal Medicine
Therapeutic Exercises-Kisner and Colby

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