GUILLAIN BARRE SYNDROME REHABILITATION

Guillain-Barre Syndrome physiotherapy should begin as soon as symptoms appear, frequently upon hospital admission. It should continue till the maximum possible level of recovery and outcome is achieved.

The extent of the disease's progression and the body regions that are affected indicate how much rehabilitation is required.

For a patient with severe GBS, a typical treatment plan would involve 3-6 weeks of inpatient rehab followed by 3–4 months of community and home-based therapy.

Physiotherapy is important in facilitating the restoration of muscle strength, limb control, balance, and coordination later, as the patient starts to regain limb control. Physiotherapy solely rehabilitates the muscles, focusing on functional restoration and stamina building; it has no impact on the nerve repair process.

REHABILITATION

• Monitor respiratory and cardiac function, prevent secondary complication and disease progression, and initiate physical rehabilitation
• When a patient is in a serious condition, this may include respiratory physiotherapy after ventilation and passive limb motions to maintain joint ranges of motion and muscle flexibility while they are immobile in bed. 
• Being a frequent symptom in illnesses involving the PNS, fatigue is reportedly the most immobilizing and difficult condition to treat during rehabilitation.

PHASE I

It is a phase when the patient is admitted in Hospital

Physical therapy plays a role  in the monitoring of the following complications during the acute phase of GBS: respiratory abnormalities, respiratory muscle weakness, contractures, deep vein thrombosis (DVT), dysautonomic diseases such orthostatic hypotension caused on by immobility, and sensory impairments. 

GOAL 

• Respiratory care 

SUCTIONING 

ACBTs

PERCUSSION 

INCENTIVE SPIROMETRY

• Prevent From Decubitus Ulcer 

POSITIONING

• Prevent From Contracture Formation 

RANGE OF MOTION EXERCISES

• Prevent DVT 

ANKLE PUMPING EXERCISES

LOWER EXTREMITY ELEVATED

• Maintain Peripheral Circulation 

PASSIVE ROM

• Assist In Swallowing

POSITIONING ( Keep Head Upright With Slight Extension 45 Degree)

The use of moderate range of motion (ROM), patient positioning, and the prescription of orthotics are all used to prevent joint contractures. Depending on the patient's capacity, these procedures can be done passively or actively .

• Using verbal cues from the therapist, the patient is urged to help with mobility.
• The patient engaged in bed mobility exercise, rolling from supine to side-lying with maximum assist +2.

• The patient shifts from being supine to sitting at the edge of her hospital bed once their muscle strength reaches Grade +3.

• Patient was instructed to maintain balance while sitting up straight so that their core could stabilize. Stretching and lower extremity ROM activities were also carried out in this position.

PHASE II

When the patient maintains respiration

• Continued with the same physical therapy schedule, with two 30-minute sessions performed in the morning for transfers, gait, and functional training, and in the afternoon for strengthening and endurance to avoid fatigue.
• With some assistance from the physical therapist and the use of her upper extremities, the patient completed log rolling and supine to sit transfers with the aid of bed rails.

• A sit-to-stand lift is used in conjunction with occupational therapy during a cotreatment session to promote simultaneous use of the upper and lower extremities as well as sustained weight bearing through the lower extremities.

• Ankle pumps against resistance, heel slides, long arc quads, glute sets, straight leg raises, and sit-to-stands were among the lower body strengthening exercises. At this point, active resistance exercises against gravity may be carried out without a therapist's help.

• The patient's ability to go from their wheelchair to standing in parallel bars with the help of their upper extremities allowed the sit to stand transfer training to progress significantly.

PHASE III

Patient have good strength in the muscle

• Prior to increasing resistance, the number of repetitions was increased to advance strength and endurance.
• The patient quickly improved her standing balance while using the parallel bars with the contact guard aid without using her upper extremities as assistance.

• With no physical assistance, bed mobility exercises continued with transfers from supine to side lying, supine to sitting, supine to prone, and prone to quadruped, although verbal cues were still necessary for lower extremities due to proprioception impairment.

• Exercises for strengthening the lower extremities proceeded, with a focus on gradual, controlled concentric and eccentric movements.

• With the purpose of enhancing proprioception and coordination, the patient was told to focus only on their legs while exercising.
• Standing dynamic balancing exercises were still being performed and improved by the patient.

STANDING BALANCE

BODY CIRCLE SWAY

SIDE STEPPING

TANDEM WALKING 

SINGLE LEG STANCE BALANCE

FORWARD REACHED USING HIP STRATEGY

• Once this is accomplished, move on to performing stair ambulation while using a single handrail, a contact guard, and a step-to-gait pattern. Patient can walk up and down a flight of stairs without getting tired and needing a break.

• To ensure that the patient could get up off the floor in the case of a fall, floor transfers were initiated.

Outcomes for GBS patients were based on quantitative assessments such as FIM scores, lower extremity strength, and range of motion. Their development is also determined by their capacity for performing functional activities, such as ambulation, transfers, bed mobility, and the frequency of required rest periods.