Definition

Guillain-Barre Syndrome refesr to an acute inflammatory demyelinating polyneuropathy. This means that the onset is sudden, there is inflammation which destroys the coverings (myelin) of multiple nerves (polyneuropathy). Demyelination takes places in the peripheral and cranial nerves. It should be noted that there are variants called axonal variants, e.g Miller-Fisher variant (which may present with ophthalmoplegia, ataxia, areflexia,little or no weakness, association with a specific antiganglioside antibody). This syndrome mainly affect the motor component of the nervous system.

The paralysis of the muscles may include bulbar musculature and respiratory muscles. This calls for emergency treatment in the intensive care unit (ICU) . Recovery takes place via axonal regeneration annd re-myelination.

Causes

GBS causes are not well understood but sufferers usually may have had an infection in the previous weeks. This autoimmune process may be triggered by different things called GBS precipitants. The preciptants may include:

    Viruses
  • Cytomegalovirus
  • Epstein-Barr virus
  • HIV
  • Bacteria
  • Mycoplasma pneumonia
  • Campylobacter jejuni
  • Sometimes it may be precipitated by vaccines such as swine influenza or soome surgical procedures.

Before diagnosing someone of GBS, think of the following differentials possible:

  • Acute spinal cord lesion
  • Poliomyelitis
  • Other acute neuropathies, e.g. due to porphyria, vasculitis, drugs, toxins, e.g. lead
  • Myasthenia gravis
  • Botulism
  • Brainstem infarct
  • Severe myopathy
  • Hysteria, malingering

Signs and Symptoms

Symptoms of GBS are from distal to proximal

    Sensory disturbances:
  • Pain is variable on motor points in muscles and nerve trunks
  • Glove and stocking pattern of sensory loss
  • Autonomic Function Disturbances:
  • Labile blood pressure
  • Cardiac arrhythmias
  • Decreased tone and reflexes
  • Motor Disturbances:
  • Progressive ascending limb weakness
  • Paralysis of legs and arms
  • Drooling
  • Dysphagia (difficult swallowing)
  • Slurred speech
  • Respiratory muscle weakness or paralysis
  • Shortness of breath (dyspnoea)
  • Fatigue
The condition may reach it's peak within hours or in less than or equal to a month. GBS victims may die due to paralysis of respiratory muscles.

Medical Management:

  • Mechanical Ventilation
  • Plasmapheresis
  • Injection with Immunoglobulins. A high-dose intravenous immunoglobulins (usually five daily infusions)
  • Anticoagulants e.g lower molecular heparin as antithrombosis prophylaxis
  • Parenteral feeding if swallowing is impaired

Physiotherapy Management

Physiotherapy Management During Acute Stage:

  • Respiratory care
  • Musculoskeletal:Joint protection, Maintenance Joint movement and soft tissue length
  • Skin: positioning & circulatory exercises
  • Circulation: Prevent DVT & Hypotension
  • Psychological support: family and patient

Physiotherapy Management During Plateau Stage:

It is very important to assess the patient and determine treatment priorities.
  • Chest care
  • Joint range
  • Muscle strength – central stability
  • Sensory awareness & Balance re-education
  • Activities of daily living
  • Prescritpion of orthosis
  • Forming motivational groups

5–10% of patients die, as a result of cardiac dysrhythmia, pulmonary embolism or sepsis. Advanced patient age, fast onset of weakness, need for ventilation, preceding diarrhoeal illness, antiganglioside antibodies, and significant axonal degeneration presence on the electrophysiological parameters indicate poor prognosis.

References:

  • Lionel Ginsberg (2010). Lecture Notes: Neurology. 9th Edition. Wiley-Blackwell. West Sussex, UK
  • Conomy JP Braatz JH 1971 Guillain-Barre Syndrome: The Physical Therapist and Patient Care. Physical Therapy 51 (5): 517 – 523
  • Downie PA 1986 Cash’s Textbook of Neurology for Physiotherapists, 4th edn. pp445-457.Faber and Faber
  • Herbison GJ Jaweed MM Ditunno 1983 Exercise Therapies in Peripheral Neuropathies. Arch Phys Med Rehabil 64: 201 - 204
  • Meythaler M 1997 Rehabilitation of Guillain Barre Syndrome. Arch Phys Med Rehabil 78: 872 – 879


Cardiopulmonary Physiotherapy
Chimwemwe Masina, PT

Author: Chimwemwe Masina

Chimwemwe Masina is currently working as a Resident Physiotherapist at DDT College of Medicine in Gaborone, Botswana. Before joining DDT College of Medicine, he worked in the Ministry of Health at Kamuzu Central Hospital in Malawi, MagWaz Physiotherapy and Wellness Services in Lilongwe, Malawi. as well as Volunteering at Physiopedia.
His interest is in Neuromusculoskeletal Physiotherapy and currently he is an assisting lecturer in Manual Therapy and Lumbar Spine Management.

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