Guillain-Barre Syndrome: PT Management

• PT Management of Guillain-Barre Syndrome is the focus of PT 834 Adult Neuromuscular Dx & Management, Spring 2025.

Guillain-Barre Syndrome

• It is an acute inflammatory demyelinating polyradiculoneuropathy.
• It is the most common form of inflammatory demyelinating neuropathies.
• It affects nerve roots and peripheral nerves.

Examination Components

• Includes a history of the pattern and sequence of symptoms, plus any recent illnesses.
• Motor function observation includes assessing symmetry of muscle bulk/wasting and function.
• Manual Muscle Testing (MMT) can identify patterns of weakness and assess disease progression or recovery.
• Fasciculation can be observed for presence or absence.
• Examination of motor function also includes cranial nerves, respiratory function, range of motion, muscle tone, reflexes, and balance/postural control.
• Evaluation of the sensory system includes identifying patterns of sensory loss or changes, using a body chart, and identifying specific sensory loss and pain types.
• Autonomic changes can be monitored by assessing blood pressure, heart rate, and bowel and bladder function.
• Current functional status is assessed by evaluating bed mobility, transfer ability, reaching and grasp, self-care abilities, and gait/locomotion.

Outcome Measures

• Assessments should be used for impairment, activity and participation level.
• The GBS Disability Scale (modified Hughes scale) can describe functional status along a 6-point scale.

General Interventions

• May include respiratory/dysphagia treatments and pain management via TENS or desensitization techniques.
• Positioning, ROM/stretching, massage, and sensory reintegration can be implemented.
• Therapeutic exercise program includes progressive active exercise, strengthening, and aerobic training.
• Functional training includes BWSTT and task-oriented practice.
• Adaptive equipment/orthoses, psychosocial support, and patient/family/caregiver education can improve outcomes.

Monitoring and Re-examination

• Serial negative changes or plateaus in motor, sensory, or respiratory impairments or functional status may indicate a relapse.
• If symptoms recur, activity should stop immediately.
• The patient also may need medical reassessment, especially if respiratory insufficiency is present.

Acute/Early Progressive Phase Interventions

• Focus on resolving respiratory and dysphagia impairments.
• Pain should be minimized.
• Prevent contractures, decubitus ulcers, and injury to weak/denervated muscles.
• Active exercise should be limited to movements the patient can make without pain or excessive fatigue.
• Adaptive devices/slings can be used to support limbs.
• Begin upright activities with a gradual sitting program

Chronic/Recovery Phase Interventions

• Begins after plateau of disease process and recovery.
• Incorporate muscle strengthening with a slow, graduated active exercise program.
• Use low-resistance exercise, low reps, and high frequency of short periods of exercise initially.
• Strictly avoid antigravity strain on muscles until strength improves to 3/5.
• Frequent rest periods are needed, plus monitoring for fatigue and overwork weakness.
• Progress to moderate to high intensity exercise as strength and exercise tolerance increase.
• Use functional training in these interventions.

Exercise Precautions

• Excessive exercise during early reinnervation can lead to further damage.
• Avoid muscle fatigue/overuse, and stop exercise at first signs of fatigue or muscle ache.
• Monitor for 3-7 days for any increased weakness, muscle spasm, or soreness before further progression.
• If weakness or soreness is present after exercise, do not repeat the activity for several days.
• Reinitiate exercise at a lower level of resistance or reps and increase gradually.

Additional Exercise Recommendations

• Submaximal exercise, low repetitions, and exercising few times a week should be considered (Bassile, 1999).
• Rotate muscle groups worked.
• Offer both concentric and eccentric training of specific muscles.
• Eccentric training can be used only if all muscles have returned to antigravity strength.
• Aerobic training beginning with minimal intensity and progressing to moderate intensity can improve outcomes.
• Incorporate functional activity training.

Neuromuscular Rehabilitation Phases

• A 2021 review indicates physical therapy in the acute phase of GBS is important for preventing muscle shortening and joint contractures.
• Patients may still improve their physical function several years after the onset of GBS.
• High-intensity multidisciplinary rehabilitation and exercise improves activity and participation in the late and chronic stages.
• Electrical stimulation and virtual motor rehabilitation seem like feasible methods in the acute and late-stage recovery of GBS, but the efficacy needs to be explored.