PPhysiopedia Guillain-Barre Syndrome Introduction

Medical Management: The mainstay of medical management of patients with GBS is.

Plasmapheresis: In plasmapheresis, blood is removed from the body, the red and white blood cells are separated from the plasma and only the blood cells are returned to the patient. It is thought that removing the plasma eliminates some of the immune factors that are responsible for the disease progression. Plasmapheresis helps in following ways:

•Reducing the length of the illness

•Shortened time on mechanical ventilation

•Early ambulation

Intravenous immunoglobulins ( I.V.I.G): Immunoglobulins are given intravenously which shows a positive impact on the speed of recovery. But it has been shown to be less effective than plasmapheresis.

Physiotherapy Management: Aims of physiotherapy management are:

1.Regain the patient's independence with everyday tasks.

2.Retrain the normal movement patterns.

3.Improve patients posture.

4.Improve the balance and coordination

5.Maintain clear airways

6.Prevent lung infection

7.Support joint in functional position to minimize damage or deformity

8.Prevention of pressure sores

9.Maintain peripheral circulation

10.Provide psychological support for the patient and relatives.

Respiratory Care: The common respiratory complications in the rehabilitation setting include incomplete respiratory recovery including chronic obstructive pulmonary disease, restrictive respiratory disease (pulmonary scarring, pneumonia), and tracheitis from chronic intubation and respiratory muscle insufficiency. Sleep hypercapnia and hypoxia, which worsens during sleep can be the result of a restrictive pulmonary function.[18][19]

Treatment methods are:

•Night time saturation records with pulse oximeter and bilevel positive airway pressure (BiPAP) may be indicated for the patients.

•Physical therapy measures (chest percussion, breathing exercises, resistive inspiratory training) may be required to clear respiratory secretions to reduce the work of breathing.

•Special weaning protocol to prevent over fatigue of respiratory muscles can be recommended for more severe patients with tracheostomy. Patients with cranial nerve involvement need extra monitoring as they are more prone to respiratory dysfunction.

•Patients should be encouraged to cease smoking.

•Posturally drain areas of lung tissues, 2-hourly turning into supine or side lying positions.

•2-4 litre anesthetic bag can be used to enhance chest expansion. Therefore, 2 people are necessary for this technique, one to squeeze the bag and another to apply chest manipulation.

•Rib springing to stimulate cough.

•After the removal of a ventilator and adequate expansion, effective coughing must be taught to the patient.

Strength and Endurance training: Strengthening exercises can involve isometric, isotonic or isokinetic exercises, while endurance training involves progressively increasing the intensity and duration of functional activities such as walking or stair-climbing[20].

Functional training: Retraining of dressing, washing, bed mobility, transfers, and ambulation activities comprise a big part of the rehabilitation process. Balance and proprioception retraining in all these functional activities should also be included, while motor control can be achieved by doing Proprioceptive Neuromuscular Facilitation (PNF) techniques[20].