Role of Physiotherapy in Guillain Barre Syndrome (GBS)

PRABIN BASTOLA, PT

BPT, MPT( Neuroscience), PGPHHM

Guillain Barre Syndrome (GBS) is the most common form of neuromuscular paralysis. It is an autoimmune disease in which the body's immune system attacks part of the peripheral nervous system causing weakness and abnormal sensations in the arms and legs. Patchy areas of demyelination occur along peripheral nerves, nerve roots and myelin sheaths as a result of self-destruction, causing impaired function of nerve.  Most of patients of GBS are found to have had a preceding upper respiratory illness. However, some of patients with GBS have no identified preceding illness.  Infection with cytomegalic virus (CMV) and Campylobacter jejune has also been implicated in the some form of GBS. We are seeing that our country is facing surges in Guillain Barresyndrome (GBS) cases recently so it is our duty to know and make ourselves aware of the GBS.

The onset of GBS can be quite sudden and unexpected. It needs immediate hospitalization. It can develop over a few days. Or it may take up to several weeks with the greatest weakness occurring within the first couple of weeks after symptoms appear.

Symptoms of Guillain-Barre syndrome may include:

·         A pins and needles feeling in the fingers, toes, ankles or wrists.

·         Weakness in the legs that spreads to the upper body.

·         Unsteady walk or not being able to walk.

·         Trouble with facial movements, including speaking, chewing or swallowing.

·         Double vision or inability to move the eyes.

·         Severe pain that may feel achy, shooting or cramp like and may be worse.

·         Trouble with bladder control or bowel function.

·         Rapid heart rate. Early fatigue. Sensory impairments

·         Trouble breathing etc.

Typesof GBS

·         Acute inflammatory demyelinating Polyneuropathy (AIDP).

·         Miller Fisher syndrome (MFS).

·         Acute motor axonal neuropathy (AMAN) and acute motor-sensory axonal neuropathy (AMSAN) .

Physiotherapy in Guillain-Barre syndrome

Patient with suspected GBS should be admitted at hospital as early as possible. Multidisciplinary medical team starts the management of GBS with their respective approach. Physiotherapy, a part of multidisciplinary team in management of GBS aims to accelerate the recoveryand lessen the severity of the condition. Once the patient gets admitted to hospital Physiotherapy should be started as soon as possible along with other medical management. Physiotherapy should continue until patients have reached the maximum potential.

 Different type of physiotherapeutic intervention helps GBS patients by improving - Muscle strength,Mobility, Balance,Education , fitness and energy levels, posture,reducing  secondary complications such as muscle contractures and chest infections, early facilitation to activities of normal life. Physiotherapy also plays the major role in ICU by promoting early mobility, Neuro muscular facilitation, Respiratory muscle training and improving lung function and clearance. It also promotes early weaning of patient from mechanical ventilator and early discharge from hospital.

After discharge from the hospital physiotherapy should be continued under the supervision of Neuro-physiotherapist which can be done on the Physiotherapy centres or at the home. Nowadays the emerging facility of Tele-rehab can also be obtained for the patient of remote areas.