Indian Journal of Public Health Research & Development, April 2020, Vol. 11, No.

04  361

Effect of Sensory Motor Integration Technique on

Motor Dysfunction in Guillain-Barre Syndrome.

Sanket R. Thorat1, G. Varadhrajulu2, Suraj B. Kanase3

1
Intern, 2Dean, 3Associate Professor, Department of Neurosciences, Faculty of Physiotherapy,
Krishna Institute of Medical Sciences Deemed to be University, Karad, Maharashtra, India

Abstract
Background: Guillian-Barre syndrome (GBS) is an autoimmune disorder that affects motor as well as
sensory nerves. There is rapidly progressing muscle weakness typically pyramidal in distribution. Autonomic
nervous system is also involved in this condition. The recovery is slow thus physical therapy along with
medical management plays an important role. Sensory motor integration is a relationship between various
sensory inputs to produce desired motor response.

Objectives: Objectives of the study were to determine the effect of Sensory Motor Integration Technique On
Motor Dysfunction in GBS and to reduce the recovery time.

Material and Method: In this experimental study, 28 subjects with GBS were assessed with GBS disability
scale and subjects were given Sensory Motor Integration Technique along with medical treatment and other
therapies.

Results: Statistical analysis was done of GBS disability scalein 28 subjects in which it was seen that post
treatment there was very significant effect of Sensory Integration Technique. (p value- 0.002)

Conclusion: The current study concluded that there is a significant effect ofSensory Motor Integration
Technique On Motor Dysfunction in Guillain-Barre Syndrome. There was significant decrease in disability
in GBS patients after the intervention thus Alternate Hypothesis accepted.

Keywords:  GBS, Sensory Motor Integration, Physical Therapy, GBS disability scale, Disability.

Introduction paralysis and death.3 Acute inflammatory demyelinating

polyradiculoneuropathy (AIDP) is the most common
Guillian-Barre syndrome (GBS) is an autoimmune
type of GBS which primarily causes demyelination
disorder which involves peripheral nervous system and
with varing degrees of secondary axonal damage. Acute
is acute in onset.1 GBS is rapidly progressing motor
motor axonal neuropathy (AMAN) is the next most
disorder associated with absent reflexes.2 GBS varies in
common type of GBS which is primary considered
severity and in its severest form, could lead to respiratory
as axonal disorder affecting just the motor nerves and
causing motor symptoms.4 Axonal variants that involve
both sensory and motor symptoms are not seen much.4

It has shown that, with age, incidence of GBS could

Corresponding Author:
be more frequent and it is predominantly most common
Dr. Suraj B. Kanase
in males but some literature suggest that it is common in
Faculty of Physiotherapy, Krishna Institute of Medical
females.2,5
Sciences Deemed to be University, Karad, Maharashtra,
India GBS is caused due to a viral or an bacterial infection,
e-mail: drsurajkanase7@rediffmail.com may be precipitated by a vaccination, could be caused
362  Indian Journal of Public Health Research & Development, April 2020, Vol. 11, No. 04
after a major surgery due to several reasons or caused
by prolonged use of several drugs such as zimelidine.5
Studies have shown that Campylobacter jejuni, Epstein
Bar virus, Mycoplasma pneumonia and Cytomegalovirus
are the most frequent causative factors.2,5
The onset of the disease starts with sensory symptoms
in the distal extremities followed by rapidly progressive
distal weakness that spreads proximally.2 The weakness
seen GBS is typically pyramidal in distribution, for
example, ankle dorsiflexion and knee and hip flexion are
often severely affected and the weakness in the arms is
usually more severe in shoulder abduction and elbow
extension.2 Sensory symptoms commonly seen although
minor and include loss of vibration and proprioception.
Symptoms such as areflexia, myalgia, sphincter
disturbances and autonomic disturbances are commonly
seen in GBS.5
GBS is a monophasic disease. The neuropathy
typically begins 7–10 days after any triggering infection
with weakness reaching its most severity in 4 weeks
followed by a plateau phase and then followed by a
recovery phase. 60% of patients are able to walk unaided
by 12 months and the some patients are have various
degrees of residual symptoms.6 Mortality rate in GBS is
between 5 and 10 percent and the major causes of death
include infection, emboli and autonomic instability.2,7
GBS is medically managed by plasmaphereis,
steroid therapy and IgG 5 but supportive management has
been more effective in improving mortality in patients
with GBS with good ICU care and modern method of
ventilation. Passive movement of the extremities and
active physiotherapy including chest physiotherapy
once the initial acute stage commences, is seen to
very beneficial.2 Since much of the damage to nerves
occurs early in the course of the disease it may be more
effective to look at treatments capable of improving
nerve regrowth and regeneration with medical drugs as
well as newer physiotherapy management approaches.
Increased knowledge of GBS and its pathophysiology
may form a base for new, targeted and personalized
treatments that hopefully will improve the outcome for
the patients.8
Katz defines sensory integration as “an innate
neurobiological process in which the brain integrates
and interprets sensory stimuli in the environment”9
Sensory integration (SI) is the ability to organize
sensory information to make an adaptive response.10
Sensory input from the environment and from the
body provides information to the brain. The brain then
organizes, integrates, synthesizes and processes this
information to obtain appropriate response to stimuli.
The processing of information allows individuals to
receive sensory inputs and respond automatically,
efficiently and comfortably to it.10
There exists a relationship between motor responses,
sensory input and normal sensorimotor development
which will be helpful for providing a treatment approach
in GBS patients.
It has been noted that sensory system has facilitatory
or inhibitory influences on the motor systems. Motor
system needs inputs from various sensory systems.
Research shows that, sensory integration techniques
stimulates cutaneous sensations, proprioceptors, visual
component to produce the desired motor response.
Aim and Objectives:
Aim: To find the effect of Sensory Motor Integration
Technique On Motor Dysfunction in Guillain-Barre
Syndrome.
Objectives:
• To determine Effect of Sensory Motor Integration
Technique On Motor Dysfunction in Guillain-Barre
Syndrome.
• To reduce the recovery time and make patient
ambulatory while studying the effect of sensory
motor integration technique along with other
therapies given.
Materials and Methodology
• Type of study- Experimental study
• Study Design-Pre-test and post test
• Place of Study-Krishna hospital, Karad
• Sample formula – n= 4 X SD2/(X€)2
• Sample size- supposed to be 30
• Sampling Method-Consecutive sampling
• Study duration- 6 months
Materials Required:
• GBS disability scale.
 Indian Journal of Public Health Research & Development, April 2020, Vol. 11, No. 04  363
Selection Criteria: • Exercise session were given for 30-45 minwith rest
intervals for 4 days/week for a duration of 8-10
Inclusion Criteria:
weeks.
• Both Male and Female
• Sensory Motor Integration techniques were given
• Have neurological impairment secondary to GBS to these patients which included vestibular based
• Unable to ambulate more than 200 feet without activities including swiss ball and wobble board
assistive devices exercises along with assisstance, proprioception
exercises that included weight bearing with the help
• Able and willing to comply with the protocol of closed kinematic chain exercises such as mini
Exclusion Criteria: squats by holding the bar with assisstance and wall
pushups, stretching of major muscle groups was
• Recent of History of seizures also done, tactile stimulaton included prehension by
• Evidence of upper motor neuron involvement holding objects with different surface designs such
as soft ball and asking the patient to feel the pressure
• Any medical condition, including psychiatric
and use of ADL table, co ordination activities
disease, which would interfere with the interpretation
included throwing the ball, catching the ball, hitting
of the study monitors.
the ball, etc and cobmination of all these exercises
• Clinically diagnosed diabetic neuropathic were given to the patient along with visual and
individuals. auditory cues.
Outcome measures: Gullian Barre Syndrome • After the intended duration of treatment the efficacy
Disability scale of the treatment protocol in both the groups were
compared.
Procedure: Individuals with GBS were selected
on basis of inclusion and exclusion criteria. Informed • Post test assessment was taken after 4 weeks by
consent was taken from the patients. Subjects were using GBS disability scale.
assessed before starting with the protocol. Subjects will • Pre-test and Post-test, the data collection sheets
be explained about the procedure of the study. were filled and assessed.
• Subjects were selected through consecutive • Statistical analysis was done using appropriate
sampling. biostatistical tools.
• Pre test assessement was taken using GBS disability
scale.

Findings:

Table 1: Age Distribution

Study Variables N Minimum Maximum Mean Std. Deviation

Age (in Years) 28 18 40 29.71 6.26

Interpretation: Table 1 represent quantitative Table 2: Gender Wise Distribution of Study

study variables distribution among study population. Population.
Here minimum age of participants was 18 years and
maximum age of was 40 years, also average age of Gender Frequency Percent
29.71±6.26. M 15 54%
F 13 46%
Total 28 100%
364  Indian Journal of Public Health Research & Development, April 2020, Vol. 11, No. 04
Interpretation: Out of 28(100%) study participants 15(54%) were males and 13(46%) were females. [Seen in
Table 2]
Table 3: Gullian Barre Syndrome Disability scale
Sr.No. Parameter Pre-test
1. GBS Disability Scale 3.10±1.13
Result
Within the group statistical analysis (Table 3) shows
that there was significant decrease in GBS diability after
the intervention. The mean pre intervention was 3.10 ±
1.13 which significantly decreased to 2.07± 1.27 post
intervention.
Discussion
This study was conducted to study the effect
of Sensory Motor Integration Technique on Motor
Dysfunction In Guillain-Barre Syndrome. Guillian-Barre
syndrome (GBS) is an rapidly progressing autoimmune
motor disorder which is acute in onset and which involves
involvement of peripheral nervous system. GBS varies
in its severity, there are patients with mild to moderate
residual symptoms and in its severest form, it could
lead to respiratory paralysis and death.3 Griffin JW et al.
suggests that there are various types of GBS including
acute motor axonal neuropathy (AMAN) which is one
of the most common type of GBS-primary considered
as axonal disorder affecting just the motor nerves and
causing motor symptoms.4 The treatment approaches
used in this study will be more beneficial to such patients.
However the incidence of GBS is 1 in 100,000, thus due
to the limitations faced this study focuses on GBS as
a broad terminology and includes patients diagnosed
with GBS as a diagnosis. The causative factors of GBS
in these patients were not known but some presented a
history of previous infection.
The onset of the disease starts with sensory
symptoms in the distal extremities followed by rapidly
progressive distal weakness that spreads proximally.
Winer JB states that the weakness seen GBS is typically
pyramidal in distribution. Ankle dorsiflexion and knee
and hip flexion are often severely affected and the
weakness in the arms is usually more severe in shoulder
abduction and elbow extension. This in turn affect the
balance, posture and gait in these patients leading to
no or less motor control required for activities of daily
Post-test t value p value Inference
2.07±1.27 3.213 <0.002 Very Significant
living. Sensory symptoms commonly seen include loss
of vibration and proprioception which play an important
role in coordination and activation of neuromuscular
system. Symptoms such as areflexia, myalgia, sphincter
disturbances and autonomic disturbances were also seen
in severe cases of GBS.5
Winer JB also suggests that 60% of patients are able
to walk unaided by 12 months and the some patients
are have various degrees of residual symptoms.6 The
objective of this study was to enhance the recovery with
less time and make patient ambulatory with sensory
motor integration along with other therapies employed.
Ayres studied the relationship between motor
responses, sensory input and normal sensorimotor
development. She defined sensory integration (SI) as
the ability to organize sensory information to make an
adaptive response. Sensory integration (SI) is a term
that states combination of various sensory inputs to
get the desired motor response.5 Katz defines sensory
integration as “an innate neurobiological process in
which the brain integrates and interprets sensory stimuli
in the environment”9
The main aim of this study was to see the effectiveness
of sensory motor integration technique on motor
dysfunction in Guillain-Barre Syndrome. Objectives of
the study were to determine the effect of sensory motor
integration technique on motor dysfunction in guillain-
barre syndrome and to reduce the recovery time and
make patient ambulatory with sensory motor integration
technique along with other therapies already given.
30 individuals were selected over a period of 6
months and they participated in the study out of which
all individuals fulfilled the selection criteria but 28
individuals continued their participation in the study
for 8 weeks. Subjects were screened by Gullian Barre
Syndrome disability scale pre-test. Out of 28 individuals
15 were males and 13 were females. Male predominance
was seen. A study titled “Population incidence of
 Indian Journal of Public Health Research & Development, April 2020, Vol. 11, No. 04  365
Guillain-Barré syndrome: a systematic review and meta-
analysis, ” by J. J. Sejvar et al. supports this difference
noted, by suggesting that GBS is more common in male
population.11
Treatment included vestibular based activities
which were carried out with movable surfaces like
swiss ball or tilt board activities to stimulate the patient
affected with GBS and improve their righting reactions,
equilibrium and autonomic responses. These exercises
helped in improving balance, postural control, muscle
tone and co activation of different muscle groups. They
also promoted self control and security with movement.5
Also tactile based activities helped to facilitate body
image awareness and included deep or light pressure
input and self controlled tactile stimulation by
prehension exercises and use of objects with various
surface modifications. Various weight bearing activities
such as CKC exercises which included mini squats and
wall pushups followed by stretching of major muscle
groups stimulated proprioception and improved co
activation of muscle groups and body perception. Co-
ordination activities included kicking the ball, catching
ball, hitting a ball with a plastic bat and writing etc which
incorporated timing of responses, pairing of vision with
motor outcomes as well as muscle activation patterns
also improved. All sensory integration techniques were
combined and incorporated and the desired results were
obtained.5 Task related training plays an important role
in improving lower limb control which in turn enhances
walking performances12.
The treatment sessions were carried out for 4 days
per week for 8 weeks. Post 8 weeks Gullian Barre
Syndrome disability scale was again assessed among
the subjects. Outcome measures showed significant
difference among disability status. This was confirmed
using statistical analysis by using ‘Paired t- test’ for
within group comparison.
Within the group comparison, the Gullian Barre
Syndrome disability status pre treatment was 3.10±1.13
which changed to 2.07±1.27 (P value <0.0002)considered
very significant which showed small but significant
improvement in GBS patients. According to mean GBS
disability score, pre intervention the patients were able
to walk 10 meters across in an open space with help or
assistance and after the treatment session which patients
were able to walk 10 meters or more without assistance
in less period of time. Myalgia was also considerably
reduced and General Health of individuals was better
than pre-intervention. Patients were able to do activities
of daily living well due to the therapies employed.
Conclusion
This study found out that there is a significant effect
of Sensory Motor Integration Technique On Motor
Dysfunction In Guillain-Barre Syndrome. There was
significant decrease in disability in GBS patients after
the intervention.
Conflict of Interest: There is no conflict of interest
concerning the content of the study.
Source of Funding: This study was funded by
Krishna institute of medical sciences deemed to be
university karad.
Ethical Clearance: The study was approved by the
institutional ethics committee of KIMSDU.
References
1. Ted M. Burns, M D.Guillain Barre Syndrome.
Semin Neurol 2008; 28:152-167.
2. Winer JB. An update in guillain-barré syndrome.
Autoimmune Dis. 2014; 2014:793024.
doi:10.1155/2014/793024.
3. Haymaker WKJ, The Landry-Guillain-Barré
syndrome: a clinicopathologicic report of fifty fatal
cases and a critique of the literature. Medicine.
1949; 28:59–141.
4. Griffin JW, Li CY, Ho TW, et al. Guillain-Barré
syndrome in northern China: The spectrum of
neuropathological changes in clinically defined
cases. Brain,1995;118(3):577–595.
5. Glady Samuel Raj. Common Approaches in
Neurorehabilitation In: Glady Samuel Raj. Glady
Samuel Raj, 1st edn. New Delhi:Jaypee Brothers
Medical Publishers; 2006;296-98.
6. Winer JB, Hughes RAC, Osmond C. A prospective
study of acute idiopathic neuropathy, I. Clinical
features and their prognostic value. Journal
of Neurology Neurosurgery & Psychiatry,
1988;51(5):605–612.
7. Souayah N, Nasar A, Suri MFK, Qureshi AI.
National trends in hospital outcomes among patients
with Guillain-é syndrome requiring mechanical
ventilation. Journal of Clinical Neuromuscular
Disease. 2008;10(1):24–28.
8. Doets, Alex Y, Jacobs, Bart C, van Doorn, Pieter
366  Indian Journal of Public Health Research & Development, April 2020, Vol. 11, No. 04
A. Advances in management of Guillain–Barré
syndrome. Current Opinion in Neurology: October
2018;31(5) :541–550.
9. Young SN, Furgal K, Effectiveness and Implication
of Sensory Integration Therapy on School
Performance of Children with Learning Disabilities.
Int J Neurorehabilitation .29 Feb 2016;3:198.
10. Jorquera-Cabrera S, Romero-Ayuso D, Rodriguez-
Gil G, Triviño-Juárez JM. Assessment of Sensory
Processing Characteristics in Children between
3 and 11 Years Old: A Systematic Review.
Front Pediatr.30 Mar 2017;(5):57doi:10.3389/
fped.2017.00,057.
11. J. J. Sejvar, A. L. Baughman, M. Wise and O. W.
Morgan, “Population incidence of Guillain-Barré
syndrome: a systematic review and meta-analysis,”
Neuroepidemiology, 2011;36 (2):123–133.
12. Suraj Bhimarao Kanase G. Varadharajulu, Effect
of Task Related Training versus Conventional
Training on Walking Performances in Post Stroke
Patients. International Journal of Science and
Research (IJSR), Volume 3 Issue 11, November
2014.