Physical  

Therapy  Management  of  a  Pa5ent  with  Guillain-­‐Barre  Syndrome  

during  and  a>er  Pregnancy:  A  Case  Report

S  Kou,  BS,  DPT  Student,  University  of  New  England

Background Evalua5on Goals

               Guillain  Barre  Syndrome  (GBS)  is  a  disorder  in  which  the  
body’s  immune  system  aNacks  part  of  the  peripheral  nervous  
system.1  The  cause  of  GBS  is  s5ll  unknown,  with  suspicions  of  
viral  or  bacterial  infec5on  preceding  diagnosis.2  It  can  affect  
people  of  all  ages,  gender,  or  ethnic  background,  with  equal  
incidence  rates  in  both  men  and  women.  The  incidence  rate  
for  GBS  is  rare,  affec5ng  1-­‐2  persons  in  100,000  annually.3  
               Usually  begins  with  distal,  symmetrical,  onset  of  
paraesthesia,  followed  by  progressive  limb  weakness.3  Pain  is  a  
common  symptom,  typically  described  as  a  deep  ache  or  
cramp  in  the  buNocks,  thighs,  or  between  the  shoulders.4  Most  
Outcome
pa5ents  eventually  reach  a  full  or  nearly  full  recovery  with  the  
ability  to  walk  unassisted  a>er  3  months  and  only  minor   Outcome'Measures' • Higher  scores  for  both  tests  
indicate  beNer  outcomes.
residual  symptoms  by  the  end  of  the  first  year  a>er  onset.4 120&
100/100& • Modified  Barthel  Index  
100&
84/100&
80&
improved  from  moderate  
dependence  with  ADL/IADLs  

Score'
56/56& Pre9pregnancy'
60&
Post9pregnancy' to  complete  independence.  
40& 32/56&
• Berg  Balance  Scale  depicts  
20&
an  ini5al  medium  fall  risk  to  
0&
Modified'Barthel'Index' Berg'Balance'Scale' no  fall  risk  at  discharge.  

• Timed  Up  and  Go  Test  (TUG)   Fall$Risk$

shows  dras5c  improvement   18# 17#sec#

in  walking  speed,  from  high   16#

Home  Exercise  Program

14#

fall  risk  to  no  fall  risk.   12#
• Increased  distance  walked   10#

Time$

Pre4pregnancy$
8#

Image  taken  from:  hNp://cpreplab.weebly.com/guillain-­‐barreacute-­‐syndrome.html

per  second  indicate  a  beNer   6# 5.13#sec# Post4pregnancy$

score  for  Gait  Speed.  Best   4#

0.97#m/s#

Purpose predictor  of  fall  risk.   2#

0#
TUG$
0.4#m/s#

Gait$Speed$

               There  is  currently  no  detailed  descrip5on  of  PT   • Numeric  Pain  Ra5ng  Scale  
Self.Assessments%
management  for  GBS  in  pregnancy  in  the  literature.  The   Sidelying  Hip   (NPRS)  is  a  subjec5ve  
Walking   Sit  <  >  Stand   Hip  Flexor  Stretch     Gastrocnemius  -­‐  Soleus  Stretch    Kick  Backs   Clamshells   Bridges   Abduc?on   Tricep  Dips   14% 13/20%
measure  that  ranks  pain  
ra5onale  of  this  case  report  is  to  describe  a  comprehensive   12% 10.5/20%
from  no  pain  (lower  score)  to  
program  focused  around  the  concept  of  func5onal-­‐based   10%
worst  pain  (higher  score).  
8%

Ra(ng%
interven5ons  to  assist  a  pa5ent  with  GBS  before  and  a>er   Pre.pregnancy%
• Rate  of  Perceived  Exer5on  is  

Interven5ons
6%
Post.pregnancy%
a  subjec5ve  scale  used  to  
pregnancy  to  regain  independence  and  safety  to  complete   4%
2/10% measure  intensity  of  exercise  
2%
daily  and  work-­‐related  ac5vi5es. 0%
0/10% from  none  (6/20)  to  maximal  
NRPS% RPE% (20/20).  

Case  Descrip5on
               SJ  was  a  healthy,  very  ac5ve  27-­‐year-­‐old  female   Discussion
hospitalized  at  25.5  weeks  of  gesta5on  (GW)  a>er  onset  of  BLE  
weakness  and  an  inability  to  walk  unassisted.                  The  significance  of  this  case  report  was  the  rare  
               Past  medical  history  included  gravida  3,  para  2  with  one   opportunity  to  document  the  outcome  of  a  PT  interven5on  for  
s5llbirth  at  34  GW.  Non-­‐smoker  and  a  social  drinker,  lived  in  a   GBS  during  pregnancy.  At  the  5me  of  discharge,  the  pa5ent  
one-­‐story  home  with  two  bathrooms.  She  was  an  elementary   achieved  all  goals  and  was  able  to  return  to  her  prior  
physical  educa5on  teacher  and  a  basketball  coach  who  prior  to   func5onal  status  with  only  mild  sensory  deficits  and  minimal  
her  diagnosis  enjoyed  running  and  playing  with  her  son.   weakness.  Therefore,  the  use  of  func5onally-­‐based  

interven5ons  during  PT  management  of  this  pa5ent  with  GBS  

in  pregnancy  proved  to  be  beneficial.  Future  work  in  this  area  
could  compare  and  contrast  the  outcomes  of  other  PT  
interven5ons  for  GBS  during  pregnancy.  





1.  Na5onal  Ins5tute  of  Neurological  Disorders  and  Stroke.  (2014).  Guillain-­‐Barre  Syndrome  fact  sheet.  Retrieved  on  September  20,  2014  at  
hNp://www.ninds.nih.gov/disorders/gbs/detail_gbs.htm


2.  World  Health  Organiza5on.  The  ICF:  An  overview.  Retrieved  on  July  12,  2014  at  
hNp://www.cdc.gov/nchs/data/icd/ICFoverview_FINALforWHO10Sept.pdf
3.  Meena,  A.  K.,  Khadilkar,  S.V.,  Murthy,  J.M.  (2011).  Treatment  guidelines  for  Guillain-­‐Barre  Syndrome.  Ann  Indian  Acad  Neurol.  S73-­‐S81.  

Gait   Balance   Transfers   Squats   Kneeling   Resistance  Training   Jumping  

4.  GBS/CIDP  Founda5on  Interna5onal.  Guidelines  for  physical  and  occupa5onal  therapy.  Retrieved  on  September  20,  2014  at  
hNp://www.gbs-­‐cidp.org/wp-­‐content/uploads/2012/01/PTOTGuidelines.pdf