Physical Therapy for

Patients with Guillain Barre

Syndrome
Sydney Wynne
Patient case
The patient is a 19-year-old male, suffered severe flu symptoms,
requiring him to stay at home from work for two days. Four days
after his return to work, he noted tingling and numbness in his
fingers, progressing through the next day. In a day was unable to
stand and could not use his hands and was admitted the hospital
with a diagnosis of Gillian-Barre syndrome (GBS). At the hospital, he
developed respiratory weakness and was placed on a ventilator. He
has nearly total paralysis of voluntary muscles, including facial and
swallowing muscles. He ambulates in a wheelchair with sip-and-puff
switches and refers to the physical therapist (PT). At this point, the
PT considers the following possible activities and exercises for the
patient that address: proper wheelchair positioning to prevent
pressure sources; postural drainage positions for lung hygiene;
tolerance to the upright position and range of motion; restoration of
normal breathing pattern; and muscle strength. Muscle strengthening
regimen is still debatable.
Clinical Question

Is physical therapy (I) for a severely progressed case of

Guillain Barre syndrome in a 19-year-old male (P) effective
in restoring function (O).
 Introduction
– Guillain Barre Syndrome(GBS) effects three to four thousand
people a year, and causes partial to full paralysis.1
– The cause is unknown, and there is no known cure to GBS2
– Physical therapy is commonly used to treat GBS, in addition to
plasma exchange and immunoglobulin treatments.2
– However, there are few studies about the effectiveness of PT in
improving GBS
– The purpose of this study is to determine whether physical
therapy is an effective treatment for restoring function in
patients with Guillain-Barre Syndrome

1Guillain-Barré
syndrome. Centers for Disease Control and Prevention. Published December 20, 2019. https://www.cdc.gov/campylobacter/guillain-barre.html.
Accessed October 27, 2021.
2Guillain-Barre
syndrome. Mayo Clinic. Published July 23, 2021. https://www.mayoclinic.org/diseases-conditions/guillain-barre-syndrome/symptoms-
causes/syc-20362793. Accessed October 27, 2021.
Hypothesis

Physical therapy will be effective in restoring function in

patients with Guillain-Barre Syndrome
Subjects
› Participants with GBSin acute state within a week since
diagnosis
› Recruited from acute care hospitals in Michigan
› Inclusion criteria
– Ages 18-25 years of age
– male
– Tetra-paresis caused by GBS
– GBS induced from viral infection (flu)
› Exclusion criteria
– Don’t have severe acute state GBS
– Previously recovered from GBS
– weeks into GBS treatment
Methods: Intervention

› Therapy daily for a total of 1 hour, for 3 weeks in acute

care setting
› Led by licensed physical therapist
› Physical therapy for functional activities and muscle
strength
– Interventions addressing vital functions, functional movements,
and muscle strength
Methods: Intervention protocol
› 60 minute physical therapy session consisting of functional
activities and strength training
› Week 1: focus on vital functioning and core for postural
control
› Week 2: focus on balance while sitting upright and distal
extremity strength through functional sitting exercise
› Week 3: focus on overall functioning and strength through
full body movement and standing/walking activities
Methods: Intervention Protocol

Week One Week Two Week Three

• 2 visits of 30 • 1 visit of 60
• 3 visits of 20 minutes daily minutes daily
minutes each • Transfers • Transfers
day • Sit • Sit to stand
• Vital àwheelchair • Walk
functioning • Sit à stand independently
• Walk with or with
• core strength assistance assistance as
• Transfers • Balance needed
• Sitting marches
Shinkarow A. Exercises you can do while sitting. Diana
Gregory Outreach Services. Published June 4, 2021.
https://dianagregory.com/exercises-you-can-do-while-
sitting/. Accessed November 3, 2021.

Amacht. Amacht. Macht Medical Group. Published July 24,

2020. http://www.machtmedicalgroup.com/2020/07/covid-
19s-got-you-inside/. Accessed November 3, 2021.

Activities of daily living (getting in and out of bed, standing up from a chair, going up/down stairs). Physio en Route
Inc. Published May 21, 2019. https://www.physioenroute.com/en/adl/. Accessed November 3, 2021.
Methods: Study Design
› Phase 1 clinical trial:
– Goal: to test whether physical therapy is helps in the recovery of
patients with GBS
› Small sample size: 3 participants
› Practice: in clinic led by physical therapists
– 15 sessions
– 1 hr/day in acute care
– 3 weeks
Methods: Data Analysis
› Primary outcomes:
– Manual Muscle Test3
– Functional tests
› 30 second sit to stand4
› 6 Minute Walk Test5
› Independent sit (Time in seconds)
› Independent stand (Time in seconds)

3Manual Muscle Test. Shirley Ryan AbilityLab. https://www.sralab.org/rehabilitation-measures/manual-muscle-test. Accessed November 2, 2021.

430 second sit to stand test. Shirley Ryan AbilityLab. https://www.sralab.org/rehabilitation-measures/30-second-sit-stand-test. Accessed November 2, 2021.

56 minute walk test. Shirley Ryan AbilityLab. https://www.sralab.org/rehabilitation-measures/6-minute-walk-test. Accessed November 2, 2021.
 Methods: Data Analysis
Evaluation schedule

Pre-Test Test 1 Test 2 Test 3

Week 1 Week 2 Week 3

Methods: Statistics
› Linear Regression to track patient progression

7
Score of 30 Second Sit to Stand Test

5
• Patient progression will be
measured using linear
regression for each test
4

3
• The four tests for each
2 intervention will be
1 measured in a plot
0
• p < .05
1 2 3 4
Test Number
Discussion of Anticipated Results
› Anticipated study findings:
– Physical therapy will be effective in improving function and
strength to patients with GBS causing tetra-paresis
› Limitations:
– Cannot test without conventional treatments such as plasma
exchange or immunoglobulin therapy because of risk of death, so
degree of effectiveness of physical therapy may be difficult to
assess