Introduction to Clinical Neurology for PT

Guillain-Barré syndrome

Nour Lubadeh

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Definition
Guillain-Barré syndrome (GBS) is autoimmune disorder, defined as a clinical entity
with quickly increasing symmetrical limb weakness, impairment of tendon reflexes,
missing or moderate sensory symptoms, and varying autonomic dysfunctions. The
condition affects people of all ages and both genders. In most cases, the neural defect
is triggered by a viral or bacterial disease. Weakness can develop within days (acute)
or chronically (within 4 weeks).

Clinical features of GBS:

Sensory dysfunction: Pain, numbness, paraesthesiae, loss of joint position sense,
vibration, touch and pain distally, Ataxia.
Motor dysfunction such as symmetrical limb weakness: proximal, distal or global,
neck muscle weakness, respiratory muscle weakness.
Autonomic dysfunction include sinus tachycardia and bradycardia other cardiac
arrhythmias (both tachy and brady) Hypertension, and postural hypotension,
fluctuations of pulse and blood Pressure, tonic pupils, hypersalivation.

Laboratory Testing
At present, no biomarkers exist in the blood, urine, or CSF that confirm the diagnosis
of GBS. Most patients with GBS will have an elevated CSF protein, but this
laboratory finding may not be present until 3 weeks after the onset of the illness.

Treatment
The treatment of GBS requires a multidisciplinary approach. The primary goal of
general/supportive treatment is to monitor and control the pulse rate, blood pressure
variations, vital capacity, urine retention, and bowel dysfunction.
Role of Physiotherapy in Guillain Barre Syndrome
There are very few studies indicating that PT can improve outcomes in GBS patients.
The numerous outcome metrics utilized in the evaluation of GBS patients.
Exercise therapies have been linked to considerable gains in muscle strength,
functional capacity, and weariness, according to research.
The most recent exercise recommendation for patients with peripheral neuropathy
includes a combination of aerobic and functional exercises as well as therapeutic
exercises such as progressive resisted exercises utilizing repetitions of specific
muscle contraction and strengthening exercises to target specific week muscle group
with caution to avoid over exertion.

The strengthening exercises can be isometric (performed against maximal resistance

with no associated joint movement), isotonic (performed against a submaximal
known resistance, typically greater than 70% of the maximal load possible, with joint
movement and limb excursion permitted), or isokinetic (performed against variable
resistance but with constant contraction speed).
Endurance workouts often entail gradually increasing the length and intensity of
aerobic activity, such as cycling, jogging, or walking.
Low load, high repetition muscular contractions may also be used in specific muscle
endurance programs.

Denis D & mullins R observational study goal was to assess GBS patients'
satisfaction with PT in the acute and subacute environment, as well as to offer an
overview of inpatient case management, including the number of problems.
Participants receiving physiotherapy expressed satisfaction with treatment
management (87%), treatment frequency (88%), duration (94%), and timetabling
(81%) as well as physiotherapist professionalism and rapport (100%). For 23
individuals, the median length of hospital stay was 20 days (range 5-198). Patients
were most typically mobilized by physiotherapists to sit, stand, transfer, and walk
(83%, 82%, 81%, and 90%, respectively). During their hospital stay, twenty patients
(87%) experienced problems, the most frequent of which was low back discomfort
(61%). This study found that GBS patients were satisfied with the care they received
by physiotherapy.

Work citied:
Hahn, A. F. (1998). Guillain-barré syndrome. The lancet, 352(9128), 635-641.

Donofrio, P. D. (2017). Guillain-Barré Syndrome. CONTINUUM: Lifelong Learning in

Neurology, 23(5), 1295-1309.

Cosi, V., & Versino, M. (2006). Guillain-barre syndrome. Neurological Sciences, 27(1), s47-
s51.

Dennis, D., & Mullins, R. (2013). Guillain–Barre´ syndrome patient's satisfaction with
physiotherapy: A two-part observational study. Physiotherapy Theory and Practice, 29(4), 301-
308.