Guillain-Barré Syndrome – Kristin Bloomquist, PT, DPT
Here is a quick fact sheet on a rare disease that I have encountered a few times in my physical therapy career. Guillain-Barré Syndrome (GBS), also known as Landry- Guillain-Barré syndrome is an autoimmune disorder that attacks the peripheral nervous system. It is sometimes called a subacute polyneuropathy because the onset is very fast and many different nerves will be affected. Often a person will go from completely healthy to having no feeling in their limbs or body and being unable to move within hours or days.
The cause of GBS is unknown, but in more than half of cases, it occurs 1-4 days after the incidence of a virus such as the Epstein-Barr virus or cytomegalovirus, or after a surgery or vaccination. The incidence of GBS is very rare (1 in 100,000 annually).
Symptoms of GBS include sudden onset of weakness that starts in the legs and moves up the body to the arms over the course of hours or days. Decreased sensation also occurs in this same manor. Eventually cranial nerves are affected, so things like eye movement and swallowing decrease. Some people have autonomic responses that can lead to sudden changes in blood pressure and heart rate. GBS, if untreated, can be deadly. Medical treatment of GBS includes monitoring and support of body functions, while the patient is in this weakened state. Medications to decrease the immune response may also be used.
Patients that have GBS may be encountered in any setting of rehabilitation from acute care to outpatient therapy. In the early stages of treatment passive range of motion and splinting to prevent skin problems or contracture may be the only intervention used. Once the patient begins to recover and starts to regain sensation and motor function therapists will begin to strengthen and provide functional activities as appropriate. One intervention that can be used early-on is aquatic therapy. This will allow the patient to get into a “standing” position before they have regained the strength to do this on land. Further treatment will include transfer and gait training, sensory stimulation and strengthening exercises geared towards the patient’s level of recovery.
One thing that is important to remember while working with patients with GBS is that they will slowly regain strength spontaneously, but it is our job as a therapist to support this process with the proper treatment plan. It is also important to remember that often patients with GBS were completely independent before this happened, so recovery to the point of walking with a walker may not be good enough and the patient may need to further therapy to return to their prior level of function. Finally, it is important to support your patient emotionally as this is a difficult and frustrating time in their life. Remind them that they will get better, even if progress is slow. I still remember the patients that I have worked with who have had GBS and the relationship that we built during the many months of rehab was a special one for the patient and for me.