Management of Guillian Barré Syndrome
Arku Jasmine Health
Many individuals who recover from the condition may require months of rehabilitation as nerve function occurs.
The physiotherapist’s initial assessment includes the present level of function of the individual which provides a basis for individualised therapy.
Therapy mainly focuses on the following;
• Muscle stretching and strengthening to prevent contractures.
• Improving balance and co-ordination.
• Prevention of pressure sores.
• Gait re-education.
• Regaining independence with everyday tasks.
Management in initial stages
• The physiotherapist may assist the individual enhance his respiratory function with graduated coughing and deep breathing exercises if the intercostal muscles – the muscles between the ribs - are affected.
• The individual may experience weakness in affected parts of the body and may find transfers or shifts to different positions difficult.
He is assisted with turning himself in bed – eg lying on his back to lying on the side – and changing positions - lying to sitting, sitting to standing, etc.
As the individual’s balance and equilibrium in sitting improves, he may be passively assisted to stand to enhance his tolerance and reduce sensitivity to weight bearing in his legs.
• There is also a need to prevent muscle contractures (shortening of muscles) and a reduction in the range of motion at the joints.
Too much movement may make the joints lax and too little may cause the joints to become stiff, hence to ensure adequate mobility, the physiotherapist takes the individual through passive mobilisations of affected limbs and appropriate positioning.
The affected upper limbs need to be supported in upright sitting with armrests or pillows to prevent stretching of shoulder muscles.
Inappropriate or prolonged sitting –more than two hours - can result in the development of a curved spine and pressure sores which should be avoided.
The individual should also avoid prolonged bending of the hip and knee joints.
• The individual may require the aid of an assistive device such as an anterior walking frame for balance, co-ordination and gait re-education.
Ankle Foot Orthosis (AFOs) may also be used when starting gait re-education as a result of the weakness in ankle joints.
Later stages of condition
When the individual regains sensation and control of the muscles in his limbs, active exercises are increased with low resistance and more repetitions.
It’s important not to exercise to exhaustion because that only delays recovery of the condition.
Therapeutic exercises
• When individuals diagnosed with Guillian Barré Syndrome begin therapy, active exercises are always graded because they tend to get fatigued quickly, hence the need to build the muscles gradually.
The exercise demands are increased as the muscles regain its strength but caution is always taken to avoid overexertion.
Focus is placed in increasing repetitions before increasing resistance in order to avoid injury to the affected muscles, tendons and joints.
• Hydrotherapy is a helpful aspect of therapy as it promotes mobility and muscle strengthening and also enhances respiratory function.
Exercising in water is much easier than in air and it facilitates active movement of the limbs. The buoyancy effect on the limbs in water enhances movement which otherwise would not be able to move without assistance against gravity.
Possible long-term complications
• Inability to walk independently hence the need to use a wheelchair.
• Loss of balance and co-ordination.
• Persistent burning or tingling sensation in affected limbs.
Benefits of early physiotherapy
• Improved function such as sitting, standing and walking balance.
• Enhanced normal patterns of movement.
• Improved posture, muscle strength and flexibility.
• Pain relief.
• Enhanced quality of life.
By Dorothy Akua Ajabu/The Mirror/Ghana
The writer is a senior physiotherapist at the 37 Military Hospital. Email: panierus@live.com