Physical Therapy for Guillain-Barré Syndrome

Guillain-Barré syndrome is a disease that occurs as a result of the body’s immune system attacking the nervous system, resulting in paralysis. It can also be referred to as nerve fiber inflammation. In the disease, the immune system attacks the outer sheath that provides insulation in the nerve fibers called peripheral nerves located outside the brain and spinal cord. Accordingly, signal transmission may be impaired in nerve fibers in the head, which provides the arms, legs, trunk, and swallowing-mimic functions. Signal transmission may be slowed down, partially or completely blocked. It usually occurs within 2-4 weeks, and most people recover completely within months. However, sometimes complaints such as weakness, loss of sensation, numbness persist for a long time. It is a rare disease; It occurs in 2 to 4 of 100,000 people each year. It can occur in both children and adults;

What Causes Guillain-Barré Syndrome?

Guillain-Barré syndrome starts in the legs and arms and spreads to the rest of the body. Primarily, involvement of the feet and legs and the upward spread of the complaints are typical for this disease. When the disease progresses severely, it can also affect the respiratory muscles and the need for intensive care may occur due to respiratory failure. The exact cause of this disease is unknown. It usually occurs following a respiratory or intestinal infection. So infections are the triggering factor. In most patients, a history of infection is taken within one month of the onset of symptoms. Influenza, Epstein-Barr virus, infections transmitted from poultry, infections such as pneumonia, HIV, vaccination, surgical interventions can trigger this disease. In the majority of cases, no cause can be identified.

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What are the symptoms?

Guillain-Barré syndrome causes various signs and symptoms such as weakness, sensory-feeling problems, balance problems, muscle-joint pain, bladder-intestinal problems, sweating problems, heart rate problems. Since this disease does not affect the brain, the cognitive functions of the person are not affected. In half of the cases, the first symptoms are abnormal sensations such as tingling in the feet and fingers. In 25 percent of patients, the first symptom is something related to muscle weakness, such as difficulty climbing stairs or staying out of a chair. In the remaining 25 percent of the patients, symptoms related to sensation and strength begin together. Pain and cramping in the buttocks, thighs, and shoulders are also common complaints. The disease starts with mild complaints and peaks in a few days or weeks. At worst, all peripheral nerves may be involved. any muscles, including speaking and swallowing, may not be able to move, and the person may have to be connected to a respirator. While dyspnea develops in 70% of the patients due to the involvement of the respiratory muscles, one third of the patients need to be temporarily connected to a ventilator. The mortality rate has been reported as 3 percent. During this period, plasma exchange or high-dose intravenous immune globulin (IVIG) therapy aids recovery.

In Guillain-Barré syndrome, spontaneous recovery usually begins after the symptoms reach the most severe point. Most patients recover completely or almost completely. Many patients are able to walk unaided after 3 months. However, sometimes recovery can be slow, taking up to 2 years. In 5-20% of all patients, limitations may continue to prevent returning to their previous lifestyles.

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Why is Physical Therapy Important?

Physical therapy must be performed in order to prevent the development of complications, to protect and restore functional independence, and to increase the quality of life of the patient. After the physical therapy and rehabilitation specialist doctor evaluates the patient, the necessary physical therapy is applied by the rehabilitation team. Recovery time for Guillain-Barré disease can vary greatly from person to person. In general, positive results are obtained within a few weeks or months with physical therapy.

How is Physiotherapy Performed in the Early Stage of the Disease?

Electrotherapy applications such as TENS for pain relief in Guillain-Barré patients, appropriate positioning to protect joints in patients who cannot move, use of devices called orthoses that can be attached to the hands and feet if necessary, passive or assisted range of motion exercises, breathing exercises and increasing the endurance of respiratory muscles in the first periods are some of the physical therapy methods applied. In addition, patients and their relatives are taught how to lie in bed, how to sit, how to get from bed to chair and from chair to bed.

How is the patient’s walking provided with physical therapy?

Stretching, strengthening exercises, balance and walking specific exercises are performed to improve walking ability. Special balance devices for balance, robotic devices for walking or a body weight supported treadmill can be used. Walking activity also increases one’s aerobic capacity. It is important not to deplete energy suddenly in patients with Guillain-Barré syndrome. For this, energy-saving methods in physical therapy and tips to avoid overtiring the body (dividing the tasks that need to be done into stages, performing them in a certain rhythm) are taught. It may be recommended for patients to use assistive devices such as walking orthoses and a cane so that they can walk safely.

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Ensuring Independence in Activities of Daily Living

Occupational therapy and occupational therapy applications for returning to daily work and professional life in the home environment can be applied to patients with Guillain-Barré syndrome as a part of physical therapy.

The patient should not be overtired in physical therapy

In Guillan-Barré syndrome, a condition sometimes called relapse, that is, worsening after the disease has healed, can be seen. The frequency of relapse is about 5 percent. Overexertion of the body is a factor that triggers relapses. For this reason, it is important that the person does not experience excessive fatigue during and after physical therapy.

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