This serious, but relatively rare condition has been in the news lately, linked to the Zika virus outbreaks in Brazil (1). At Sian Owen Physiotherapy we offer a number of therapies to clients who are dealing with the aftermath of this debilitating illness.
Most people in North America (2) who are in the earliest stages of GBS will feel tingling and muscle weakness, often in their feet and legs. This can spread very quickly throughout the body and turn into complete paralysis. Unchecked, the disease can make it impossible to breathe on your own. GBS happens when our own immune system attacks our nerves, which control all of our muscles. The symptoms usually get worse over a two to four week period after the disease begins, and the amount of damage done to the nerves during this time will affect the degree of disability the person experiences, and their chances of a full recovery. That is why early diagnosis and treatment, usually in hospital, is essential. (3)
Physiotherapy is important in every stage of the disease process, from helping the person with breathing difficulties to assisting with the recovery of physical function once the condition has stabilised.
What can physiotherapy do to help once the condition has stabilised?
1. In the early stages, when the person can’t move by themselves, the physiotherapist will set up a passive range of motion program. They will also teach family members how to gently move the joints to keep them flexible.
2. When the nerve starts to recover, and can communicate with the muscle again, strength and control slowly begin to return. At this stage the physiotherapist will engage the person in doing as much active movement as possible, but will assist where necessary. From this “active assisted” exercise, the physiotherapist will progress the person’s program to independent strength training.
3. Physiotherapy will help the person regain normal movement of limbs. In my experience, clients will move any way they can, and the movement may be abnormal. For example, the client may lift their foot too high when walking. This is because the foot is not working properly and they will catch their toes and fall if they don’t compensate. The physiotherapist can help retrain the small muscles in the foot to work correctly so that this “high stepping gait” is not necessary.
4. Perform functional tasks such as standing up, standing still and walking. Those who were completely mobile before GBS, and who lost their mobility, will know how difficult these apparently simple tasks can be. There may be good active range of motion in the legs, but this doesn’t always mean you can get up from a chair! It takes the right kind of practice.
5. Improve balance and control during standing and walking. For example, the physiotherapist might work on standing with your legs closer together, or one foot in front of the other, or even one leg off the floor! Walking practice may include walking sideways, turning or walking on an incline.
6. Most important, whatever the physiotherapy program consists of, it should be a positive, motivating reflection of the client’s goals. I have one client who, before GBS, didn’t exercise in a formal way, for example in a gym, or following a set routine. She loved keeping her home and garden beautiful, cooking and baking. This was how she exercised. It’s been hard for her to commit to a regular exercise routine, even standing just for the sake of it. But when I suggest going into the kitchen and chopping vegetables, she has absolutely no problem. She becomes highly motivated and can stand for longer this way. She has helped me understand there are many ways to reach the same end!
7. As the client progresses, frequency of sessions will decrease with a plan towards discharge. However, some clients will need a long term relationship with a physiotherapist, perhaps for years, if they haven’t returned to full function.
And of course physiotherapy isn’t the only profession involved. We will liaise with other team members, such as the Occupational Therapist, to ensure we are all working together.
Physiopedia lists a detailed account of physiotherapy management for GBS. (4)
Let me know what your experience of GBS has been!
R. Sian Owen PT
3. The Mayo Clinic has a nice summary of this condition and treatments http://mayoclinic.org/diseases-conditions/guillain-barre-syndrome/basics/treatment/con-20025832?p=1