Conditions & Treatments - Guillain-Barre Syndrome                                            


In Guillain-Barre Syndrome (GBS), the immune system attacks the peripheral nervous system and causes peripheral neuropathy and weakness (1). Acute lower extremity weakness with areflexia appears rapidly, in some cases over as little as seven days (1). GBS equally affects men and women at an incidence of 1 in 100,000. GBS may be mediated by a response to an infection suffered at most a month prior, with common infection-causing pathogens including Campylobacter jejuni, cytomegalovirus, Mycoplasma pneumoniae, and Epstein-Barr virus (1). Vaccines may also create an immune response capable of starting GBS (1). At least five subtypes of GBS exist: acute inflammatory demyelinating polyradiculoneuropathy, acute motor axonal neuropathy, acute motor and sensory axonal neuropathy, Miller Fischer Syndrome, and chronic inflammatory deymelinating polyradiculoneuropathy (2).

Symptoms and Prognosis
GBS symptoms, including lower extremity weakness, numbness, tingling, and total loss of sensation, can progress over hours, days, or weeks; however, for most individuals, symptoms plateau within two weeks of onset (1). Symptom worsening coincides with the progressive destruction of the myelin along the peripheral nerves (1). Before plateauing, weakness in the lower extremities may progress to the trunk, arms, and cranial nerves (1). If respiratory muscles are affected, mechanical ventilation is required to maintain airway and breathing functions (1). After the plateau phase (which lasts 2-4 weeks), the recovery phase begins with gradual resolution of the paralysis (which may take up to 1-2 years and may never fully return) (3). An estimated 7-15% of individuals with GBS will have permanent neurologic sequelae (3), and the syndrome has a 5% mortality rate (2).

A poor prognosis with GBS is related to quadraparesis, the need for respiratory support, cranial nerve involvement, rapid progression, older age at onset, and a history of GI illness (2). Additionally, if the individual with GBS is older than 60 years old, achieves maximal deficits in less than seven days, and needs ventilatory support, he or she has less than a 20% chance of walking six months after onset of GBS (2).

Medical management of GBS consists of plasmapheresis or immunoglobulin infusion (IVIg). IVIg therapy, where antibodies are infused into the patient to counteract his or her antibodies, is the preferred choice for therapy (1). Plasmapheresis involves connecting the patient to a machine that filters the plasma and circulating antibodies out of his or her blood stream (1).

Physical therapy management of GBS varies greatly depending upon the course of the disease. In the acute phase, physical therapists (PTs) monitor the progression of sensory symptoms (often in a stocking glove pattern) by testing and recording the areas where the patient can distinguish sharp from dull and light touch (2). PTs also monitor deep tendon reflexes and muscle strength via manual muscle tests (2). By carefully evaluating sensation, reflexes, and strength, PTs help the care team determine if symptoms are progressing, plateauing, or remitting.

Acutely, PTs help preserve range of motion through splinting, passive range of motion, active assistive range of motion, and facilitation of active range of motion (2). PTs help maintain respiratory hygiene via chest therapy and help patients develop a tolerance to upright positions (2). In the acute setting, PTs will start working on bed mobility, transfers, and wheelchair mobility (2). When the patient is medically stable and able to tolerate three hours of therapy daily, he or she may transfer from the medical floor to inpatient rehabilitation (3). An estimated 40% of GBS patients will require inpatient therapy (1). In inpatient therapy, the individual with GBS will continue to work on bed mobility, transfers, wheelchair mobility, and ambulation. For seven patients in a study by El Mhandi et al., the inpatient therapy stay lasted three to four weeks (3) Upon discharge, these seven patients participated in four to 10 weeks of outpatient physical therapy (3).In outpatient therapy, goals include further increasing strength and functional mobility. Important strategies to use include frequent rest breaks and using low intensity high reps (2).

Last revised: December 15, 2013
by Michelle Kornder, SPT


1) Bowyer HR, Glover M. Guillain-Barre Syndrome: Management and Treatment Options for Patients with Moderate to Severe Progression. Journal of Neuroscience Nursing. 2010;42(5):288-293. Accessed November 22, 2013.
2) Duwane J and Patterson K. PT 636 Motor Control Dysfunction II: Demyelinating Disorders Lecture. Madison, WI: Department of Physical Therapy. 2013: 295-299. Accessed November 22, 2013.
3) El Mhandi L, Calmels P, CamdessancheŽ JP, Gautheron V, FeŽasson L. Muscle strength recovery in treated Guillian-BarreŽ syndrome: a prospective study for the first 18 months after onset. Am J Phys Med Rehabil. 2007;86:716–724. Accessed November 22, 2013.

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