Guillain Barre Syndrome
Ariel Kendell
Client Dx/Pertinent Hx: 34 y.o. female w/ Guillain Barre Syndrome
Tests and Measures
Aerobic Capacity/Endurance Pain
Assess BP, RR, and HR at rest and during Universal Pain Assessment Tool
and after exercise Note areas and type of pain
Use the BORG Rating of Perceived Reflex Integrity
Exertion
Assess deep tendon reflexes
Assistive and Adaptive Devices
Sensory Integrity
Assess the need for assistive or adaptive
devices and equipment for functional Establish sensory system functional status
activities (somatosensory, vision, hearing) before
completing cognitive/perceptual testing
Circulation Assess superficial (pain, temp, touch),
Cranial and Peripheral Nerve Integrity deep (proprioception, vibration) and
Assess cranial nerves combined cortical sensations
Assess peripheral nerves for sharp/dull Ventilation and Respiration
discrimination and light touch Auscultation of lungs for breath sounds
Muscle Performance Pulse oximetry
Caution should be taken to avoid Signs of dyspnea and tachypnea
overexertion so MMT should be done over Tidal volume and vital capacity with
several sessions spirometry
Avoid substitutions for weakened muscles Strength of cough
MMT of individual muscles (as opposed to Ability to clear airway
testing muscle groups) should be
performed for monitoring progression Chest Expansion
Safety and Precautions
*When working with a patient with GBS the no pain, no gain mentality
should not be applied.
Overuse of painful muscles may result in prolonged recovery period or lack of recovery;
frequent rest periods are recommended.
Overstretching can occur due to the denervation and weakened muscle.
*Medical Red Flags
Deep-Vein-Thrombosis (DVT): A firm, tender, warm or swollen calf raises suspicion of DVT.
Autonomic Dysfunction: Tachycardia, bradycardia, paroxysmal hypertension, anihidrosis or
diaphoresis, orthostatic hypotension.
Respiratory Distress: Change in cardiopulmonary function including dyspnea and tachypnea.
Dysphagia: Pain on swallowing, choking, aspiration, airway obstruction, pneumonia
GOALS
Long Term Goals Short Term Goals
Pt will safely perform bed Pt will demonstrate log roll
technique for improved bed
mobility independently by mobility w/ use of bed side rail in 2
D/C. weeks.
Pt will demonstrate ability Pt will tolerate upright supported
to sit independently in sitting for 5 min. in 2 weeks.
order to perform ADLs by Pt will demonstrate improved trunk
control in EOB sitting w/ B UE
D/C. support and assist w/ legs from
Pt will safely perform therapist in 2 weeks.
functional transfers from Pt will hold prone prop position for
5 min. weight shifting to single arm
bed<>w/c with min A by support and performing reaches w/
D/C. opposite arm in order to facilitate
upper trunk extension in 2 weeks.
General Guidelines for Implementing
Interventions for GBS
Expand activities gradually.
Increase repetitions before resistance in order to
avoid injury to muscles, tendons and joints. Use
of proprioceptive neuromuscular facilitation
(PNF) techniques may be helpful.
Teach energy conservation (e.g. pacing and
breaking tasks into steps).
Train caregivers in proper body mechanics for
transfers, positioning, etc. to decrease the risk of
injuries to themselves and the patient.
Interventions
STG 1: Pt will demonstrate log roll technique
for improved bed mobility w/ use of bed
side rail in 2 weeks.
Start w/ pt sidelying w/ the therapist
positioned in line w/ the scapula and pelvis
applying stabilizing (isometric)
reversals>>>increase resistance gradually as
needed
Sidelying, rolling begin w/ therapist
providing rhythmic initiation>>>hold-relax-
active motion
Supine>sidelying, rolling w/ therapist using
PNF lift pattern (D2) w/ rhythmic initiation to
facilitate rolling
Interventions
STG 2: Pt will tolerate upright supported sitting for 5
min. in 2 weeks.
Elevate head of bed to within pts tolerance>>>increase elevation>>>increase
time>>move to supported sitting in chair w/ back>>>add puzzle or card game to
promote arm movements and trunk control
STG 3: Pt will demonstrate improved trunk control in EOB sitting w/ B UE
support and assist w/ legs from therapist in 2 weeks.
EOB sitting w/ back support from wedge and B UE support therapist performing
alternating isometrics to upper trunk applying gentle resistance in all
directions>>>remove wedge
EOB sitting w/ back support from wedge and B UE support therapist performing
rhythmic stabilization to upper trunk>>>remove wedge
EOB sitting w/ back support from wedge and B UE support have pt perform
lateral weight shifts onto hands>>>remove wedge
Interventions
STG 4: Pt will hold prone prop position for 5 min. weight shifting to single arm support
and performing reaches w/ opposite arm in order to facilitate upper trunk extension in 2
weeks.
Prone on elbows w/ wedge underneath pts chest for support>>>remove
wedge
Prone on elbows holding position>>> alternating isometrics w/ gentle
resistance applied to upper trunk>>>add rhythmic stabilization
Prone on elbows w/ medial-lateral weight shifts w/ slow reversals>>>add
slow reversal holds>>>have pt weight shift to one side and lift opposite arm
and perform cone stacking activities
References
Fenderson, C. B., & Ling, W. K. (2009). Neuro
notes: clinical pocket guide. Philadelphia: F.A.
Davis Company.
OSullivan, S. B., & Schmitz, T. J.
(2016). Improving functional outcomes in
physical rehabilitation. Philadelphia: F.A. Davis
Company.
Hansen, M., DPT. (n.d.). Guillain-Barr
Syndrome, CIDP and Variants [Guidelines for
Physical and Occupational Therapy].
