Autoimmune infection GBS

1. Dechasa Imiru, MSc PT
Department of Physiotherapy
Institutes of Health
Jimma University
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6. Guillain-Barré Syndrome (GBS)
 Is a rare autoimmune disease that affects the peripheral
nervous system (PNS).
 It is an acute, progressive autoimmune, inflammatory
demyelination of polyneuropathy of PNS
 The exact mechanism is unclear, but the majority of
GBS cases are triggered following bacterial or viral
infection.
 Following the triggering event, an autoimmune reaction
takes place where the immune system targets and breaks
down the myelin sheath surrounding peripheral nerves
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7.  The first symptoms noticed are typically numbness,
tingling, or pain beginning in the feet and ascending
proximally towards the head.
 Over the course of days to weeks, there is progressive
muscle weakness in the extremities and potential
paralysis.
 GBS can also lead to weakening of the respiratory
muscles and eventual respiratory failure.
 Many complications can arise during the acute stage of
GBS including: deep vein thrombosis, pulmonary
embolism, heart attack, pneumonia, infection, and death
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8. Guillain-Barre Syndrome
 is a disease of the nervous system due to damage to the
myelin sheath around nerves.

 The myelin sheath acts as an insulator the same as
rubber or plastic around electrical wires.
 Ascending paralysis, weakness beginning in the feet
and hands and migrating towards the trunk, is the most
typical symptom.
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9. .
GBS is also known as:
Acute idiopathic polyneuritis
Acute inflammatory demyelinating
polyneuropathy/AIDP
Landry's ascending paralysis/landrys
paralysis
Landry GBS
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10. Etiologies
 GBS is not contagious or hereditary,
 the actual cause is unknown.
 However, about half of all cases are linked to follow a
viral or bacterial infection such as, common cold, flu,
viral hepatitis infectious mononucleosis.
Antecedent events
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11. Risk factors
 Age (15-35) and (60-75)
 In men more likely than woman.
 Recent gastrointestinal or respiratory infection by
viruses or bacteria.
 Recent vaccination (especially influenza and
meningococcal)
 Recent surgery
 History of lymphoma, Systemic lupus erythromatosus,
or HIV and AIDS
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12. Epidemiology
More common in men
Risk increases with age
Incidence of subtypes varies between countries
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13. Signs and Symptoms
 Bilateral numbness, tingling, or pain that begins in the
hands and feet
 Progressive bilateral weakness of the extremities
 Impaired gait and balance
 Weakness of facial muscles
 Difficulty with swallowing or speaking
 Double vision
 Severe pain that may worsen during the night
 Changes to bowel/bladder control
 Paralysis
 Respiratory failure
 Autonomic dysfunction (abnormal changes to heart rate
and blood pressure)
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14. Differential diagnosis
 Spinal cord lesions
Acute transverse myelitis
Myasthenia gravis
Myopathy
HIV
Poliomyelitis and etc.
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15.  Subtypes of GBS
Acute Inflammatory demyelinating
polyneuropathy
Miller Fisher syndrome
Acute motor axonal neuropathy
Acute motor sensory axonal neuropathy
Acute panautonomic neuropathy
Bickerstaff’s brainstem encephalitis
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16. Guillain Barre Syndrome diagnosis:
 Dx rely on History and PE
 Laboratory ( CSF analysis)
 Imaging (MRI)
 Functional testing (Nerve conduction studies)
 Electro diagnostic tests of nerves and
muscles
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17. Diagnostic criteria :
Required
Progressive, relatively symmetrical weakness
of two or more limbs due to neuropathy.
Areflexia/ hyporeflexia
Disorder course < 4 weeks.
Exclusion of other causes.
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18. Conti…
Supportive:
Relatively symmetric weakness accompanied by
numbness and/or tingling.
Mild sensory involvement.
Facial nerve or other cranial nerve involvement.
Absence of fever.
Typical CSF findings obtained from lumbar
puncture.
Electrophysiologic evidence of demyelination
from electromyogram.
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19. GBS management:
 The majority of patients can expect a slow but
progressive recovery over several months.
 In severe cases the primary concern is maintaining
vital functions and passively exercising the
muscles.
 This sometimes requires temporary artificial
breathing machines for severely affected patients.
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20. GBS treatment
The mainstay of medical management GBS is
a) Plasmapheresis
b) Intravenous immunoglobulins ( I.V.I.G)
 Supportive Care
i. ICU monitoring
ii. Basic medical management often determines
mortality and morbidity. Etc.
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21. GBS Rehabilitation
 Although most people recover from GBS disease, the
length of your illness is unpredictable,
 So, may require months of hospital care and
rehabilitation.
 As nerve function returns, patient may need assistance
to learn how to use affected muscles.
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22.  Rehabilitation may include several types of therapy.
 Physical therapy stimulates muscles and joints to
rebuild strength, flexibility and range of motion.
 Occupational therapy focuses on activities to help
patient be as self-sufficient as possible in daily life.
 Patient may need to learn to use assistive devices, such
as leg or arm braces, canes, walkers and wheelchairs to
aid mobility during recovery or, if GBS causes
permanent disabilities, for long-term use
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23. Physiotherapy Management
Aims of physiotherapy management are:
 Regain the patient's independence with everyday tasks.
 Retrain the normal movement patterns.
 Improve patient's posture
 Improve the balance and coordination
 Maintain clear airways
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24.  Prevent lung infection
 Support joint in functional position to minimize
damage or deformity
 Prevention of pressure sores
 Maintain peripheral circulation
 Provide psychological support for the patient and
relatives.
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25. Cardiorespiratory Care
 Manual techniques like vibration with/ without over
pressure.
 chest percussion, breathing exercises, resistive
inspiratory training may be required to clear
respiratory secretions to reduce the work of breathing.
 Patients with cranial nerve involvement need extra
monitoring as they are more prone to respiratory
dysfunction.
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26. Cont.…
 Patients should be encouraged to cease smoking.
 Positioning/ Postural drainage areas of lung tissues,
 Rib springing to stimulate cough.
 After the removal of a ventilator and adequate
expansion, effective coughing must be taught to the
patient.
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27. Cont.….
 Proper positioning
 Avoid prolonged hip and knee flexion
 Change position at least every two hours
 Support weak upper extremities with
armrests, a wheelchair tray and/or pillows.
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28. Cont.…
 Prevention of Pressure Sores
 2- hourly change in patients position from supine to side-
lying.
 If the sores have developed then UVR or ice cube massage to
enhance healing.
 Maintenance of Circulation
 Passive movements
 Effleurage massage to lower limbs
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29. Maintain Normal Range of
Movement
 Gentle passive movements through full ROM at
least three times a day especially at. hip ,
shoulder, wrist, ankle, feet.
 Support joints
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30. Strength and Endurance training
 Strengthening exercises
 endurance training involves progressively increasing the
intensity and duration of functional activities such as
walking or stair-climbing.
 Functional training : Retraining of dressing, washing,
bed mobility, transfers, and ambulation.
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31. Cont.….
 Muscle strength training exercising as often as possible
in the correct way.
 Stretch tight muscles and prevent soft tissue
contractures.
 Improve patient's posture in lying, sitting and standing
and sleeping.
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32. Cont.….
 Balance and proprioception retraining in all these
functional activities should also be included,
 while motor control can be achieved by performing PNF
techniques.
 Assistive devices such as Wheelchairs. walking sticks
should be made available to individuals if required in
order to facilitate safe and effective ambulation.
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33. The role of physiotherapy for GBS disease can
be divided into three parts -
 acute phase
 the middle phase of rehabilitation
 long-term, on-going rehabilitation
 The important factor is communication with
this multi-disciplinary approach with the aim
of the team to help the flow of the treatment
of the patient.
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34. The Acute Phase
• In the acute phase a large part of physio is
for respiratory care.
• If it affects the intercostal muscle the one
between the ribs that lifts up the ribs as we
take a breath.
• Equally if the diaphragm is affected the part
of the body between the abdomen and the
chest patient have the inability to take a large
breath.
• So in acute phase regular breathing
exercises are necessary.
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35. Phase of Rehabilitation
• So then the first part of the rehabilitation
phase begins.
• We realize the patients can fatigue quite
quickly and so we try to build up the
strength very gradually.
• The positioning of the patient is vital.
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36. Prognosis
– Approximately 85% of patients with GBS achieve a full
functional recovery within several months to a year, although
minor findings on examination (such as areflexia) may persist
and patients often complain of continued symptoms, including
fatigue.
– The mortality rate is <5% in optimal settings; death usually
results from secondary pulmonary complications
– Poor prognostic signs
• Advanced age Axonal variants
• Early facial and bulbar involvement Delayed treatment
• Severe proximal weakness Autonomic and respiratory
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37. Case study
• Fatuma, a 53-year-old female, arrived at the
emergency department complaining of weakness and
discomfort in her extremities. Fatuma explained she
had been feeling numbness and tingling in her toes
for two weeks now, with symptoms progressively
worsening. One month prior, Fatuma was diagnosed
with COVID-19 and attributed her symptoms as
residual effects of the infection. Over the past 3 days,
Fatuma had experienced increased weakness and
impaired motor skills. She noted a specific difficulty
holding her toothbrush and brushing her teeth,
influencing her to seek medical attention. Due to her
rapidly progressing signs and symptoms, Fatuma
was admitted to the hospital.
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38. • Fatuma’s status worsened the next week while in
hospital. She was unable to move her upper or lower
extremities and had trouble breathing and swallowing.
Fatuma was admitted to the ICU where she was
provided with supplemental oxygen to assist with
breathing and a nasogastric (NG) tube was inserted to
provide nutrition.
• Fatuma was transferred from the ICU to the hospital’s
medical unit where her condition stabilized. After one
week in the ICU and one week in the medical unit,
Fatuma was transferred to the inpatient unit. Inpatient
unit physiotherapy began four weeks after symptom
onset when Fatuma status had stabilized.
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39. Client Characteristics
• Patient profile: Marie Smith, 53-year-old
Caucasian female
• Medical Diagnosis: Guillain–Barré
syndrome (Acute inflammatory demyelinating
polyradiculoneuropathy)
• Primary complaint: Patient was experiencing
progressive pain and weakness in bilateral
extremities. Symptoms progressed to inhibit motor
function and lead to poor coordination
• Nature of condition: Patient is in the sub-acute
phase of rehabilitation, with her condition
improving since hospital admission
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40. • Primary Reason patient was referred to
physiotherapy: Patient was referred to
inpatient physiotherapy to address weakness
and loss of range of motion in bilateral upper
and lower extremities, improve balance,
ambulation, and ADLs
• Previous medical history: Diagnosed with
COVID-19
• Current Medication: Advil regular strength
(200mg 2x per day), Intravenous Immunoglobin
Therapy (IVIg) (high dose IVIG- taken as
needed
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41. Case study 2
• 33 y/o male admitted to JMC via ambulance on
May 30th, 2023, due to inability to move lower
limbs after waking up. Pt presents with bilateral
acroparesthesia and paralysis in lower
extremities, with bilateral areflexia and
flaccidity. Pt currently unable to ambulate due to
impaired strength, sensation, and balance in
lower extremities.
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42. Goals
Short-Term Goals
1. To be able to maintain independently sitting balance for
10 minutes while reading and interacting with daughters
in the next week
2. Achieve a sit-to-stand and be able to stand with minimal
support and a 2WW within the next 3 weeks.
3. To be able to complete 10 repetitions of in-bed resistance
exercises (glute bridge, quad-over-roll), twice a day
within the next 2 weeks
Long-Term Goals
1. To be able to walk independently with a 2WW to get to
the bathroom within the next 3 months
2. Gain the lower extremity strength to be able to perform
10 arm-supported squats within the next 2 months
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