Guillain-Barré syndrome (GBS) : Popularly known as “French polio” is an acute inflammatory demyelinating polyneuropathy marked by inflammation of the peripheral nerves, that affecting arms and legs. characterized by progressive muscle weakness and areflexia, and disrupted proprioception . In Guillain-Barré syndrome, the myelin sheath surrounding the axon is lost makes nerve impulse transmission is aborted. All forms of Guillain–Barré syndrome are autoimmune disease, due to an immune response to foreign antigens

1. GUILLAIN-BARRÉ
SYNDROME

2. DESCRIPTION
⦿ Guillain-Barré syndrome (GBS) :
• Popularly known as “French polio” is an acute inflammatory
demyelinating polyneuropathy marked by inflammation of the
peripheral nerves, that affecting arms and legs.
• characterized by progressive muscle weakness and areflexia,
and disrupted proprioception .
• In Guillain-Barré syndrome, the myelin sheath surrounding the
axon is lost makes nerve impulse transmission is aborted.
• All forms of Guillain–Barré syndrome are autoimmune disease,
due to an immune response to foreign antigens.
(Lugg, 2010)
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3. TYPES
⦿ Guillain-Barré syndrome (GBS) :
• Acute inflammatory demyelinating polyradiculo neuropathy = (AIDP).
• Acute motor axonal neuropathy=(AMAN) •
• Acute motor and sensory axonal neuropathy= (AMSAN).
• Miller fisher syndrome =(MFS).
• Acute Panautonomic Neuropathy.
(Lugg, 2010)
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4. ETIOLOGY
⦿ Guillain-Barré syndrome(GBS) :
• No clear cause (Idiopathic).
• Neither contagious nor hereditary.
• Inappropriate immune response like surgery may trigger the syndrome.
• vaccinations may increase the risk of (GBS).
• When (GBS)is preceded by a viral infection, there is no evidence of direct
viral infection of peripheral nerves or nerve roots.
(Haber, Sejvar, Mikaeloff, & DeStefano, 2009)
• Usually (GBS)occurs a few days or weeks after the patient has had
symptoms of a respiratory or gastrointestinal viral infection like:
(COVID-19) stimulates inflammatory cells and produces various
inflammatory cytokines which is lead us to Guillain Barre syndrome
associated with COVID-19 infection . (Sedaghat & Karimi, 2020) 4

5. INCIDENCE & PREVALENCE
⦿ Guillain-Barré syndrome(GBS) :
• Although rare, with an incidence of (0.4 to 2 per 100,000), Guillain-Barre
syndrome (GBS) has major effects on the health care system.
• Each year, it is estimated (100,000) patients worldwide would contract (GBS).
(Nguyen & Taylor, 2021)
• Nondiscriminatory: can affect persons of any gender, age, or ethnic background
but males are affected at (one and a half times) higher incidence than females.
(Willison, Jacobs, & van Doorn, 2016)
• With the marked decline in the incidence of polio, Guillain- Barré syndrome is
now the most common cause of acute flaccid paralysis in healthy people. 5

6. SIGNS AND SYMPTOMS
⦿ Guillain-Barré syndrome(GBS) :
• Numbness and tingling in hands and feet.
• Distal progression: muscle weakness, diminished reflexes and
proprioception, decreased sensation.
• For some, progresses to trunk, face, and cranial nerves, resulting
in difficulty swallowing, chewing, speaking, and facial
expressions.
• Deep, aching pain/hypersensitivity to touch.
• Respiratory/cardiac dysfunction and failure.
(Nguyen & Taylor, 2021) 6

7. PROGNOSIS
⦿ Guillain-Barré syndrome(GBS) :
1. (80%) experience complete recovery may last from( 2 months to 2 years).
2. The syndrome may develop rapidly over the course of hours or days, or may take up to (3 to 4 weeks)
to develop.
3. Most patients demonstrate the greatest weakness in the first weeks of the disorder.
4. Patients are at their weakest point by the third week of the illness.
5. In the beginning, a flaccid, ascending paralysis develops quickly.
6. The patient may first notice weakness in the lower extremities that may quickly extend to include
weakness and abnormal sensations in the arms.
7. Deep tendon reflexes are usually lost, even in the earliest stages.
8. (3 distinct phases):
• Acute (4 wks) - initial rapid onset of symptoms. (Nguyen & Taylor, 2021)/(Lugg, 2010)
• Plateu (few days to few weeks) - symptoms neither worsen nor improve.
• Recovery - gradual improvement. 7

8. DIAGNOSIS
⦿ Guillain-Barré syndrome(GBS) :
Guillain-Barre syndrome can be difficult to diagnose in its earliest stages
,Its signs and symptoms are similar to those of other neurological
disorders and may vary from person to person.
1. Physical and neurological exam(usually begin with weakness or
paresthesias of the lower extremities and ascend in a symmetrical pattern).
2. Lumbar Puncture CSF analysis (reveal increased protein).
3. Electromyography ( helps confirm diagnosis = prolonged or absent F wave).
4. MRI of the spinal cord (Thickening of the cauda equina and intrathecal nerve
roots)
5. Nerve conduction studies (The majority show demyelinating pattern while –
some patients may show evidence of axonal loss with little or no
demyelination).
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(Nguyen & Taylor, 2021)/(Lugg, 2010)

9. MEDICAL/SURGICAL MANAGEMENT
⦿ Guillain-Barré syndrome(GBS) :
1. Intravenous immunoglobin therapy: prevents immune system from
further attacking Schwann cells and myelin by blocking receptors on
microphages.
2. Plasmapheresis: filters blood plasma to remove antibodies and aids
in replacing lost fluids.
3. Corticosteroids: inhibit inflammation associated w/ symptoms.
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(Nguyen & Taylor, 2021)/(Lugg, 2010)

10. Physiotherapy Management
⦿ Guillain-Barré syndrome(GBS) :
1. ACUTE PHASE (It is a phase when patient is admitted in hospital).
2. SUBACUTE REHAB PHASE (when patient maintain his respiration).
3. Chronic- Rehab PHASE (when patient have good strength of
muscles).
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11. Rehab: Acute Care
⦿ Guillain-Barré syndrome(GBS) :
• Prevention of contractures and maintenance of
posture and joint alignment (Knee rolling , Double
knee-and-hip flexion).
• Reducing effects of prolonged immobilization: tilt
tables for weight-bearing and repositioning to
prevent skin issues (Ulcer).
• Introduce breathing and coughing exercises
(Respiratory care).
• Provide gentle stretching and active or active
assistive exercise at a level consistent with patient’s
strength (Prevention from Contracture formation).
• Prevention from DVT(Active pumping ex’s and Keep
lower extremities elevated).
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(pumping ex’s)
(Knee rolling)
(Double knee-and-hip flexion)
(International, n.d.)/(Khan, 2004)

12. Rehab: Sub-Acute
⦿ Guillain-Barré syndrome(GBS) :
• Rehab similar to incomplete spinal cord injured patient
Partial body weight support treadmill training .
• Pain management-TENS.
• Stretching exercise.
• Progress strengthening and endurance ex’s.
• Progress to ambulation- decrease assistance as patient
progresses balance and coordination.
• Aerobic ex’s (WALKING, CYCLING, SWIMMING).
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(International, n.d.)

13. Rehab- Chronic
⦿ Guillain-Barré syndrome(GBS) :
• Strengthening.
• Stretching.
• Improve gripping and upper limb function.
• Balancing and reducing falls incidence (Tai chi)
(Winser, Tsang, Krishnamurthy, & Kannan, 2018)
• Hydrotherapy.
• Gait training.
• (12-week) bicycle extensive training program has positive
effects on fatigue, anxiety, depression, and functional
outcome. (Meena, Khadilkar, & Murthy, 2011)
• Pool therapy Functional training.
• Dynamic balance and strength training Make it fun yet
challenging.
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(International, n.d.)

14. Case Study: Guillain-Barre Syndrome (Sub-Acute)
History of Present Illness
• F.K, 57 year old single female, Approximately one week prior to her admission to the king Abdullah
emergency department described a gradual onset of bilateral lower extremity weakness initially involving
both feet and subsequently progressing upward to affect both legs and thighs.
• One month prior to the beginning of her symptoms, she recalled a self-‐limiting gastrointestinal type illness
with several episodes of diarrhea. She also reports having a recurrent diarrheal illness at nearly the same
time each year.
• A few weeks later she felt numbness and tingling in in the same lower extremities along with radiating
burning pain at 5/10 in severity that got worse with movement. She has found it increasingly difficult to
ambulate for which she became dependent on her mother and sister for assistance leading to admission to
the king Abdullah emergency department .
• .F.K could hardly move for 3 weeks and required ICU medical support. It has been 3 months since her last
admission to the hospital. No other medical conditions/comorbidities have since arisen and her medical
status has remained stable. 14

15. Case Study: Guillain-Barre Syndrome (Sub-Acute)
Physical examination
• Reflexes:
Lower limb reflexes were reduced but still present at a low level (1+) on inspection, and there were no variations
between individual lower limb dermatomes, but general hypersensitivity was discovered.
• ROM:
Hip Flexion:
AROM: 56
90/ 110 degrees PROM
• Manual Muscle Testing (MMT):
Hip extensors (3)
Hip flexors (3)
Knee flexors (3)
Ankle plantar flexors (3)
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Knee flexion:
AROM: 35
120/140 degrees PROM
Ankle Dorsiflexion:
AROM: 5
10/ 20 degrees PROM

16. Case Study: Guillain-Barre Syndrome (Sub-Acute)
Physical examination
• Gait assessment : Upon examination, during gait cycle she has slightly drop foot in stance phase at initial
contact and decrease in knee flexion in swing phase at mid swing that lead to walk with a narrow and short
stride .
• Palpation (lower limb) :
No joint swelling.
No redness.
No deformity but has per articular muscle atrophy especially in quadriceps and plantar flexors .
Balance Assessment:
She will balance on her own two feet with her eyes open.
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17. Case Study: Guillain-Barre Syndrome (Sub-Acute)
Treatment plan(30–60 minutes per session 3 times weekly/ 6-12 weeks )
• Pain management-TENS.
• Range of Motion:
Passive and active ROM for lower limb.
• Stretching exercise:
For dorsiflexors ,knee and hip flexors.
• Progress strengthening and endurance ex’s:
start at Low-level aerobic exercise by using stationary bike .
Also for strengthening exercise (isometric and isotonic resistance exercise) : bridging and sit to stand.
• Progress to ambulation- decrease assistance as patient progresses balance and coordination.
Starting with Parallel bar gait training .
Marching gait.
Tandem gait. 17

18. REFERENCES
⦿ Guillain-Barré syndrome(GBS) :
• Lugg, J. (2010). Recognising and managing Guillain-Barré syndrome. Emergency Nurse, 18(3).
• Haber, P., Sejvar, J., Mikaeloff, Y., & DeStefano, F. (2009). Vaccines and guillain-barre syndrome. Drug Safety, 32(4),
309–323.
• Sedaghat, Z., & Karimi, N. (2020). Guillain Barre syndrome associated with COVID-19 infection: A case report.
Journal of Clinical Neuroscience, 76, 233–235. https://doi.org/https://doi.org/10.1016/j.jocn.2020.04.062
• Nguyen, T. P., & Taylor, R. S. (2021). Guillain Barre Syndrome. Treasure Island (FL).
• Willison, H. J., Jacobs, B. C., & van Doorn, P. A. (2016). Guillain-Barré syndrome. Lancet (London, England),
388(10045), 717–727. https://doi.org/10.1016/S0140-6736(16)00339-1
• International, F. (n.d.). Guidelines for Physical and Occupational Therapy Guidelines for Physical and Occupational
Therapy.
• Khan, F. (2004). Rehabilitation in Guillian Barre syndrome. Australian Family Physician, 33(12), 1013.
• Meena, A. K., Khadilkar, S. V, & Murthy, J. M. K. (2011). Treatment guidelines for Guillain–Barré syndrome. Annals of
Indian Academy of Neurology, 14(Suppl1), S73.
• Winser, S. J., Tsang, W. W. N., Krishnamurthy, K., & Kannan, P. (2018). Does Tai Chi improve balance and reduce
falls incidence in neurological disorders? A systematic review and meta-analysis. Clinical Rehabilitation, 32(9),
1157–1168.
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19. Thanks!
Any questions?
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