GUILLIANE-BARRE SYNDROME :

INTRODUCTION:-
Guillain-Barré syndrome is a rare but serious autoimmune disorder in which the immune system attacks healthy nerve cells in your peripheral nervous system. This leads to weakness, numbness, and tingling. It can eventually cause paralysis. The cause of this condition is unknown, but it’s typically triggered by an infectious illness, such as the stomach flu or a lung infection.

CAUSES:-
→ About two-thirds of people with Guillain-Barré develop it soon after they’ve been sick with diarrhea or a respiratory infection.
→ Campylobacter jejuni infection has been associated with Guillain-Barré.Campylobacter is one of the most common bacterial causes of diarrhea. It’s also the most common risk factor for Guillain-Barré. Campylobacter is often found in undercooked food, especially poultry.

The following infections have also been associated with Guillain-Barré:
→ Influenza.
→ Cytomegalovirus, which is a strain of the herpes virus.
→ Epstein-Barr virus infection, or mononucleosis.
→ Mycoplasma pneumonia, which is an atypical pneumonia caused by bacteria-like organisms.
→ HIV or AIDS.

SYMPTOMS:-
→ Tingling or prickly sensations in your fingers and toes.
→ Muscle weakness in your legs that travels to your upper body and gets worse over time.
→ Difficulty walking steadily.
→ Difficulty moving your eyes or face, talking, chewing, or swallowing.
→ Severe lower back pain.
→ Loss of bladder control.
→Fast heart rate.
→ Difficulty breathing.
→ Paralysis.

DIAGNOSIS:-
Spinal tap
A spinal tap involves taking a small amount of fluid from your spine in your lower back. This fluid is called cerebrospinal fluid. Your cerebrospinal fluid is then tested to detect protein levels. People with Guillain-Barré typically have higher-than-normal levels of protein in their cerebrospinal fluid. This test is also referred to as a lumbar puncture.

Electromyography
An electromyography is a nerve function test. It reads electrical activity from the muscles to help your doctor learn if your muscle weakness is caused by nerve damage or muscle damage.

Nerve conduction tests
Nerve conduction studies may be used to test how well your nerves and muscles respond to small electrical pulses.

TREATMENT:-
→ There’s no cure for Guillain-Barre syndrome. But two types of treatments can speed recovery and reduce the severity of the illness:

Plasma exchange (plasmapheresis). The liquid portion of part of your blood (plasma) is removed and separated from your blood cells. The blood cells are then put back into your body, which manufactures more plasma to make up for what was removed. Plasmapheresis may work by ridding plasma of certain antibodies that contribute to the immune system’s attack on the peripheral nerves.
Immunoglobulin therapy. Immunoglobulin containing healthy antibodies from blood donors is given through a vein (intravenously). High doses of immunoglobulin can block the damaging antibodies that may contribute to Guillain-Barre syndrome.
→ These treatments are equally effective. Mixing them or administering one after the other is no more effective than using either method alone.

You also are likely to be given medication to:

Relieve pain, which can be severe
Prevent blood clots, which can develop while you’re immobile

People with Guillain-Barre syndrome need physical help and therapy before and during recovery.

PHYSIOTHERAPY:-
The role of physiotherapy for GBS disease can be divided into three parts –

(1) Acute phase
(2) The middle phase of rehabilitation
(3) 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.

Chest Physiotherapy Treatment In GBS

(1) The Acute Phase
→ In the acute phase a large part of physio is for respiratory care. If it affects the intercostal muscle – the onebetween 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.

 

(2) Phase of Rehabilitation
→ So then the first part of the rehabilitation phase begins. When we start to get patients moving we have to keep in mind the physiotherapy must be graduated. We realize the patients can fatigue quite quickly and so we try to build up the strength very gradually, deliberately providing a little more demand each time in exercising the respiratory muscles.
→ The positioning of the patient is vital. He/she needs to be nursed so that the lungs are kept clear – from side to side and if need be to be “jacked up” with the head down so allowing any secretion in the lungs to be drained out.
Patient suffering from GBS disease often complain of severe pain, which can be managed by applying TENS, IFT and other pain relieving techniques.
→ If muscles are kept in a shortened position long enough then there is an increase in the stiffness of the muscle. So there should be “passive” movements, ie aided – through the full range at least once a day. If there is too much movement with weak muscles around a joint, the joint can become quite loose and set up later some pain. Too little movement and you end up with a stiff joint. You can have muscle stiffness and then joint stiffness. This again can become quite painful.
→ There are available Resting Splints for wrist/hands and for ankles which can be important in the early stages. Tight calf muscles can later on make it more difficult for one to walk, particularly upstairs and downstairs and even on a slight slope. You get too tired.
→ The important feature at the next phase when patient gets out of bed is that his/her circulation is quite dependent on the muscles in the body.
→ There will be swelling in the ankles and hands if one doesn’t move around much. So a patient’s blood pressure is monitored at this stage to check there is no sudden drop. Such patients wear elastic stockings to push the blood back to the heart and also to prevent blood clots. If the blood sits in the legs there is more potential for clotting.
→ Some patients with weak abdominal muscles may need abdominal corsets. Once the patient is getting up the whole effect of what gravity has on the joints becomes important. The shoulder joint particularly relies on its muscles around it. He/she may need the arms supported in the early stages of sitting up and walking.
→ It is important to get good seating. If necessary one can make do with a cushion, towel or pillow to support the lumbar spine. Prolonged sitting with a curved spine can lead to small damage to the joints in your upper spine, producing backache. It is similarly important to support the middle and top of the spine as well as the arms.
→ Stretching the arms including the hands, legs including the feet, body (particularly by slumping), helps to rehabilitate not only the peripheral muscles but also, we believe, the associated nerves. This is important for GBS and CIDP patients suffering from nerve damage. One has to be careful not to overstretch.
→ Functional tasks of daily living that involve exercise tend to be beneficial. These tasks include walking, repeated sitting to standing, rolling over and moving up and down in bed, putting on and taking off clothes. These tasks help to restore the patient to normal living.

 

Cuffing Huffing Exercise

(3) Ongoing Rehabilitation :

pectoralis Muscle stretching Exercise

→ Hydrotherapy is fantastic as patient can float; so their weight is supported and also they can exercise against the graded resistance of the water – the faster they move the harder it is, the slower the more gentle. It does not suit everyone – some find the heat too much.
→ It is important to watch the posture as muscle weakness can affect it. It is often the physio’s role to nag and give patient advice about posture.
→ The patient may need balance retraining because we know the ankles are important for balance. The patient may find the hips have to be moved to keep the balance.
→ As patient progress then we begin some training in advanced skills of walking up and down slopes and stairs.
As an ongoing practice it is important to have regular exercises to keep stretching muscles that may be at risk of tightening up – calf muscles, hamstrings, arm muscles.
→ Hydrotherapy, walking, exercise bikes or anything that can get patient’s heart rate up are important for ensuring that your cardiovascular and general fitness are in good condition.

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