Physiotherapy Intervention for Patients with GBS
What is GBS?
GBS is short for Guillain-Barre Syndrome (GBS). It is an acute autoimmune disease of the peripheral nervous system in which the nerves in the arms and legs become inflammed and stop working.
Who can get GBS?
This syndrome can affect either sex at any age, more common between 20-50 years. It is found world wide and in all seasons. The illness is neither hereditary nor contagious. About 60% of patients suffer from a throat infection; influenza or stress syndromes 2 weeks prior. Attacks can also occur after vaccinations. There are no statistics in Bangladesh on how many people are affected by GBS, but in the UK 150 people are affected every year.
What are the symptoms?
The first symptoms are usually tingling and numbness in the fingers and toes with regressive weakness in the arms and legs in the following few days. The paralysis starts distally and moves proximally. Usually lower limb involvement occurs earlier than that of the upper limb; the disease may progress to involve the trunk and cranial muscles. Pain may be present with tenderness following deep pressure. Both sensory and motor nerve conduction velocities are reduced.
How is Guillain-Barre Syndrome (GBS) diagnosed?
Diagnosis is dependent on patient history and clinical examination. Tow conformity tests may be helpful and are perfonned in most cases. Lumbar puncture and Electromyogram( EMG).
Prognosis : 80% of patients make a total recovery. Most patients will recover in 3t06 months and some time need I to 2 years. Some patients do not recover completely and have some residual disability.
What is the treatment for GBS?
GBS improves spontaneously. Good medical and physiotherapy care are essential from the first day and throughout the rehabilitation phase.
Physiotherapy has an important role in the management of GBS patients. It helps to maximise a patients physical potential, particularly where weakness is predominant problem.
- Acute phase
- Recovery or acute rehabilitation stage.
- The long-term or ongoing rehabilitation stage.
In the acute phase, a large part of physiotherapy treatment is related to for respiratory care.
When patient is under intensive care in the acute progressive stage, the main aims of physiotherapy are to maintain a clear airways, prevent lung infection, maintain anatomical joint range, support joints in a functional position to minimise damage or deformity, prevention of pressure sores and maintain peripheral circulation by using various physiotherapy techniques.
Recovery stage :
The recovery stage is when the patient can maintain his own airway and ventilation and there is some motor recovery. After doing a problem-oriented assessment physiotherapist make a treatment plan. Physiotherapists give emphasis on respiratory function; increase active and passive joint range of movement, increase muscle power, improve balance in various functional positions.
Rehabilitation stage :
As patients recover at different rates it is impossible to outline a course of treatment to suit them all. However some basic principles are common to all treatment programmes.
Maintenance of the airway and ventilatory capacity-patients can be taught breathing techniques and coughing together with instruction on frequency of practice.
Strengthen and re educate normal muscle function-the proximal muscles tend 0 recover first. To facilitate voluntary contraction of the muscles some of the following techniques may be useful:
- Neuromuscular facilitation techniques
- Afferent stimulation of skin
- Free active exercise
- Equilibrium and righting reactions
- Progressive resistance exercise
- Re education of sensory awareness.
Firoz Ahmed Mamin
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