Gullien-Barre Syndrome

Gullien-Barre Syndrome

| Gullien-Barre Syndro
What is Gullien-Barre Syndrome ?

Guillain-Barré (Ghee-yan Bah-ray) Syndrome is an inflammatory disorder of the peripheral nerves outside the brain and spinal cord.It’s also called:

  • Acute Inflammatory Demyelinating Polyneuropathy
  • Landry’s Ascending Paralysis

GBS is characterized by:

  • Rapid onset of muscle weakness caused by the immune system damaging peripheral nervous system.
  • Initial symptoms are typically changes in sensation or pain often in the back along with muscle weakness, beginning in the feet and hands.
  • Often spreading to the arms and upper body, with both sides being involved.
  • The symptoms may develop over hours to a few weeks. During the acute phase, the disorder can be life-threatening, with about 15 percent of people developing weakness of the breathing musclesand, therefore, requiring mechanical ventilation.
  • Some are affected by changes in the function of the autonomic nervous system, which can lead to dangerous abnormalities in heart rate and blood pressure.

Tingling, numbness and pain alone or in combination followed by weakness in the legs and arm that affects both side equally and worsens over time. The weakness can take half a day to over two weeks to reach maximum severity, and then becomes steady. In one in five people, the weakness continues to progress for as long as four weeks. 


Guillain-Barré syndrome is often preceded by an infection. This could be a bacterial or viral infection. Guillain-Barré syndrome may also be triggered by vaccine administration or surgery.

In the context of Zika virus infection, unexpected increase in cases of Guillain-Barré syndrome has been described in affected countries. The most likely explanation of available evidence from outbreaks of Zika virus infection and Guillain-Barré syndrome is that Zika virus infection is a trigger of Guillain-Barré syndrome.


Diagnosis is based on symptoms and findings on neurological examination including diminished or loss of deep-tendon reflexes. A lumbar puncture may be done for supportive information, though should not delay treatment. Other tests, such as blood tests, to identify the underlying trigger are not required to make the diagnosis of GBS and should not delay treatment.

  • Guillain-Barré syndrome is potentially life-threatening. GBS patients should be hospitalized so that they can be monitored closely.
  • Supportive care includes monitoring of breathing, heartbeat and blood pressure. In cases where a patient's ability to breathe is impaired, he or she is usually put on a ventilator. All GBS patients should be monitored for complications, which can include abnormal heart beat, infections, blood clots, and high or low blood pressure.
  • There is no known cure for GBS. But treatments can help improve symptoms of GBS and shorten its duration.
  • Given the autoimmune nature of the disease, its acute phase is typically treated with immunotherapy, such as plasma exchange to remove antibodies from the blood or intravenous immunoglobulin. It is most often beneficial when initiated 7 to 14 days after symptoms appear.
  • In cases where muscle weakness persists after the acute phase of the illness, patients may require rehabilitation services to strengthen their muscles and restore movement.
  1. The patient's independence with everyday tasks.
  2. Retrain the normal movement patterns.
  3. Improve Patients posture.
  4. Improve the balance and coordination
  5. Maintain clear airways
  6. Prevent lung infection
  7. Support joint in functional position to minimize damage or deformity
  8. Prevention of pressure sores
    1. Provide psychological support for the patient and relatives.Maintain Regain peripheral circulation
    • Maintain Normal ROM

    Gentle passive movement through full ROM atleast three times a day especially at hip,shoulder,wrist,ankle,feet.

    • Orthosis

    Use of light splints (eg. Using plastazote) may be required for the following purpose listed below:

    • Support the peripheral joints in comfortable and functional position during flaccid paralysis.
    • To prevent abnormal movements.
    • To stabilize patients using sandbags, pillows
    • Strength and Endurance Training

    Strength training involved isometric, isotonic or isokinetic exercises, while endurance training involves progressively increasing the intensity and duration of functional activities such as walking and stair climbing.

    Role of physiotherapy for GBS divided into three parts:

    • Acute phase
    • Middle phase
    • Long term

    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.


          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.

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