Guillain-Barre is a disease in which the peripheral nerves become inflamed and cease to work properly. This results in a general ascending and symmetrical weakness throughout the body, first affecting the feet and legs, hands and arms, before spreading towards the trunk and face, and in severe case involving the muscles used for swallowing and breathing.

It is thought that the development of this disease is through an autoimmune response following an episode of acute infection of some kind (e.g. chest infection or bout of diarrhoea), attacking the peripheral nerves and damaging the myelin, the fatty insulating layer of the nerve important in nerve impulse conduction. This leads to a muscle paralysis that may be accompanied by sensory disturbances. Symptom presentation can be severe initially but recovery can be rapid if remyelination occurs. Guillain-Barre, unlike disorders such as Multiple Sclerosis, is a peripheral nerve disorder and does not generally cause nerve damage to the brain or spinal cord.

Early symptoms include tingling and numbness in the fingers and toes and progressive weakening of the limbs. Some individuals describe their legs feeling ‘rubbery and unsteady’, and this rapid progression of deterioration often happens within a period of days.

Cases can be mild with a moderate difficulty with walking and moving around functionally, needing the use of a stick or frame, and progression of the muscle weakness ceasing a short time after the onset. In more severe cases, the weakening continues to progress and can result in paralysis of the legs and arms. In about 40% of those affected, weakness becomes more widespread, causing respiratory difficulty and problems with swallowing and speech. Most people reach the stage of greatest weakness about 2 weeks after the onset of the disease, most require hospitalisation to some level and about 30% require ventilation of some kind.

Most of the time recovery starts after the fourth week from the onset of the disorder. Approximately 80% of patients have a complete recovery within a few months to a year, although minor symptoms may persist. About 5-10% recover with severe disability, with most of such cases involving peripheral motor and sensory nerve damage with inability of remyelination and axonal regeneration. About 30% of those with Guillain-Barre still have a residual weakness after 3 years. About 3% may suffer a relapse of muscle weakness and tingling sensations many years after the initial attack. Reduced stamina and exhaustion after a period of increased activity is often reported during the recovery phase. In addition, pain will be an issue for Guillain-Barré ex-patients. 50-75% of the recovered patients complain about occasional pins and needles, pain and other vague sensory irregularities in their feet and legs.

How is it treated?

There is no known cure for Guillain-Barre syndrome. However, there are therapies that lessen the severity of the illness and accelerate the recovery in most patients. There are also a number of ways to treat the complications of the disease.

Currently, plasma exchange (sometimes called plasmaphoresis) and high-dose immunoglobulin therapy are used. Both of them are equally effective, but immunoglobulin is easier to administer. Scientists still don't know exactly why plasma exchange works, but the technique seems to reduce the severity and duration of the Guillain-Barre episode.

Physiotherapy

Physiotherapy input for Guillain-Barre should start immediately following the onset of the disease, often upon hospital admission. It should continue until maximum recovery and outcome is achieved.

The rehabilitation required largely depends upon the extent of the disease progression and body areas affected. In severe cases this can include respiratory physio following the ventilation of an individual and passive limb movements to maintain joint range and muscle flexibility whilst immobilised in bed. Later, as the patient begins to recover limb control, physiotherapy is vital in assisting the restoration of muscle strength, limb control, balance and co-ordination. Patients are shocked to discover how little they can do after just a few weeks in bed. Physiotherapy does not affect the nerve healing process, it rehabilitates the muscles only, working towards functional restoration and increasing stamina.

Patients recovering from Guillain-Barre require long periods of recovery between bouts of exercise. During rehabilitation, the patient is taught to use his limited energy constructively, by using his body correctly, avoiding unnecessary routines, and compensating for difficult activities by rethinking them and doing them another way. As the muscles become stronger, the patient will feel less exhausted.

An important part of the physiotherapy is learning to recognise the body's signals and warnings when the limit of exercise for that session is reached. These signals can include tingling, numbness or other sensory abnormalities within the muscle group. Pushing oneself over the limit can lead to pain, spasms, weakness and temporarily fatigued muscles. Patients learn their own limits, the need to rest as required and to interpret their body's signals and symptoms.

Rehabilitation aims to increase muscle strength, maintain joint range, restore mobility and balance, retrain normal movement patterns necessary for normal function and independence.

Guillain-Barre syndrome patients face not only physical difficulties, but emotionally painful periods as well. It is often extremely difficult for patients to adjust to sudden paralysis and dependence on others for help with routine daily activities. Physiotherapy can help through support and education as part of an holistic approach, and can advise patients about help and support that can be provided through the use of other professionals.

PEAK Physiotherapy can provide essential rehabilitation throughout the whole of the recovery process, and sessions can take place at home or within our designated neurorehabilitation clinic (Iveridge Hall).

We actively support the involvement of relatives and carers in the rehabilitation process, encouraging self management and independent exercise between physiotherapy sessions to maximise outcome.

For more information, or to arrange an appointment, please click here or contact Cathy Preston (07908 684440) or Sarah Joice (07908 684441).

Return to Main Neurophysiotherapy page