Guillain-Barre Syndrome

Kelsey Smith
Physical Health II

Overview of Diagnosis
Guillain-Barrre Syndrome (GBS) is an autoimmune inflammatory polyneuropathy that has
varying severity, at the highest severity may be fatal. Polyneuropathy means damaged peripheral
nerves which can damage nerve functions in many areas of the body. It can cause acute
neuromuscular paralysis and respiratory failure. The cause of Guillain-Barre Syndrome is
unknown, it has been linked to diagnosis of influenza, anorexia, respiratory and gastro-intestinal
infections, Lupus, and pneumonia. Events such as trauma, immunization, surgery and bone
marrow transfusion have also preceded the onset of Guillain-Barre Syndrome (Khan, & Ng,
2009).
Features of GBS may include: paralysis, weakness is legs and arms, sensory loss, ataxia, pain,
fatigue, and respiratory problems. The disease can be a rapid progression requiring ventilator
support within a few days. In this case, progression may last two weeks, plateau, and be followed
by a gradual recovery. Other progressions may take a few weeks display symptoms. Most cases
have an illness durations of 12 weeks, some of these may have lasting side effects that affect
daily occupations. The majority of patients with this prognosis will have a recovery of returning
to previous function, as 80% of patients are fully ambulatory after six months of symptom onset
(Khan, & Ng, 2009). Most patients show gradual increases in muscle strength two to four weeks
after disease plateaus, and continue to recover about 2 years after disease onset. Recovery can
take up to ten years for some patients (Khan, & Ng, 2009). Factors that play into this are older
age, rapid onset, progression to quadriplegia, and need for respiratory support.
In recent years, an outcome measure for Guillain-Barre Syndrome has been developed. It can be
performed on a patient to help determine the outcome of the patients recovery 6 months from
the onset of disease. It is called the Erasmus GBS Outcome Score and it based on three variables:
age, preceding diarrhea, and GBS disability score at 2 weeks into onset. This prognostic model
was developed after previous studies had identified common patient characteristics associated
with poor outcome in Guillain-Barre Syndrome. It has been able to accurately predict the
outcome at six months after onset (outcomes such as ambulation ability).
Statistics of Diagnosis
Guillain-Barre Syndrome affects 1-2 out of 100,000 people worldwide yearly. In the United
States, the prevalence is 1.65-1.79 out of 100,000 people per year (Schub, & Schiebel, 2014).
The average age of diagnosis is forty years old. Prevalence is not different between genders or
races. Guillain-Barre Syndrome is fatal in 3% of cases, and fatality rate increased 15% when
deaths due to complications of GBS are added (deaths from respiratory failure, infection, and
pulmonary emboli). Most patients with Guillain-Barre Syndrome recover completely, with
children having quickest recovery rate. Around 20% of people have leftover deficits from GBS

and half of this percentage are left with severe disabilities. Currently 25,000-50,000 people in the
United States have long-term functional deficits from Guillain-Barre Syndrome. Guillain-Barre
Syndrome has a recurrence rate of less than 3% (Schub, & Schiebel, 2014).
Role of Occupational Therapy in Treatment of Diagnosis
Occupational Therapy Practitioners may be very involved in assessments for patients during the
first week or two of Guillain-Barre Syndrome onset. These assessments may include but not be
limited to: Erasmus GBS Outcome Score, Canadian Occupational Performance Measure, Box
and Blocks Test of Manual Dexterity, Berg Balance Test, Functional Independence Measure,
Tinetti Assessment Tool (measures gait and balance), assessment of range of motion, manual
muscle testing, and grasp dynamometry. Assessing early on in a diagnosis of Guillain-Barre
Syndrome will help patient to begin therapy early on during the worse stage of the disease which
will allow stronger functional improvement be made during the recovery stage.
Occupational Therapy (OT) can offer evaluation of walking abilities, provide functional
strengthening exercises, assistive equipment (walkers, wheelchairs, canes, etc.), and adaptations
made to the home or hospital room to allow for increased independence during recovery. Skilled
OT can also educate patients are compensatory techniques to complete daily occupations with
limited strength and fatigue. Occupational Therapy could provide a home evaluation for patients
who have residual deficits lasting beyond a typical 12 week recovery period. After a home
evaluation, OT could recommend further adaptations such as furniture set up, assistive devices
and/or equipment, and safety education.
Occupational Therapy may assist patients in social participation when returning to the work,
school, and leisure activities of life. Guillain-Barre Syndrome may have a significant effect on a
persons mental health, as this is an unexpected, sudden disease and has the possibility of being
fatal. Occupational Therapy may work with patients on coping skills, personal goals and values
interventions, relaxation techniques, and therapeutic social participation activities to assist in
taking care of mental health.
Many patients with GBS experience pain (33-71% of patients), occupational therapy
practitioners can provide pain management therapies with patients (Khan, & Ng, 2009). This can
include patient education and/or desensitization therapy. Desensitization therapy is a technique
that modifies sensitivity by giving consistent stimulation to the affected area for short periods of
time to allow acclimatization, which helps in reducing the bodys pain response (Khan, & Ng,
2009). This type of intervention helps patients in tolerating therapy while practicing functional
daily occupations such as ADLs.
Patient that experience chronic fatigue as a residual symptom several months after their onset of
GBS may also struggle from self-worth and self-image as a result (Khan, & Ng, 2009). After
returning home, families may be under stress with new or changing family roles, financial strain,
possibly being unable to return to driving or work, and increased care needs of affected
individual. OT intervention may provide monitoring, continued education, and coping skills. OT
may work with patient and family in outpatient or home setting. OT may refer patient or both
patient and family to a community support group, educate on possible community mobility, new

leisure and social participation activities to replace those that may have been lost, and many
more.
References
Chandr and, S., & Momi, H. (2014). Guillain-Barr syndrome with pulmonary tuberculosis in a
child. Journal Of Pediatric Neurology, 12(2), 91-93.
Schub, T., & Schiebel, D. (2014). Guillain-Barr Syndrome.
Khan, F., & Ng, L. (2009). Guillain-Barr syndrome: An update in rehabilitation. International
Journal Of Therapy & Rehabilitation, 16(8), 451-460.