- Guillain-Barre Syndrome (GBS/AIDP), Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), and Miller Fisher Syndrome are a group of inflammatory diseases that causes demyelination of axons in peripheral nerves.
- Cause is uncertain, possible causes include: genetic, vaccination (infrequently), viral infection, enteritis, respiratory tract infection, HIV/AIDS may precede GBS.
- 2/3 of people develop GBS days or weeks after diarrhea or a respiratory illness.
- Bacterial infection is the most common risk factor, but also after having the flu or other infections.
- Also called acute inflammatory demyelinating polyneuropathy (AIDP).
- 3000-6000 people in the US are diagnosed with GBS (CDC, 2012).
- Disability occurs over the course of a few days to 4 weeks.
- Starts distally and ascends.
- 50% develop abnormal sensations (tingling in feet/fingers).
- 25% develop muscle weakness.
- Flaccid paralysis of nearly all skeletal muscles
- Breathing – possible intubation or ventilator use
- Pain is a common symptom (deep aching, cramping in buttocks/thighs/between shoulders).
- Minor cognitive impairment (executive, short-term memory, decision making)
- Onset & acute inflammation: weakness occurs in at least 2 extremities
- Plateau: most debilitating, with little change over days to weeks.
- Recovery: remyelination and axonal regeneration.
- Most reach full or nearly full recovery.
- Many will walk without aid after 3 months.
- Recovery can be slow – 6 months to 2 years+.
- 5-20% are left with significant residual symptoms on long-term disability.
- Recovery typically begins at the head & neck.
Miller Fisher Syndrome
- An uncommon variant of GBS
- Clinical features often accompany GBS
- External ophthalmoplegia (weak eye muscles that cause diplopia)
- Ataxia (ataxic gait)
CIDP (Chronic Inflammatory Demyelinating Polyneuropathy)
- Chronic counterpart to GBS.
- Rare compared to GBS.
- Can persist for years.
- Disability develops slowly compared to GBS (over the course of 2 months+)
- Recurrent relapses & remissions of ascending weakness (over the course of years) or slow progressive deteriorating course without improvement.
- If left untreated, CIDP can lead to irreversible and severe nerve damage.
- Characterized by symmetrical weakness and sensory changes.
- Unlike GBS, breathing, swallowing, speech is rarely affected.
Therapists should be encouraging and hopeful regarding the patient’s recovery, but not make promises about the degree of recovery or time frame.
- Occupational profile
- Safety (falls & injury)
- Psychosocial (fear, anxiety, depression, stress)
- Communication (A/E & environmental modifications if needed)
- Pain (TENS, heat, sensory desensitization)
- Autonomic Nervous System
- Postural hypotension
- Positioning & comfort (all stages)
- Splinting (wrist, fingers, ankle)
- Sensation (legs, hands, cranial nerves – face)
- ROM & MMT – Strengthening
- Progressed from PROM to AAROM to AROM
- Progress from low repetitions & resistance with frequent rest breaks
- Consider gravity eliminated, low friction
- Consider PNF techniques
- Function (ADLs)
- Bladder dysfunction (urinary retention)
- Endurance / Fatigue / Energy conservation
- Discharge: home environment, return to function, prior occupations
- Prevention: Pressure sores, DVT