GUILLAIN-BARRÉ SYNDROME

Description/Overview
Guillain-Barré Syndrome (GBS) is an acute inflammatory disease that results in demyelination and/or axonal
degeneration in peripheral nerves, spinal sensory and motor nerve roots, and at times in cranial nerves.
Criteria used in the diagnosis of GBS include:
■ A history of flu-like symptoms preceding the GBS symptoms
■ Progressive motor weakness in more than one limb
■ Symmetric, bilateral pattern of weakness
■ Cranial nerve involvement
■ Diminished or absent deep tendon reflexes
■ Progression of symptoms stabilizes after 2 to 4 weeks
Medical Red Flags
All assessment and intervention should cease; medical attention should be obtained

Symptoms Possible cause Management

Swelling, heat and erythema in
the involved area
Positive Homans’ Sign
Tachycardia
Bradychardia
Paroxysmal hypertension
Anhidrosis or diaphoresis
Orthostatic hypotension
Change in cardiopulmonary
function including dyspnea and
tachypnea
Pain on swallowing
Choking
Aspiration
Airway obstruction
Pneumonia
Deep Vein Thrombosis
Due to immobilization, thrombus
may form in the deep veins in the
legs and/or arms
Autonomic disturbances
Dysfunction in the
parasympathetic & sympathetic
systems
Respiratory distress
Severe weakening of respiratory
muscles
Dysphagia
↓ coordination of swallowing
muscles
Diminished swallow reflex
Reduced lingual pharyngeal
control
Cranial nerve deficits
Cease treatment and seek
immediate medical attention
Avoid any exercise of the lower
extremities
Cease treatment and seek
immediate medical attention
Cease treatment and seek
immediate medical attention
For aspiration, seek immediate
medical attention
Administer the Heimlich
maneuver or CPR, if warranted
Speech-language feeding
program

Precautions
■ Overuse of painful muscles may result in prolonged recovery period or lack of recovery; frequent rest periods
are recommended
■ Overstretching can occur due to the denervation and weakened muscle

Physical Therapy Examination

History
Refer to Tab 2 for full history. Include:
■ Date of onset
■ Description of progression of symptoms
Tests and Measures
Aerobic Capacity/Endurance
■ Assess BP, RR, and HR at rest and during and after exercise
■ Use the Borg Rating of Perceived Exertion
Potential findings
■ The respiratory status may be impaired in the initial stages of GBS
■ Initially endurance is poor and overexertion should be avoided

Assistive and Adaptive Devices

Assessment
■ Assess the need for assistive or adaptive devices and equipment for functional activities
Findings
■ A WC is usually required during the initial few months; selection should consider avoidance of muscle
fatigue, existing strength, need for positioning, and ease of maneuvering in patient’s home/work
environment

Circulation
Potential findings
■ Decreased cardiac output and cardiac arrhythmia
■ Fluctuations in blood pressure between hypotension and hypertension

Cranial and Peripheral Nerve Integrity

Assessment
■ Assess cranial nerves (CN)
Potential findings
 ■ CN involvement may cause weakness of the ocular muscles and reflex responses (CN III, VI, and X),
facial (CN VII), and oropharyngeal (CN IX and XII) muscles
■ Resultant dysphagia, dysarthria, ophthalmoparesis, and ptosis may occur
Assess peripheral nerves for sharp/dull discrimination and light touch.
Potential findings
■ Deficits in sharp/dull discrimination and light touch are often long standing

Environmental, Home, and Work Barriers, Gait, Locomotion, and Balance

Balance assessment using
■ Romberg and Timed Up and Go
■ Berg Balance Scale
■ Performance-Oriented Mobility Assessment
Gait and locomotion assessment
■ Observational Gait Analysis
Potential findings
■ Gait and balance will be affected by pain, diminished endurance, and muscular weakness
■ Common findings include a drop foot and diminished heel strike

Motor Function
Assessment
■ Use the Rivermead Mobility Index

Muscle Performance
Considerations
■ Caution should be taken to avoid overexertion so manual muscle testing should be done over several
sessions
■ Avoid substitutions for weakened muscles
Assessment
■ Manual muscle testing of individual muscles (as opposed to testing muscle groups) should be
performed for monitoring progression
■ Facial and respiratory muscles should be tested
■ Use dynamometry to improve sensitivity to change in strength over time
Potential findings
■ Muscular weakness generally proceeds in a symmetric manner from proximal to distal, first in the lower,
then the upper limbs
■ Facial and respiratory muscles are often involved

Orthotic, Protective, and Supportive Devices

Considerations
■ The need for devices is usually short-term so consideration should be given to cost
■ An ankle-foot orthotic is often required due to residual weakness of the anterior tibialis and intrinsic
muscles of the foot
■ Resting splints may be needed to prevent contractures of the hands and ankles
Assessment
Assess the need for:
■ Orthotic devices
■ Positioning devices to reduce or eliminate pressure (e.g., specialty pressure reducing mattresses,
cushions, multipodus boots, etc.)
■ Walkers, crutches, and canes

Pain
Assessment
■ Universal Pain Assessment Tool
■ Note areas and type of pain on the Ransford Pain Drawing
Potential findings
■ Pain, which may be severe, often occurs in the back and legs
 ■ Pain often worsens at night
■ Pain may be described as feelings of dysesthesia, such as burning, tingling or shock-like

Reflex Integrity
Assessment
■ Assess deep tendon reflexes
Potential findings
■ Deep tendon reflexes are diminished or absent in the early stages of the illness

Self-Care and Home Management

Assessment
■ Assess with the Functional Independence Measure (FIM)
■ Administer the Katz Index of Activities of Daily Living

Sensory Integrity
Assessment
■ Establish sensory system functional status (somatosensory, vision, hearing) before completing
cognitive/perceptual testing
■ Assess superficial (pain, temp, touch), deep (proprioception, vibration) and combined cortical
sensations
Potential findings
■ initially there is paresthesia or anesthesia beginning in the feet, although this may also occur in the
hands
■ Decreased vibratory and position sense may be present

Ventilation and Respiration

Assessment
Assess respiratory status including:
■ Auscultation of lungs for breath sounds
■ Pulse oximetry
■ Signs of dyspnea and tachypnea
■ Tidal volume and vital capacity with spirometry
■ Strength of cough
■ Ability to clear airway
■ Chest expansion
■ Use the Medical Research Council Dyspnea Scale during and after exercise
Potential findings
■ Impaired respiratory muscle strength can result in a weak cough, decreased vital capacity, tidal volume,
and oxygen saturation
■ Aspiration may occur when there is cranial nerve involvement resulting in oromotor weakness

Work, Community, and Leisure

Assessment
■ Assess mobility skills with WC, orthotics, and/or assistive devices within the community and work
environments

Medications/Treatment
■ Plasmapheresis has been found to shorten the course of GBS and to lessen symptoms

Indications Generic name Brand name Common side effects

GBS symptoms IV immunoglobulin Gammagard S/D, Headache, skin rash,
Gammar IV, Iveegam back pain, wheezing,
tachycardia, nausea,
and hypotension
Neuropathic pain Acetaminophen c Tylenol c Codeine Lightheadedness,
codeine dizziness, drowsiness,
 and nausea
Hypersensitivity and Gabapentin Neurontin tegretol Low WBC count,
neuropathic pain carbamazepine nausea, vomiting, and
dizziness
Muscle spasms Diazepam Valium Drowsiness, dizzinessm
blurre vision, impaired
coordination and
balance, short-term
memory loss

Reference:
Fenderson, B.C., & Ling, W. K. (2009). Neuro Notes Clinical Pocket Guide. Philadelphia, PA: FA Davis Company