Physical Therapy Guide to Guillain-Barré Syndrome
Guillain-Barré syndrome is an autoimmune disorder that affects nerves and how they function in the body. GBS is not inherited, nor is it contagious. The exact cause of the disorder is not known. However, research has shown that approximately two-thirds of GBS cases occur following bacterial or viral infections, or after immunizations. It can also occur with no identified trigger. GBS is rare, and occurs in fewer than 4 per 100,000 people worldwide, and slightly more often in men. It can affect adults and children; its affects do not vary across race, ethnicity, or geographic location. The incidence of GBS increases with age, with average onset at 40 years of age. In the United States, diagnoses of GBS peak in young adulthood (ages 15 to 35 years), and at a second higher peak in persons aged 50 to 75 years. Physical therapists design individualized treatment programs to help people with GBS regain movement and return to their preferred daily activities.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
What Is Guillain-Barré Syndrome
Guillain-Barré syndrome is an autoimmune condition in which the immune system attacks nerves in the affected person’s own body, destroying the outer insulation layers of the peripheral nerves (nerves other than those in the brain and spinal cord). GBS can cause damage that results in serious health problems.
Quite often, GBS occurs after a viral or bacterial infection, such as:
- Epstein-Barr virus
- Hepatitis viruses
- Chicken pox and other herpes infections
Research has shown that GBS also can occur following some immunizations (such as those for rabies and swine flu). Other possible triggers include infection by insect-carried organisms such as:
- Zika virus
- West Nile virus
- Lyme disease
Food-borne organisms also have been known to trigger GBS in people who have ingested contaminated food. Sexually-transmitted viruses and bacteria have been linked to the onset of GBS as well.
Signs and Symptoms
GBS can cause a variety of signs and symptoms, including:
- Muscle weakness, often occurring equally on the right and left sides of the body, starting in the feet and moving up toward the trunk.
- Sensation changes, such as numbness and tingling.
- Autonomic nerve dysfunction, such as problems with sweating, digestion, heart rate, incontinence, vision.
- Nerve, muscle, or joint pain.
How Is It Diagnosed?
GBS is usually diagnosed by your physician.
When you are referred for physical therapy, your physical therapist will conduct a thorough evaluation that includes taking your health history. Your therapist will also ask you detailed questions about your condition, such as:
- How and when did the symptoms start?
- Have the symptoms changed over time?
- What daily activities, hobbies, or work skills are you having trouble doing?
- What is your current activity level?
The physical therapist will perform tests on your body to find physical problems, such as:
- Weakness or tightness in the muscles.
- Loss of skin sensation in some areas (numbness).
- Loss of reflexes.
- Joint stiffness.
- Poor posture.
- Balance problems.
- Breathing difficulty.
- Skin problems.
If your physical therapist finds any of the above problems, physical therapy treatment may begin right away to help get you on the road to recovery and back to your normal activities.
If severe medical problems are found with any of the testing, your physical therapist may collaborate with a physician or surgeon to obtain special diagnostic testing or treatment. Physical therapists work closely with physicians and other health care providers to ensure that you receive the treatment and care needed.
How Can a Physical Therapist Help?
Once you have been diagnosed with GBS and referred to physical therapy, your physical therapist will work with you to design a specific treatment program that will improve your recovery, including exercises and treatments that you can do on your own. Physical therapy will help you return, as much as possible, to your normal lifestyle and activities. The time it takes to help heal the condition varies for each person, but results can start to be felt in a few weeks to a month.
Depending on your condition, your physical therapist may work with you to improve your:
Comfort level. GBS may cause pain or discomfort. Your physical therapist may show you how to use pillows to make your body position more comfortable in a chair or when lying down. Your therapist also may use technologies, such as gentle heat or electrical stimulation to help decrease your pain and alleviate your symptoms, and teach you gentle exercises or techniques to perform on your own to relieve discomfort. All of these options may reduce or eliminate the need for pain medication, including opioids.
Skin and joint protection. Your physical therapist will check your skin frequently to make sure that it stays healthy and injury free during your recovery. Your physical therapist may apply splints to parts of your arms and legs to protect your joints or to keep them gently stretched out. Your therapist will also teach you (and your caregivers or family) skin care and protection methods.
Walking ability. Your physical therapist will help improve your ability to walk using techniques such as strengthening exercises, walking training, and balance activities. If you have nerve damage (neuropathy), your physical therapist may provide bracing and other techniques to make it easier or safer for you to walk. Your therapist also may recommend using an assistive device, such as a walker or cane.
Aerobic capacity. Research shows that aerobic exercise, such as walking on a treadmill for at least 20 minutes 3 times per week, may help improve aerobic capacity, reduce fatigue, and optimize healing. Your physical therapist can assess your aerobic capacity and determine the best aerobic activities for you. Your physical therapist will teach you how to conserve energy and avoid overworking your body, so that healing can occur and relapse is avoided. If you have needed a ventilator in the past to help you breathe, your physical therapist will work with you to help improve your breathing endurance during activities like walking.
Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in any stiff joints or muscles. These might begin with "passive" motions that the physical therapist performs for you, and progress to active exercises and stretches that you do yourself. You can perform these motions on your own, when able, to help hasten improved motion and pain relief.
Ability to move around. Your physical therapist will teach you and your caregiver or family how to help you move around safely, and help you regain the ability to move from your bed to a chair, sit down, stand up, walk, climb stairs, use a wheelchair, and perform any other daily activity with which you have difficulty.
Flexibility. Your physical therapist will determine if any muscles are tight, start helping you to stretch them, and teach you how to stretch them on your own.
Strength. If your physical therapist finds any weak or injured muscles, your therapist will choose, and teach you, the correct exercises to steadily restore your strength and agility.
Coordination. Your physical therapist will help you improve and regain your coordination and agility so you can perform household, community, and sports activities with greater ease.
Balance. Your physical therapist will examine your balance, and choose specific exercises you can perform in the clinic and on your own to improve your balance and prevent falls. Your physical therapist also may teach you how to use a cane or walker to help maintain your balance when walking and standing.
Independent activities. Your physical therapist will teach you strengthening, stretching, and pain-reduction exercises to perform on your own. These exercises will be designed specifically for your needs, to help restore your ability to perform daily activities.
Participation in favorite activities. Your physical therapist can help you return to your preferred recreational activities over time, using a rehabilitation program designed just for you.
Family support. Your family’s knowledge of your condition will benefit you and them. Your physical therapist can help teach them how best to support you during your recovery.
Can This Injury or Condition Be Prevented?
Although little is known about how to prevent all cases of GBS, research shows that it may be prevented in some cases by:
- Using insect repellant to prevent bites from insect-carriers of organisms that have been linked to GBS.
- Storing food properly and avoiding ingestion of spoiled or contaminated foods to prevent exposure to infectious organisms that have been related to GBS onset.
- Practicing safe sex to prevent transmission of viruses and bacteria related to GBS onset.
Relapse of GBS cases has been known to occur. Relapse can best be minimized or avoided by not overworking the body to the point of significant fatigue.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat people who have Guillain-Barré syndrome. You may want to consider:
- A physical therapist who is experienced in treating people with neurologic problems.
- A physical therapist who is a board-certified neurologic clinical specialist or who completed a residency or fellowship in neurologic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist:
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with GBS.
- Be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association believes that consumers should have access to information that could help them make health care decisions and also prepare them for a visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of a herniated disc. The articles report present research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are listed by year and linked either to a PubMed abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Simatos Arsenault N, Vincent PO, Yu BH, Bastien R, Sweeney A. Influence of exercise on patients with Guillain-Barré syndrome: a systematic review. Physiother Can. 2016;68(4):367–376. Free Article.
Lizarraga AA, Lizarraga KJ, Benatar M. Getting rid of weakness in the ICU: an updated approach to the acute management of myasthenia gravis and Guillain-Barré syndrome. Semin Neurol. 2016;36(6):615–624. Article Summary in PubMed.
Khan F, Amalya B. Rehabilitation interventions in patients with acute demyelinating inflammatory polyneuropathy: a systematic review. Eur J Phys Rehabil Med. 2012;48(3):507–522. Article Summary in PubMed.
Khan F, Pallant JF, Amatya B, Ng L, Gorelik A, Brand C. Outcomes of high- and low-intensity rehabilitation programme for persons in chronic phase after Guillain-Barré syndrome: a randomized controlled trial. J Rehabil Med. 2011;43(7):638–646. Free Article.
Khan F, Ng L, Amatya B, Brand C, Turner-Stokes L. Multidisciplinary care for Guillain-Barré syndrome. Cochrane Database Syst Rev. 2010;(10):CD008505. Article Summary in PubMed.
Davidson I, Wilson C, Walton T, Brissenden S. Physiotherapy and Guillain-Barré syndrome: results of a national survey. Physiotherapy. 2009;95(3):157–163. Article Summary in PubMed.