Understanding GBS-Specific Physical Challenges
Neurological Recovery Patterns:
- Recovery typically follows proximal to distal pattern (trunk before limbs)
- Lower extremities often recover before upper extremities
- Motor function typically returns before sensory function
- Recovery can continue for 18-24 months or longer
Common Physical Impairments:
- Muscle Weakness: May be asymmetrical and affect different muscle groups
- Sensory Loss: Impaired position sense, touch, and temperature sensation
- Balance Deficits: Due to weakness, sensory loss, and vestibular involvement
- Fatigue: Central and peripheral fatigue affecting exercise tolerance
- Autonomic Dysfunction: Blood pressure changes, temperature regulation issues
Comprehensive Physical Therapy Approach
Acute Phase Physical Therapy:
- Passive Range of Motion: Maintaining joint flexibility to prevent contractures
- Positioning: Proper positioning to prevent nerve compression and pressure sores
- Respiratory Care: Chest physiotherapy, breathing exercises, airway clearance
- Early Mobilization: Bed mobility, transfers, standing as medically appropriate
Active Recovery Phase Physical Therapy:
- Progressive Resistance: Starting with gravity-eliminated exercises, advancing to resistance
- Functional Strengthening: Exercises that mimic daily activities
- Core Strengthening: Essential for posture and balance
- Endurance Training: Gradual increase in activity duration and intensity
Balance and Coordination Training:
- Static Balance: Standing balance with various support levels
- Dynamic Balance: Walking with direction changes, obstacle navigation
- Sensory Integration: Training with eyes closed, varied surfaces
- Fall Prevention: Teaching safe falling techniques and recovery strategies
Gait Training:
- Pre-gait Activities: Weight bearing, stepping, balance preparation
- Assistive Device Training: Proper use of walkers, canes, crutches
- Gait Pattern Correction: Addressing compensatory movement patterns
- Community Mobility: Stairs, curbs, uneven surfaces, long distances
Advanced Physical Therapy Techniques
Neuroplasticity-Based Interventions:
- Task-Specific Training: Practicing actual functional activities rather than isolated exercises
- Motor Learning Principles: Repetition, feedback, and progressive challenge
- Constraint-Induced Therapy: For asymmetrical weakness, encouraging use of weaker side
- Virtual Reality Training: Using technology to provide engaging, challenging exercises
Specialized Equipment and Techniques:
- Functional Electrical Stimulation (FES): Electrical stimulation to assist muscle activation
- Body Weight Support Systems: Harness systems for safe gait training
- Aquatic Therapy: Water-based exercises reducing joint stress while providing resistance
- Biofeedback: Visual or auditory feedback to improve muscle activation and control
Fatigue Management in Physical Therapy:
- Energy Conservation: Pacing activities and using efficient movement patterns
- Interval Training: Alternating activity with rest periods
- Heart Rate Monitoring: Staying within appropriate cardiovascular limits
- Activity Modification: Adapting exercises based on daily energy levels
Home Physical Therapy Program
Equipment-Free Exercises for Different Recovery Stages:
Early Recovery (Minimal Movement):
- Ankle Pumps: Flex and point feet to improve circulation (10-20 repetitions hourly)
- Deep Breathing: Diaphragmatic breathing to maintain lung function (5-10 breaths every hour)
- Gentle Range of Motion: Moving joints through available range without forcing
Intermediate Recovery (Some Movement Returning):
• Seated Exercises:
- Seated marching: Lift knees alternately, 10-20 repetitions
- Seated arm circles: Forward and backward, 10-15 each direction
- Heel and toe raises: Strengthen calves and shin muscles
- Seated trunk rotation: Gentle spinal mobility
• Standing Exercises (with support):
- Stand-to-sit practice: Using arms minimally, 5-10 repetitions
- Weight shifting: Side to side and forward/back while standing
- Heel raises: Rise onto toes, 5-15 repetitions
- Mini squats: Partial squats with chair support
Advanced Recovery (Significant Movement):
- Walking Program: Start with 5-10 minutes, gradually increase duration
- Stair Practice: Up and down with rail support, focus on safety
- Balance Challenges: Standing on one foot, walking heel-to-toe
- Functional Activities: Carrying objects while walking, reaching overhead
Safety Guidelines for Home Exercise:
- Always have someone nearby during initial exercises
- Stop immediately if you experience pain, dizziness, or shortness of breath
- Progress gradually – increase duration before intensity
- Maintain communication with physical therapist about home program
- Use appropriate assistive devices and safety equipment