Objective: determine the effect of physical exercises on the patient with GBS, moreover to determine the relationships between physical exercises and three domains studies in these patients: physical, physiological and psychological status of a patient.
Design: prospective with descriptive and relational analyses.
Subjects: sixteen? patients with GBS.
Main outcome measure: determine it is an effect on the physical, physiological and psychological status of the patient with GBS.
Results: the patient who had a monitored intensity exercise had improvement in physical, physiological and psychological status.
In the early 19thcentury, particularly in 1927 was present the first case of GBS by Dragonescu and Claudine, however, before that, particularly after world war one was named by Landry’s ascending paralysis, acute febrile or perhaps infectious neuropathy and radiculoneuritis which described by GUILLIAN. (1)
According to the WHO the definition of GBS is an autoimmune disease where the immune system attacks peripheral nerves, especially motor neurons that control muscle movement and as well as sensory neurons that carry pain, temperature, and sensation as a result of that muscle weakness, loss of sensation in legs and arms. It has affected in all individual ages, but it most commonly in adult and males. The individuals who have GBS are fully recovered even in severe conditions so GBS is rarely causing death. In fact, 85% of people with GBS make a full recovery within 6 to 12 months. Once you get better, the chance of it returning is very small. (2)(11)
The symptoms of GBS are involved numbness, pins and needles, pain, muscle weakness, pain and the problem with balance and coordination, moreover, the previous symptoms began with feet and hands then spread to the other parts of the body. These symptoms usually affect on both sides of the body at the same time, however, in the later stages of GBS the symptoms may be continued to worsen over time as a result difficulty in walking without assistance, difficulty with bladder control and bowel function, rapid heart rate, low or high blood pressure, and faculty in breathing etc. (4) (5)
The primary cause of GBS isn’t known, however, two-thirds of the peoples who have GBS is related to post infection and diarrhea, which indicate to improper immune reaction to the previous disease according to CDC (centers for disease control and prevention). The most common bacteria that are associated with GBS is Campylobacter Jejune which is the main causal agent of diarrhea in the United States which found in uncooked food especially poultry. In addition, GBS is associated with other infections such as HIV, influenza and Mycoplasma pneumonia, etc. (3). Moreover, GBS could be triggered by vaccine administration or operation. (2)
GBS has been divided into four types that involve in AIDP, MSF, AMAN, and AMSAN.but AIDP and AMAN are the most common types although they have the same clinical features they have different pathology. In Acute Inflammatory Demyelination Polyradiculoneuropathy (AIDP), the macrophages of the immune system primary attack against myelin sheath and caused demyelination, as a result, it is characterized by weakness begins in the lower parts of body then gradually spread to the upper parts which are more common in the USA, however in Acute and the surrounding Schwan membrane moreover in severe cases cause axonal degeneration which is more common in Japan. (6) (7) (8) Motor Axonal Neuropathy (AMAN) the macrophages invade to the nodes of Ranvier where between nodes of Ranvier
GBS is differentiated according to the signs and symptoms that mentioned previously.in addition the diagnosis is confirmed by reflexes tests such as knee jerks which are usually lost, moreover there are two tests that usually used to confirm diagnosis of GBS which they are lumbar puncture to detect if there is an increase in proteins rate with normal cell count of CSF and electrical test of nerve and muscle function to detect the slowness in the nerve conduction. However, the most common types of GBS are differentiated by specific tests.” In the acute inflammatory demyelinating polyneuropathy (AIDP) form, immune system reactions result in demyelination. It is diagnosed when nerve conduction studies show slowing of nerve conduction suggestive of demyelination in two or more motor nerves. Acute motor axonal neuropathy (AMAN) is diagnosed when nerve conduction studies show a reduction of compound muscle action potential (CAMP)* without significant conduction slowing. Testing for serum antibodies to certain nerve components may be useful for confirming the diagnosis of Miller Fisher syndrome (MFS)”. (9) (10)
* (CMAP) is the sum of motor unit action potentials in the muscle. (13)
The treatment of GBS is ranged from intensive care unit sever cases to gentle reassurance in the outpatient setting in mild cases. Treatments of GBS have involved Plasmapheresis where doctor take the blood out of the patient body, clean it from plasma protein and over the time body replace the removal plasma protein, then return red blood cells. Moreover, it is the useful method for quick recovery.in addition, doctors may give patient healthy antibodies or immunoglobulin in IV which take from donors to lessen immune system attacks against the body.GBS lasts from 14-30 days if the symptoms remain more than the patient will sever from a chronic form of GBS and that will require aggressive treatments. However, 50% afflicted with GBS will return to normal health 1 year after being diagnosed. After 3 years, almost one-third diagnosed will continue to have some weakness. Relapse occurs in only 3%. The percentage of people who die from GBS is less than 5%. (11) (12) (14) (15)
The length of illness isn’t expected so it may need months for rehab.as the function of nerve returned, patient, will require assistance to learn how to use the affected parts. Moreover, the rehabilitation of GBS is involved several types of therapy: physical therapy which the physiotherapist’s goals to improve independence, coordination, balance, endurance, strength, posture and retrain gate pattern, also prevent muscle tightness and contracture formation etc. While the occupational therapist’s goals focus on activities to be the patient self-sufficiency as well as in daily activities. However, PT achieves the previous goals by using several exercises such as strength exercise for the abdomen and respiratory muscles, in addition, PT uses several modalities and assistive devices such as TENS to relieve pain, parallel bars, crutches, canes, and walker to retrain gate pattern and improve stability and balance of patient. (14)
The method of research depends on systematic review articles on some websites and journals. Moreover, the questionnaire had made on sixteen patient with GBS on social media (Facebook).in addition, some information and statics had been taken from WHO, GBS/ CIPD international foundation and other websites that will mention in resources.
Instruments: questionnaire has included following questions:
What did the types of treatment that you have received during your treatment phase? (Please name them)
What did the types of exercises and modalities that your physiotherapist was counseling for you? (Please name them)
How the physiotherapist’s exercises and rehabilitation programme does be affected by your physical, physiological and psychological states?
In your opinion, which do you think is more effective in GBS treatments, medications or physiotherapist’s care, and why?
Case (1): a 27 Y/O female was diagnosed with GBS at age of 15 Y/O In 2010, she treated with 9 rounds of IVIG.she was hospitalized and given 5 spinal taps to track the progress of my treatment through white blood cell count- one in the fetal position and four lying faces down.she received both physical and occupational therapies. Physical therapy consisted of building up her physical strength: walking, sitting and standing, and eventually weight training mostly in my legs and arms. Moreover, Occupational therapy consisted more of balance exercises and returning fine motor skills. She said that ”she believed that physical therapy is important in rehabilitation. Without physical therapy, she could not walk, go to the bathroom by herself, or even hold a spoon to eat?. She would never have been able to build her strength back up without having the IVIG treatments first, then physical therapy exercises to help her get back to where she was before physically and she returned to ballet dancing classes and dancing as she was before.’?
Discussion: the physical exercises have positive effects on the physical, physiological and psychological status, for example, the strength exercises for elbow and knee are decreasing disability and improve oxygen taking as a result decrease fatigue and heart rate while aerobic exercises improve cardiopulmonary endurance, on the other hand, patient with muscle reservation must monitoring the intensity of exercises because overworking or high-intensity exercises on partially denervation muscle will cause further damage as a result cause increase in fatigue. Finally, the physical exercises have an effective impact on the recovery of daily activities more than medications.
Conclusion: Although physical exercises are different, they are very effective in the recovery of daily activities, psychological, physiological and physical performance. However, the intensities, frequencies and time of exercises are different among to the patient condition.