After the Hospital, A Guide to Rehabilitation for GBS

After the Hospital, A Guide to Rehabilitation for GBS

The progression of disability during the acute phase of Guillain-Barré Syndrome can vary from a few days to four weeks, and, infrequently, six weeks. Then a low stable level of impairment (paralysis, weakness, etc.) continues for a variable time, days to weeks, and, less often, months or longer.

When the patient has recovered from acute life-threatening complications such as breathing difficulty and infections, and muscle strength has stabilized and perhaps even begun to return, treatment in an acute care hospital is usually no longer required. However, many patients will still require rehabilitative care including intensive physical and occupational therapy.

Where this care is provided will depend in part on several factors. Choices available for further rehabilitation include:

  1. In-patient care in a rehabilitation hospital. A common requirement to justify this intensive rehabilitation is the patient’s ability to participate in at least 3 hours of therapy daily.
  2. Sub-acute rehabilitation, in a nursing/rehab facility.
  3. (So-called) Day hospital care. The patient sleeps at home and is transported, by a wheelchair-accommodating van, to the rehabilitation hospital or center regularly (daily) for daytime therapy.
  4. Out-patient rehabilitation.
  5. Home-based therapy, via visiting therapists or by following instructions set up by a therapist for a home therapy program.

The decision as to the type and location for rehabilitation should be individualized to each patient’s particular needs, considering factors such as overall physical condition, strength, endurance, amount of return of use of arms and legs, and insurance. For example, patients with mild impairment, who can walk with the assistance of a quad (four-footed) or straight cane may not need an in-patient rehabilitation facility and may obtain sufficient care in an out-patient setting. In contrast, patients who can’t walk, or require substantial assistance to do so, but are showing some improvement, may be transferred to an in-patient rehabilitation hospital setting for optimal care. Physicians may occasionally be reluctant to place Guillain-Barré Syndrome patients in rehabilitation hospitals because of concern about depression or relapse of symptoms that could require readmission to an acute care facility for further treatment.

Regardless, transfer of a patient to a rehabilitation center should be considered as a positive next step in the patient’s recovery.

The rehabilitation process itself does not improve nerve regeneration. Rather, the major goal of rehabilitation is to assist the patient in optimal use of muscles as their nerve supply returns, and to adapt to a lifestyle within their functional limitations. In addition to helping the patient regain use of muscles, the rehabilitation center treats any remaining medical complications. These can include control of high blood pressure, antibiotics for infections, treatment or prevention of blood clots, etc.

Strength usually returns in a descending pattern, so that arm and hand strength usually returns towards normal before leg strength. Often, right-handed persons note more rapid return of strength to the left side and vice versa. As arm strength returns, the patient is again able to perform some restricted things that used to be taken for granted, such as brushing their teeth, feeding, grooming and dressing themselves, cutting meat and so forth. As ability to perform activities of daily living improves, the success can be emotionally gratifying.

Rehabilitation in many centers is accomplished by the coordinated efforts of several groups of professionals in a team approach. The team members may include, depending upon the particular patient’s needs, a physiatrist (rehabilitation doctor), physical therapist, occupational therapist, registered nurse, neurologist, internist, psychologist, social worker, etc. Each team member contributes their specific expertise and experience to the patient’s care. Team conferences may be held at intervals, for example, weekly, to assess the patient’s status, determine progress and plan further care. The team’s overall goal is to assist the patient to maximize use of returned function and ultimately return to normal activity. Most patients will eventually lead a normal or near normal life. For those patients with incomplete recovery, the goal is to adapt their lifestyle to their persisting functional limitations.

The physiatrist (pronounced: fiz-eye’-a-trist) (not to be confused with a psychiatrist) is a physician who specializes in physical medicine and rehabilitation. A physiatrist usually coordinates and oversees the total rehabilitation program.

Principles of Rehabilitation for the GBS Patient

Occupational Therapy

Physical Therapy

Speech Therapy

Long-Range Plans


Natural History and Prognosis

Immunization Safety