24/07/2025
Guillain-Barré Syndrome (GBS) is a rare autoimmune disorder causing acute peripheral neuropathy, leading to muscle weakness, sensory loss, and, in severe cases, paralysis. In pediatric patients, physiotherapy plays a critical role in managing symptoms, preventing complications, and promoting recovery. The approach must be tailored to the child’s age, developmental stage, and disease severity, with family involvement for optimal outcomes.
1. ✅ Acute Phase (Initial Onset and Progression)
👉 Goal: Minimize complications, maintain joint and muscle integrity, and support respiratory function.
• 👉 Positioning and Postural Care:
• Frequent repositioning (every 2–4 hours) to prevent pressure sores and maintain circulation.
• Use supportive devices (e.g., splints, foam wedges) to position limbs in neutral alignment, preventing contractures.
• Elevate limbs to reduce edema, common due to immobility.
• 👉 Respiratory Management:
• Monitor respiratory function closely, as diaphragmatic or intercostal muscle weakness may occur.
• Breathing exercises (e.g., diaphragmatic breathing, incentive spirometry) to maintain lung expansion, if the child can cooperate.
• Chest physiotherapy (e.g., percussion, postural drainage) to clear secretions, especially in mechanically ventilated patients.
• 👉 Passive Range of Motion (PROM):
• Gentle PROM exercises for all major joints to maintain flexibility and prevent contractures.
• Perform 10–15 repetitions per joint, 1–2 times daily, avoiding overstretching.
• 👉 Pain Management:
• GBS often causes neuropathic pain or muscle aches in children. Gentle massage, warm/cold packs (as tolerated), and transcutaneous electrical nerve stimulation (TENS) may help.
• Coordinate with medical team for pharmacological pain relief.
• 👉 Family Education:
• Educate parents on the importance of positioning and gentle handling.
• Teach caregivers basic PROM techniques to support therapy between sessions.
2. ✅ Plateau Phase (Stabilization)
👉 Goal: Maintain muscle and joint function, begin gentle strengthening, and prepare for recovery.
• 👉 Continued PROM and Stretching:
• Maintain daily PROM to prevent joint stiffness.
• Introduce gentle stretching to improve muscle flexibility, focusing on commonly affected areas (e.g., hamstrings, calves).
• 👉 Active-Assisted Range of Motion (AAROM):
• Encourage active-assisted movements as muscle strength begins to return, using therapist support or assistive devices.
• Focus on functional movements (e.g., reaching, grasping) to engage the child.
• 👉 Respiratory Support:
• Continue chest physiotherapy if respiratory muscles remain weak.
• Encourage active coughing and deep breathing exercises for cooperative children.
• 👉 Low-Intensity Strengthening:
• Introduce isometric exercises (e.g., gentle muscle contractions without joint movement) for major muscle groups, if tolerated.
• Use play-based activities (e.g., blowing bubbles, squeezing soft toys) to engage younger children.
• 👉 Psychosocial Support:
• Incorporate play therapy or gamified exercises to maintain motivation and reduce anxiety.
• Involve family members to create a supportive environment.
3. ✅ Recovery Phase (Rehabilitation)
👉 Goal: Restore strength, coordination, endurance, and functional independence.
• 👉 Strengthening Exercises:
• Progress to active exercises with low resistance (e.g., bodyweight exercises, therapy bands).
• Focus on proximal muscles (e.g., hip flexors, shoulder girdle) before distal ones, as recovery often follows this pattern.
• Use functional tasks (e.g., sitting-to-standing, walking with support) tailored to the child’s developmental level.
• 👉 Balance and Coordination Training:
• Activities like sitting on a therapy ball, standing with support, or obstacle courses to improve balance.
• Incorporate fine motor tasks (e.g., stacking blocks, drawing) for upper limb coordination.
• 👉 Gait Training:
• Begin with assisted walking (e.g., using parallel bars, walkers, or harness systems).
• Progress to independent walking as strength improves, with focus on proper gait mechanics.
• Use orthotics (e.g., ankle-foot orthoses) if foot drop persists.
• 👉 Endurance Training:
• Low-impact aerobic activities (e.g., cycling, swimming) to build stamina.
• Gradually increase duration and intensity based on the child’s tolerance.
• 👉 Functional Retraining:
• Tailor therapy to age-appropriate activities of daily living (ADLs), such as dressing, feeding, or school-related tasks.
• Use adaptive equipment (e.g., utensil grips, raised seats) to promote independence.
• 👉 Aquatic Therapy:
• Consider hydrotherapy for low-impact strengthening and mobility, as water buoyancy reduces joint stress and encourages movement.
4. ✅ Long-Term Management and Follow-Up
👉 Goal: Optimize functional outcomes, address residual deficits, and support reintegration.
• 👉 Ongoing Strengthening and Conditioning:
• Continue progressive resistance training to address residual weakness.
• Encourage participation in sports or recreational activities to promote physical and social well-being.
• 👉 Monitoring for Relapse or Residual Symptoms:
• Regularly assess for persistent weakness, fatigue, or sensory deficits.
• Adjust therapy plan if new symptoms arise, as GBS can occasionally have a relapsing course.
• 👉 School and Community Reintegration:
• Collaborate with schools to provide accommodations (e.g., wheelchair access, modified physical education).
• Educate teachers and peers about the child’s needs to foster inclusion.
• 👉 Psychosocial Support:
• Address emotional challenges (e.g., frustration, low self-esteem) through counseling or support groups.
• Engage family in therapy to maintain long-term adherence.
Special Considerations in Pediatrics👇
• 👉 Developmental Stage: Therapy must be age-appropriate, using play-based or gamified interventions for younger children and more structured exercises for adolescents.
• 👉 Fatigue Management: Children with GBS may tire quickly. Schedule short, frequent sessions (e.g., 20–30 minutes) and monitor for overexertion.
• 👉 Pain and Sensory Issues: Sensory deficits or dysesthesia may persist. Use desensitization techniques (e.g., textured objects, vibration therapy) if needed.
• 👉 Multidisciplinary Approach: Coordinate with neurologists, occupational therapists, speech therapists, and psychologists for holistic care.
• 👉 Growth and Development: Monitor for musculoskeletal changes due to rapid growth, which may exacerbate residual weaknesses or contractures.
Precautions👇
• 👉 Avoid aggressive stretching or high-resistance exercises, as they may cause muscle damage or fatigue.
• 👉 Monitor for signs of autonomic dysfunction (e.g., heart rate variability, blood pressure changes) during therapy.
• 👉 Ensure proper hydration and nutrition, as children with GBS may have swallowing difficulties or reduced appetite.
Evidence and Outcomes👇
• 👉 Recovery in pediatric GBS is generally faster and more complete than in adults, with most children regaining full function within 6–12 months.
• 👉 Early physiotherapy reduces complications (e.g., contractures, respiratory infections) and improves long-term outcomes.
• 👉 Regular reassessment using tools like the GBS Disability Scale or Functional Independence Measure for Children (WeeFIM) helps track progress.
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