Guillain-Barré Syndrome | Restoring Muscle Strength and Joint Functions by Physiotherapy

Guillain-Barré Syndrome also known as G B Syndrome is a rare medical condition that triggers the immune system of the body to attack its own nervous system, specifically the peripheral nerves that are responsible for sensation and motor control. This in turn affects the way brain signals are sent across the body and thus causes weakness, tingling, changes in sensations, and paralysis. Though there is no known cure for Guillain-Barré Syndrome. But, some treatments lessen the severity of the disease. Physiotherapy is one such treatment that plays a large role throughout the entire progression of Guillain-Barré syndrome. Physiotherapy does not affect the nerve healing process, it rehabilitates the muscles and works towards functional restoration and increasing stamina. This blog has been written to discuss exercises that help patients suffering from G.B Syndrome, to remain active and maintain strength.

 

G B Syndrome:

It is thought that GB syndrome occurs due to an autoimmune response after exposure to acute infections like a chest infection or diarrhea. It attacks the peripheral nerves and damages the myelin, an insulating layer of the nerve which is important in nerve impulse conduction. The patient has symptoms like feeling of altered sensation in the feet and hands, tingling and numbness in the fingers and toes, and progressive weakening of the limbs, legs, chest, hands, and arms spreading towards the trunk and face.  This rapid progression of deterioration leads to the paralysis of muscle, sensory disturbances, respiratory difficulties, and problems with swallowing and speech. Most people reach the stage of greatest weakness after two weeks of the onset of the disease and might require hospitalization and ventilation. GB syndrome patients usually have a residual weakness after 3 years, reduced stamina, and exhaustion after a period of increased activity during the recovery phase.

 

Physiotherapy Exercises

Physiotherapy treatment for patients with G-B Syndrome should be started immediately and continued until maximum recovery. Physiotherapy rehabilitation aims to maintain joint ranges of movement, increase muscle strength, restore mobility and balance, and re-train the normal movement patterns that are necessary for normal function and independence.

The treatment required depends on the extent of the disease progression and the areas of the body which are involved.

 

Respiratory Exercises:

In severe cases, respiratory physiotherapy may be required. Patients who need more care, mechanical ventilation and suctioning are provided. If the muscles of the chest and respiratory system are compromised and weakness or paralysis occurs in the chest, individuals will experience respiratory issues. Then physiotherapy will promote lung hygiene and respiration through positioning, breathing exercises, secretion clearance, and manual chest physiotherapy techniques

 

Exercises:

During the rehabilitation process, the patient suffering from G-B Syndrome is taught to use the energy constructively. This can be achieved by using the body correctly, avoiding unnecessary routines, and compensating for difficult activities by doing them another way. Passive limb movements to maintain joint ranges of movement and muscle flexibility while immobilization is recommended. Later, as the patient begins to recover physiotherapy is vital in assisting the restoration of muscle strength, limb control, balance, and coordination.

 

Range of motion exercises:

1: Ankle joint ROM exercises:

The patient is made to sit on the floor with legs straight. Wrap a towel around the feet. And hold both ends of the towel in your hand. For ankle dorsiflexion gently point the toes toward the body, and slowly return to starting position, for ankle plantar flexion, point the toes away from the body, eversion of the foot is, by moving the foot outwards, inversion of the foot is by moving the foot inwards, and ankle circumduction of the foot, is by moving the foot in a circular motion.

2: Knee joint ROM exercises:

The patient is positioned supine lying for heel slides, bend the hip and knee by sliding the heel up toward the buttocks while keeping the heel on the bed. Slide the heel back down to the starting position and relax. Use a plastic bag under the heel to slide it easily.

3: Hip joint ROM exercises:

The patient is positioned supine lying for hip flexion, move the leg by sliding with knees straight, for leg slides ( hip abduction ) slide the leg out to the side, for adduction( Hip Adduction ) slide the leg back to the starting position, for hip extension, the patient is in standing position and push the leg towards the back.

4: Shoulder joint ROM exercises:

The patient is in a sitting position for shoulder flexion, raise the arm forward over up to the head, for shoulder extension bring the arm back to the side and return it to the starting position, for shoulder abduction raise the arm by the side and then up over the head as far as possible, for Shoulder adduction return the arm to the side, for shoulder rotation roll the shoulders in a smooth circle clockwise and anticlockwise.

5: Elbow joint ROM exercises:

Elbow flexion is done with the palm facing forward, just bending the elbow, and for the elbow, the extension return the arm to the starting position.

6: Wrist joint ROM exercises :

Wrist flexion is done by bending the hand back towards the wrist so that the fingers point towards celling, for wrist extension bend the hand down so that the fingers points towards the floor, for wrist side to side movements move the hand from side to side, for wrist rotation roll the hand in circles clockwise and anticlockwise.

7: Hand and Fingers exercises:

Fingers bands make a tight fist and then relax it, for fingers spread open the hand and stretch the fingers as far apart as possible bring the fingers together again, for the finger to thumb touch, touch each fingertip with the pad of the thumb, for the thumb to palm stretch move the thumb across the palm.

8: Neck ROM exercises:

The patient is sitting or standing with the face forward shoulder should be straight and relaxed. For neck flexion gently bow down the head and try to touch the chin to the chest, for neck extension tilt the head back while looking towards celling, for neck side flexion tilt the head to the side and raise the shoulder, for neck rotations turn the head to look over the shoulder.

 

Strengthening Exercises:

1: Static quadriceps:

Static quadriceps are done by tightening the muscles on the top of the thigh, by pushing the back of the knee down into the towel. Hold for 5 -10 secs and then relax.

2: Cat and Camel exercises:

The patient begins the exercise from 4 points kneeling, tucking in the chin, and rounding the back upward. Reverse by letting back one segment at a time, and keep the neck in neutral at the end. Hold 30 secs and repeat 3 times per session.

3: Bridging:

The patient is asked to lie on the back with knees bent and feet flat, and slowly lift the hips off. Hold for 5 - 10 secs and return. Make sure that the head and neck remain straight during the lift.

4: Knee to chest:

The patient is made to lie on the back with knees bent towards the chest. Wrap the arms around the legs to hold the hands in the position. Gently tuck the chin to the chest and hold the position for 30 secs, repeat 2 to 3 times.

5: Knee roll:

The patient is made to lie flat with knees bent and feet flat on the ground. Roll the knees side and stretch diagonally across the trunk. Bring back to the middle, and repeat the exercise over another side.

6: Chair stand:

The patent is asked to perform sit-to-stand exercises from the chair and repeat them 5 -10 times.

7: Gait Training:

A gait training program is given and gradually the distance of walking is increased.

 

Positioning:

Due to bed rest and prolonged sitting, pressure sores can develop. Physiotherapists ensure that proper bed positioning and continuous change in posture ensure that the risk is minimized. Physiotherapists also recommend the proper assistive devices such as orthoses and wheelchairs, if required.

 

Life Modification and Homecare:

The physiotherapist modifies the lifestyle of the patient to prevent the contractures, DVT, and bedsores, and also support the weak extremities. Multiple rests between treatment sessions should be taken to reduce the level of stress by applying gentle massage to the affected area, maintaining a healthy weight, and doing regular physical activity. Individuals with Guillain-Barré Syndrome can also face emotionally painful periods as it is extremely difficult for patients to adjust to a state of sudden paralysis and dependence on others. The physiotherapy treatment plan can help through support and education as part of a holistic approach, and also advise patients about the help and support that can be provided through the use of other associated health professionals.

The physiotherapist recognizes the body's signals and warnings when the patient's limit of exercise for that session is reached. These signals may include tingling, numbness, or other sensory abnormalities, by pushing oneself through the limit can cause pain, weakness, spasm, and temporarily fatigued muscles. The patient must learn his/her limit, the need to rest as required, and to interpret the body's signals and symptoms.

 

Cerebral Palsy | Improving Functional Mobility by Physical Therapy

Cerebral Palsy is the most common cause of disability in children. It encompasses a wide range of neurological motor impairments and can be severely disabling. Cerebral palsy requires treatment for optimizing an individual's motor functions. Physiotherapy being a part of the rehabilitation program is found to be effective in promoting the brain's ability to make adaptive changes. The more the patient performs an action, the stronger the neural pathways in the brain for that action become. In the same way, neglecting an action may cause its neural pathways to weaken.  Physiotherapy helps to identify the functional disability of the patient that needs help. The physiotherapist improves and develops a personalized rehabilitation plan to help the patient. In this blog, we have discussed cerebral palsy and its physiotherapy management.

 

Cerebral Palsy

Cerebral palsy is a non-progressive, nonfatal, and non-curable, chronic motor disability that results from damage to the growing brain before or during birth, or in the postnatal period. It may be associated with brain damage responsible for some defects of vision and hearing, abnormalities of speech & language and perception, apraxias, (restricted movements such acts as writing, drawing, and construction or even dressing), behavioral problems such as distractibility and hyperkinesia, which are based on the organic brain damage.

 

Physiotherapy Management:

The physiotherapist conducts a detailed assessment to find out the functional capacity of the child and the nature and extent of the motor as well as associated deficits. Physiotherapy involves highly repetitive, task-specific exercises, promotes neuroplasticity and achieves their optimal functional potential.  The aim is to achieve the milestones, maximize the tone, maintain muscle length, correct the posture and teach activities of daily living. Physiotherapy improves the functional capacity of the patient and makes the patient independent as much as possible through a planned intervention program.

 

Assistive aids and modifications

The physiotherapist recommends modifications like two-handled cups, angled spoons, etc. can be made to help the patient, a stiff cloth collar can be used to help provide neck support, old stools and boxes can be adapted to provide support during sitting, parallel bars can be constructed with wood logs to help gait training. The patient can use air beds and continuous change in position for pressure relief through bed positioning and seating adaptations. Many such homemade modifications can be made to prevent deformities to develop in cerebral palsied children.

 

Supportive Aids

Supportive devices like lightweight splints may be required to maintain normal postures. Splinting and exercise programs help to achieve the near-normal posture. Casts and splints should not be used for prolonged periods because they may lead to disuse atrophy of the muscles. AFO and calipers may be required to provide stability to the joints in a child who is learning to stand and walk.

 

Braces

Braces are used to correct deformity, obtain an upright position, and control athetosis. Children with spasticity are provided with muscle braces. Athetoid patients are trained to control simple joint motion. Ataxic patients may be given strengthening exercises for weak muscle groups.

 

Progressive patterns

The patient is taught motion according to the development like head and trunk rotation from side to side, arm on the face side in abduction-external rotation, elbow semi-flexed, hand open, and thumb out towards the mouth.

 

Synergistic Movement Patterns

Reflex responses are used initially and voluntary control of these reflex patterns is used later. Head and trunk control is attempted with stimulation of attitudinal reflexes such as tonic neck reflexes, tonic lumbar reflexes, and tonic labyrinthine reflexes, followed by stimulation of righting reflexes and later balance training.

 

Proprioceptive Neuromuscular Facilitation

Movement patterns are based on patterns observed while functional activities. The movement patterns consist of flexion or extension, abduction or adduction, internal rotation or external rotation, sensory stimuli are skillfully applied to facilitate movement. Stimuli used are pressure, touch, stretch, traction, compression, the proprioceptive effect of muscle contracting against resistance, and visual and auditory stimuli. Resistance to motion is also used to facilitate the action of the muscles, and form the components of the movement patterns.

Techniques used are:

·  Relaxation techniques – Hold Relax & Contract Relax

·  Rhythmic Stabilization

·  Repeated Contractions

·  Stimulation of Reflexes

·  Reversals

 

Neuromotor Development

The child is not permitted to use motor skills beyond his/ her level of development. The child is placed in a normal posture to stimulate normal tone, once postural security is obtained, achievements are facilitated and developmental sequences are followed throughout the training.

 

Reflex Inhibition & Facilitation

Reflex inhibitory patterns are used to inhibit abnormal tone, abnormal movement patterns, and abnormal posture. The reversal or breakdown of the abnormalities gives the child the sensation of a more normal tone and movements. The physiotherapist attempts to change the patterns of spasticity making the child prepared for movement. Mature postural reactions use key points of control like head, neck, shoulder, and pelvic girdles, though work is also done from distal key- points.

 

Sensory Stimulation for Activation & Inhibition

Techniques of stimulation, like icing, heating, brushing, stroking, massage, pressure, slow & quick muscle stretch, joint retraction & approximation, and muscle contractions are used to activate, facilitate or inhibit the motor response.

 

Reflex Creeping & other Reflex Reactions

Creeping patterns involve the head, trunk, and limbs and are facilitated at various trigger points or reflex zones. Touch, pressure, stretch, and muscle action against resistance are used to trigger or facilitate creeping, also resistance is recommended for the action of muscles.

 

Balance Interventions

Patients with cerebral palsy have a disorder with multisystem impairments, that affect the visual, vestibular, and somatosensory, inappropriate sequencing of muscle activity, poor postural control, and postural stability that is frequently interrupted by destabilizing synergistic or antagonistic muscle activity in patients. The physiotherapists work with the patient to manage the balance issues.

 

Electrical Stimulation Techniques

Patients with cerebral palsy should receive neuromuscular electrical stimulation (NMES) or transcutaneous electrical stimulation (TENS) in cerebral palsy physiotherapy.

 

Hydrotherapy

Hydrotherapy helps to learn new movement skills, which leads to increased functional skills, and mobility. The body is immersed in warm water, causing muscle relaxation and reducing spasticity, thus resulting in increased joint range of motion and creating better postural alignment.

The physiotherapist provides advice, education, and supervision regarding cerebral palsy to the patient, his/her family, and caretakers.

 

Plantar Fasciitis | Top 10 Exercises to Relieve Heel Pain

Plantar fasciitis pain can be challenging. People suffering from plantar fasciitis usually experience pain in the sole of the foot during the morning when they first step out of bed or while standing up after sitting. Mostly, this pain and discomfort subside after moving around. There are many treatments that can be taken to manage plantar fasciitis such as medication, self-massage techniques, supportive shoe inserts, a night splint, or exercises. Exercises can be done easily and quickly to relieve pain and discomfort. This blog has been written to discuss a few exercises, these exercises have been reviewed and are being recommended by well qualified and experienced physiotherapists:

 

Seated Towel Stretch with Towel

• The patient is instructed to sit on the floor with the painful leg stretched in front.
• Loop the towel around the painful foot.
• Hold the towel with both hands, like holding onto a horse’s reins, then gently pull the foot towards the body, keeping the knee straight.
• Hold the stretch for 15-30 seconds.
• Relax and then repeat 5 times

 

Frozen Water Bottle Rolls

• The patient is asked to sit down on a chair.
• Place the barefoot on the bottle filled with ice-cold water.
• Roll the foot back and forth, repeat 10 -20 times.

 

Wall Calf Stretch

• The patient stands facing the wall.
• Place the palms on the wall at eye level.
• Keep the painful leg back and keep the heel on the ground.
• Move the other leg forward and bend the knee.
• Rotate the back foot slightly inward.
• Slowly lean towards the wall until a stretch is felt in the calf muscles.
• Be careful to put the back leg straight.
• Hold the stretch for 15-30 seconds.
• Return to the starting position and repeat 5 times.

 

Tennis Ball Roll

• The patient sits in a chair and places the ball under the painful foot.
• Then the patient rolls the ball back and forth under the arch of the foot so that a stretch can be felt in the out the plantar fascia ligament.
• Continue to roll the ball for 3 to 5 minutes.
• Repeat to stretch twice a day.

 

Sideways Leg Lifts

• The patient is asked to rest on the side and relaxes the head down on the lower arm.
• Straighten the legs and stack them on top of each other.
• Clench the front thigh muscles on the upper leg.
• Lift the upper leg away from the other leg approx. 8 inches.
• Keep this leg straight and slowly lower it.
• Do 2 sets with 15 repetitions.

 

Reach and Stretch

• This exercise is performed by standing next to the chair with the painful leg farther from the chair.
• Stand on a painful foot and bend this knee slightly.
• Raise the arch of the foot while keeping the big toe on the floor.
• Keep the foot in this position.
• Now bend at the waist and reach forward with the far hand.
• Avoid bending the knee furthermore.
• Do 2 sets with 15 repetitions.

 

Crossover Fascia Stretch

• In this exercise, the patient crosses the painful foot over the other knee.
• Grab hold of the toes and pull them towards the shin until the patient feels a stretch in the arch.
• Hold this stretch for 15 seconds and do 3 repetitions.

 

Ballet Raises

1. The patient stands behind the chair and places both the feet flat on the floor.
2. Take the support of the chair and raise on to the tiptoes and hold for five seconds
3. Slowly lower down.
4. Do 2 sets of 15 repetitions and take a rest in between for 30 seconds.

 

Step-Up Arch Extensions

• The patient lowers the heel towards the step below until the patient feels a stretch in the arch.
• Then hold the stretch for 15-30 seconds and repeat 3 times.

 

Monkey Foot Towel Lift

• In this exercise, the patient sits on a chair and places the towel on the floor in front.
• Placing the heel bone on the ground and lifting the towel with the toes.
• Release the towel and do 10 to 20 repetitions.

 

If any of the exercises cause more pain or discomfort, then immediately stop and consult your physiotherapist.