Guillen-Barre Syndrome - 3 months in the ICU

Hello everybody, Am an ICU physio and now we have a patient with Guillen-Barre Syndrome. He's 3 months here and the last few weeks he started to move. We have slight contraction to all the muscles groups but he's still too weak. Still with a tracheostomy and a levin.

Am thinking to try electrical stimulation for the muscle atrophy is it going to work? I have been working in the ICU for 5 years and its the second time I deal with GBS. The first time, the patients had fully recovered here in the ICU but now things are much more difficult.

Any advice would be really appreciated.

thank u.

i've been told--- but never done any research for myself-- that e-stim may be contraindicated in GBS------- but i think that's mainly because they're just not sure if it screws things up or not... either way, i think you just need to focus on proximal-to-distal progressive strengthening--- core stability stuff should come first... i've found that PNF seems to wake up some muscles that have some strength and is really helpful to increase the strength of the muscles that do return...

other than that, it's sort of just a waiting game......

good luck...


patrick, PT

If you are getting the movements of patients as you have described that he may walk, it is a better to start with active exercises instead of electrical stimulation. Electrical stimulation can only be used if you are not getting any type of response of movement from the patient. So just concentrate of exercises.

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Originally Posted by Stella

hello everybody.

Am an ICU physio and now we have a patient with Gullien Barre Syndrome. He's 3 months here and the last few weeks he started to move. We have slight contraction to all the muscles groups but he's still too weak.
Still with a tracheostomy and a levin.
Am thinking to try electrical stimulation for the muscle atrophy is it going to work?
I have been working in the ICU for 5 years and its the second time I deal with GBS. The first time, the patients had fully recovered here in the ICU but now things are much more difficult.
Any advice would be really appreciated.

thank u.

---

Stella,

As GBS is a peripheral neuropathy, I would not recommend the use of EMS. As the others have said, I would suggest the use of exercise in functioning muscle groups with focus on functional strengthening.

That said, I have a few other questions for you:
1. What is a levin? (pardon my ignorance here)
2. He has a trach, but does he still need to use mechanical ventilation?
3. He has been in the ICU for 3 months? This seems like a VERY long time for an individual with classic GBS. Is it possible that he has some other pathology? A number of patients that I have seen with "GBS" that have a very slow recovery were ultimately diagnosed with Chronic Inflammatory Demyelinating Polyneuropathy (as opposed to classic GBS which is Acute Inflammatory Demyelinating Polyneuropathy). There may not be a big difference in the clinical presentation, but the medical management is different.
4. Be cautious with the level of difficulty of the exercises. It has been suggested that working a patient with GBS-type neuropathies may result in paradoxical weakness, so monitor the exercise level carefully.

Best of luck to you and your patient!
Etc.

One of my patients has GBS and she has very weak legs MMT 1+ and her arms are not bag like 3+ or 4 minus but toward the end of the day her arms are getting very tired as well so it gets 2+ so she is good only in the morning and after that she gets very tire even if she doesn't do anything she gets tired fast and also she is very heavy.
She changed several PSW because nobody can lift her for transferring from chair to commode even two people can not lift her and cause strain in her back muscles do you think of any solution for her mobility ? by the way she is living in her house not in hospital.
Thanks