Long Range Plans
As the patient progresses with their rehabilitation program, there may be a role to plan for multiple long-range problems. These problems include learning to drive and use convenient parking, re-employment, learning to pace activities, sexual activities, limitations of the wheelchair-bound patient and so forth. A social worker may assist in handling many of these problems. The majority of patients who were in a rehabilitation centre may be placed on an outpatient therapy program when sufficient strength has returned. At home, one level living may be temporarily helpful, on a floor with a bathroom and a bed, until the patient is able to climb stairs.
As sufficient strength returns, driver retraining may be appropriate, especially if the patient has been hospitalised and not driving for a long time. Driver retraining, and adaptation of an automobile for hand controls, is available through some rehabilitation centres.
The frustration of physical exhaustion or shortness of breath associated with prolonged walking may be reduced in the recovering patient by parking near a building entrance, in a handicapped parking space. A special parking placard or licence plate is available in some states.
As the patient approaches the end of in-hospital rehabilitation, it is usually appropriate to plan for re-employment. This is hopefully a cooperative effort between patient, social worker, former employer and, if available, a state bureau of vocational rehabilitation. A potential barrier to return to work, as well as resumption of a normal overall life style, is the onset, following a certain amount of activity, of muscle aches, physical exhaustion, and abnormal sensations, such as tingling and pain.
This problem may be circumvented by returning to work part-time initially, and if possible, timing activity, such as walking, to be intermittent with periods of rest on a couch or cot when exhaustion or muscle aches occur or are anticipated. Many patients learn by trial and error how much activity they can tolerate. For example, as the author progressed through the day's activities he would experience tingling of the right fourth and fifth fingers shortly before exhaustion set in, thus signalling the time for reduced activity and rest.
After discharge from a formal hospital-based in- or outpatient rehabilitation program there may still be a role or desire for continued exercise. Usually, some of the physical and occupational therapy exercises done as an in-patient can be performed at home. Also activities of daily living, such as bathing, dressing, walking and stair climbing may suffice as a practical outpatient exercise program. Should muscle or joint cramps or aches develop after activity, over-the-counter mild pain medications such as aspirin or acetaminophen (Tylenol®) may provide relief. Since pain relief does not relieve the muscle, tendon or joint strains, rest periods or a temporary reduction of activity may be helpful.
Some caution is warranted with respect to non-hospital based exercise programs, jogging and sports. Although these activities are popular, their benefit and safety for the still-recovering Guillain-Barré patient is questionable. Patients who engage in these activities are capable of exerting beyond the physical limitations of their tendons and muscles. Muscle tears as well as stress fracture of bones can result and may require prolonged casting. Obviously these injuries should be avoided by common sense pacing of activities until the patient is recovered.