Intermediate Course and Rehabilitation
The downhill course of Guillain-Barré syndrome can vary from a few days to a few weeks. Usually, a low stable level of impairment (paralysis, weakness etc.) is then maintained for a variable length of time - days to weeks, and rarely, longer. However, once improvement begins, relapse or recurrence of the syndrome is rare. Generally, the shortest the time for recovery to begin after maximum disability is reached, the less likely that some long-term disability will remain. When the patient has recovered from medical com-plications, such as breathing difficulty and infections, and some muscle strength has returned, treatment in an acute care hospital is usually no longer required. Physical therapy is continued and if the patient is sufficiently weak they are transferred to a rehabilitation hospital.
In the rehabilitation centre, emphasis is placed on regaining maximal use of the weak muscles. Simultaneously, any remaining medical complications are treated. These can include control of high blood pressure, antibiotics for infections, treatment of blood clots, and so forth.
Strength usually returns in a descending pattern, so that arm and hand strength usually returns before leg strength. Often, right-handed persons note more rapid return of strength to their left side and vice versa. As arm strength returns, the patient is again able to do things that used to be taken for granted, such as care for mouth hygiene, cut meat and so forth. As ability to perform these routine tasks returns, the successes can be emotionally quite fulfilling, leading to outright crying with tears of joy. Rehabilitation in many centres is accomplished by the coordinated efforts of several groups of professionals. Their overall goal is to assist the patient to return to as near normal a life style as possible. The specialist in rehabilitation medicine usually coordinates and oversees the total rehabilitation program.
An occupational therapist instructs the patient on exercises to strengthen the upper limbs - shoulders, arms, hands and fingers. They help to retrain or re-learn many activities usually taken for granted such as holding a pencil, using a utensil, and so forth. Muscle testing may be performed, and exercises designed to strengthen the weaker muscles, such as the small muscles of the hands.
The physical therapist emphasises exercises to maintain tone and strengthen lower limbs, and ultimately teaches the patient to walk as independently as possible. A variety of methods are used to accomplish these goals. Methods may include exercises in a pool where water gives buoyancy; exercises on a mat with weights, stationary bicycle pedalling and so forth. As leg strength improves various assistive devices are used to provide balance and support during walking. These may include parallel bars, walker, crutches and canes. Eventually, if possible, independent walking without an assistive device is accomplished. During this whole learning process emphasis is placed on proper body mechanics, avoidance of substitution of stronger muscles for weaker ones, and prevention of muscle strain.