PT on the Net Research

Guillain-Barret Syndrome


Question:

I have a client who suffered from a condition called Guillain-Barret Syndrome a couple of years ago. The situation progressed so much that, due to malpractice, she slipped into a coma. To make this long story shorter, she has made a recovery from her coma and is now mobile and functioning again. I have been hired through her Physical Therapist to continue to work with her to gain coordination and strength. The PT told me to work on bimanual motor skills, balance and coordination exercises. My client can not jump, has some trouble with short-term memory and trouble using her hands and limbs with any kind of fluid motion. She has had to learn how to live all over again from scratch. Do you have any suggestions on how I can train my client so she may gain strength in her legs to be able to jump and walk up and down stairs without holding on to the railing (or someone's hand)? Can you suggest any "drills" I can give her that would challenge her memory and eye/hand coordination along with lower extremity balance and strength? A drill I've given her is with sticks. She can hit them with some force, but she has a hard time following directions with regard to hitting patterns. She can do only one task at a time. But the one thing that we've always had success with is simply sitting and standing with a kitchen chair (to simulate squats and to build endurance in her legs and glutes for proper muscle activation). I've also seen success when I've had her do low step ups with a balance. If she holds on to the banister in a stairwell, she does this very well. However, she has a profound and crippling fear of falling on stairs, so it's been hard to build her confidence. Any advice you could provide would be greatly appreciated.

Answer:

First, I want to start off by saying KNOW YOUR ROLE! I am slightly confused why the PT and the MD want you to do all of this work? Also, why are they somewhat focused on your client jumping when she has trouble even walking, etc.? I am a Registered/Licensed Occupational Therapist and have worked with many patients in the past with this syndrome. If your client has insurance, it should cover inpatient and even outpatient OT, PT and Speech Therapy, which she needs. I am not saying you might not have the knowledge, but if you are at simply the personal training level, you are over stepping some boundaries. There are many things you can do when working with clients such as this, when they come to you. You can be the intermediate person or coordinator who gives recommendations on where to go and the next step in the healing process.

Personally, I would refer your client back to her MD to see if she can get outpatient OT, PT and Speech. All of the fine motor, gross motor and memory dysfunctions will be addressed by these professionals. The other course of action you can take would be to refer your client to a CHEK Level 3 or 4 Practitioner. This individual would be better able to suit the needs of your client through assessments, program design and addressing nutrition and lifestyle principles to rebuild her immune system, etc. At the same time, you can go with her and absorb all of this information.

Most people can recover from this syndrome. There are many physical, mental, emotional, nutritional and lifestyle principles that need to be addressed, though. If you are at all in doubt of what to do, refer out! Most trainers are not skilled enough to work on fine motor/gross motor skill development, memory and hand/eye coordination, attention span, activities of daily living, etc. This as well is not the job for one person. That is why we have OTs, PTs and Speech Therapists. You might be able to help her to some extent, but it sounds like it would be farther down the road when she needs conditioning. The best thing you could do for your client at this time would be to refer her out.