1

TABLA N 1
Manifestaciones clnicas
Parestesias
Dolores musculares
Debilidad en las piernas
Debilidad en los brazos
Afeccin de nervios craneales
*Facial
*Glosofarngeo
*Oculomotor
Reflejos osteotendinosos
Parlisis de msculos respiratorios

Al inicio de la
enfermedad (%)*
65.6
81.9
85.3
0
16.3
16.3
0
0
31.8
0

E el curso de la
enfermedad (%)*
100
100
100
72.2
36.3
36.3
36.3
90
100
9

2
Cuadriparesia

Disfuncin esfinteriana
Ataxia

4.5
18.1

4.5
0
0

*Porcentaje de pacientes que padecen los sntomas.

Trabajo original Sndrome Guillain Barr en nios. Dres.L.Valds Urrutia, S. Oliver Lpez y R. lvarez Fumero

Rehabilitation Program:
Physical Therapy: Estimates suggest that approximately 40% of patients
hospitalized with GBS require inpatient rehabilitation. Unfortunately, no longterm rehabilitation outcome studies have been conducted, and treatment often
is based on experiences with other neurologic conditions. The goals of the
therapy programs are reducing the functional deficits and targeting the
impairments and disabilities resulting from GBS.
Early in the acute phase of the disease course, patients may not be able to
participate fully in an active therapy program. At that stage, patients benefit
from daily range of motion (ROM) exercises and proper positioning to prevent
muscle shortening and joint contractures. Addressing upright tolerance and
endurance also may be a significant issue during the early part of
rehabilitation. Active muscle strengthening then can be introduced slowly and
may include isometric, isotonic, isokinetic, or progressive resistive exercises.
Mobility skills, such as bed mobility, transfers, and ambulation, are targeted
functions. Patients should be monitored for hemodynamic instability and
cardiac arrhythmias, especially upon initiation of the rehabilitation program.
The intensity of the exercise program also should be monitored, as
overworking the muscles, paradoxically, may lead to worsening weakness.
Occupational Therapy: Occupational therapy professionals should be
involved early in the rehabilitation program to promote upper body
strengthening, ROM, and activities to promote functional self-care. Both
restorative and compensatory strategies can be used to promote functional
improvements. Energy conservation techniques and work simplification also
may be helpful, especially if the patient demonstrates poor strength and
endurance.
Speech Therapy: Speech therapy is involved to work on safe swallowing and
speech skills for patients with significant oropharyngeal weakness, with
resultant dysphagia and dysarthria. In ventilator-dependent patients,
alternative communication strategies also may need to be implemented. Once
weaned from the ventilator, patients with tracheostomies can learn voicing
strategies and eventually can be weaned from the tracheostomy tube.
Cognitive screening also can be performed conjointly with neuropsychology to
assess for deficits, as cognitive problems have been reported in some patients
with GBS, especially patients after an extended stay in the intensive care unit
(ICU).
Recreational Therapy: Participation in recreational therapy assists in the
patient's adjustment to disability and improves integration into the community.
Recreational activities, either new or adapted, can be used to promote growth,
development, and independence of the often long-term hospitalized patient.