Rehabilitation

Introduction

A better outcome may be achieved by a mutidisciplinary, holistic approach to behavioural attitudes, coincidental medical disorders, anxiety, depression and social problems [48]
Psychological support and rehabilitaton is important: unresolved psychological problems, including post-traumatic stress disorder may contribute to or exacerbate any physical disability.
The Guillain Barre Syndrome Support Group of the UK offers a helpful counselling service for the 10% with severe persistent disability.
Discharge home or transfer to the child's local hospital should be anticipated well in advance and must only be undertaken when the child's rehabilitation needs can be adequately undertaken at their local hospital or in their local community.
Joint therapy sessions between the child's current therapists (with whom the family can become very attached) and the therapists who will be involved in the long term rehabilitation of the child following discharge or transfer will facilitate the ease of transition of care.
Most survivors (80%) regain independent ambulation, although this may take up to two years, and may never be completely normal.

Physiotherapy

Should be involved from admission.
Chest physiotherapy may help to prevent atelectasis and pooling of secretions.
Neurophysiotherapy is important in the mobilising of the patient, prevention of contractures (with early and appropriate splinting), and muscle wasting.
Orthosis may be used.
Before discharge a graduated programme of activity should be agreed with the physiotherapist.[49]
At some stage during rehabilitation, the rate of recovery will slow down and it is often at this stage that the patient will be discharged home.
Simple fatigue may become more evident as more activities are taken on and children and their families should be forewarned of this phenomenon.
Patients should not attempt to resume their former activities or sports without advice. It is important to re-integrate slowly into "normal" activities.
Exercising too quickly leads to fatigue, this may become chronic and subsequently difficult to overcome.
Swimming, hydrotherapy, horse riding and cycling are all helpful activities.
Follow-up should be regular and at least every six months until either complete recovery or a clear plateau in recovery

Psychological Status

It is important to tell the patient at an early stage that,while improvement is certain and many people recover completely, 10-20% are left with residual symptoms, which may be severe in 10%. Relapses occur in only 10% of patients, usually within two years.
General practitioners need to reinforce the advice that major improvement is likely and complete recovery possible to reduce the risks of prolonged illness behaviour.
The "acute stress reaction" to GBS is likely to be more intense and last longer in some patients than others.This depends on many factors: severity of the illness, personality,the way in which people are given information about their illness, and practical and emotional support from professionals and relatives.[50]
A clinical psychologist should be involved from an early stage, particularly when sedation has been reduced or withdrawn.
Most people with GBS, whether or not they make a good physical recovery, will also make a good psychological recovery. A significant number experience severe emotional disturbances, including anxiety, depression and post-traumatic stress disorder.
Embarrassment, self consciousness, mood swings are not uncommon and children need reassurance during this time.
Patients should have access to an informed GP and a neurology consultant for follow-up. Ongoing management may include counselling, anti-depressants, relaxation techniques and graded exercise.
The Guillain- Barre support group or Muscular Dystrophy Group of Great Britain may provide invaluable support and counselling because of the "I've been through it myself" phenomenon.
Fatigue may be severe and may persist for years, even after what appears to have been a full physical recovery; this may contibute to the development of clinical depression and post-traumatic stress disorder.[51]

Education.

During the child's admission and whenever appropriate the hospital school should be involved. Regular school work should be encouraged as the patient improves.
Follow up liaison with the child's local school and education authority should be arranged prior to discharge.
Home tutoring may need to be arranged if mobility is greatly affected.
It may be necessary to return to school in a wheelchair. The school facilities need to be assessed (eg: access to toilets, height of desks and chairs).
School transport should be arranged.
Writing aids including a laptop or other computers may also be required.
A welfare officer from the local education authority(LEA) can visit to arrange adaptations.
A visit to the school by the parents is advised to inform the teacher of the current limitations and needs of the child.
The school and/or examination board(s) should also be informed in case the child requires additional time to complete written examinations.

Equipment and Adaptations

Wheel chairs or walking aids may be needed on a temporary or permanent basis.
Home/school adaptations may be necessary and may include whelchair ramps, walking frames on wheels, downstairs toilets, cushioned chairs.
The capabilities of the carers and extended family should also be taken into consideration.
The appropriate aids need to be arranged prior to discharge home.
Social Services and Local Eduacation Authority (LEA) may provide equipment.
These issues may take considerable time to organise and planning should be made weeks before the expected discharge date.