Guillain Barré Syndrome
Conditions
Keywords
Guillain-Barre syndrome, proprioceptive neuromuscular facilitation, core strengthening, balance, muscle strength, activities of daily ;iving, neurorehabilitation
Brief summary
This randomized controlled trial will evaluate the effectiveness of proprioceptive neuromuscular facilitation combined with core strengthening exercises in Guillain barre syndrome patients on balance, strength and ADLS. A total of 32 participants will be recruited using purposive sampling and randomly assigned into two groups through the sealed envelope method. Balance will be assessed using berg balance scale, strength will be measured by MMT and ADLS will measure by berthal index at baseline and after completion of the intervention participants in the experimental group will receive PNF + core strengthening exercise four times in week for eight weeks, and conventional physical therapy will perform on control group .
Detailed description
Guillain-Barré Syndrome (GBS) is an acute immune-mediated inflammatory polyneuropathy characterized by rapidly progressive muscle weakness, diminished or absent deep tendon reflexes, sensory disturbances, impaired balance, and functional limitations in activities of daily living (ADLs). Although most patients recover gradually following the acute phase, many continue to experience persistent muscle weakness, impaired postural control, reduced trunk stability, and decreased functional independence during the subacute stage. Early rehabilitation plays a vital role in maximizing neurological recovery and improving functional outcomes. Conventional physiotherapy is considered a standard rehabilitation approach for patients with subacute GBS and typically includes range of motion exercises, muscle strengthening, balance training, gait training, and functional mobility exercises. However, there is limited evidence regarding the additional benefits of combining Proprioceptive Neuromuscular Facilitation (PNF) with core strengthening exercises in this population. Proprioceptive Neuromuscular Facilitation is a therapeutic approach that facilitates neuromuscular control through diagonal movement patterns, proprioceptive input, and manual resistance to improve muscle activation, coordination, strength, and motor function. Core strengthening exercises target the muscles of the trunk and pelvis, enhancing postural stability, balance, and functional movement, which are essential for regaining independence after neurological impairment. This randomized controlled trial aims to evaluate the effectiveness of combining PNF with core strengthening exercises in patients with subacute Guillain-Barré Syndrome. A total of 32 participants meeting the eligibility criteria will be randomly allocated into two equal groups (16 participants per group). The experimental group will receive PNF techniques in combination with core strengthening exercises in addition to conventional physiotherapy, whereas the control group will receive conventional physiotherapy alone. Outcome measures will be assessed at baseline, after four weeks, and after eight weeks of intervention. Primary outcomes include balance, muscle strength, and activities of daily living, assessed using the Berg Balance Scale (BBS), Manual Muscle Testing (MMT), and the Barthel Index (BI), respectively. It is hypothesized that the addition of PNF and core strengthening exercises to conventional physiotherapy will result in greater improvements in balance, muscle strength, and functional independence compared with conventional physiotherapy alone. The findings of this study are expected to provide evidence supporting more effective rehabilitation strategies for individuals with subacute Guillain-Barré Syndrome and contribute to evidence-based neurological physiotherapy practice.
Interventions
BEHAVIORALProprioceptive neuromuscular facilitation combined with core strengthening exercise
Participants will receive Proprioceptive Neuromuscular Facilitation (PNF) using the Contract-Relax (CR) and Contract-Relax Agonist-Contract (CRAC) techniques for both upper and lower extremities. Each repetition consists of a 10-20 second passive or active stretch, followed by a 3-6 second isometric contraction against therapist resistance, and then a further stretch to the newly gained range of motion. In addition, participants will perform progressive core strengthening exercises, including pelvic control exercises, curl-ups, bridging (including single-leg and crossed-leg variations), and side bridging. Participants will be instructed to activate the transversus abdominis and multifidus muscles throughout the exercises to improve trunk stability, balance, muscle strength, and functional independence.
BEHAVIORALconventional physiotherapy
The conventional therapy included stretching and strengthening of upper and lower extremities, techniques to normalize the muscle tone, weight bearing exercises, active functional training to enhance postural and functional control and conventional balance training. The program included four sessions per week for eight weeks with duration of each session of about 45 minutes which included warm up of 5 minutes, conventional therapy for 35 minutes and cool down of 5 minutes with 1-2 minute rest between the tasks.
Sponsors
Rida
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 45 Years
Healthy volunteers
No
Inclusion criteria
* participants diagnosed with Guillain Barré Syndrome (GBS) based on neurological criteria * At the subacute or recovery stage of GBS, meaning within two to 12 weeks from disease onset * Age ranges from 18 to 45 years * Gender does not matter; both males and females can participate * Medical stability of the patient and being medically cleared to engage in intensive rehabilitation by a physical Ability to give informed consent
Exclusion criteria
* Patients with cognitive disabilities and those who cannot follow commands * Patients with unstable heart and breathing rates and other systemic disease * Patients refusing to give their informed consent * Presence of musculoskeletal problems with balance problems (recent fractures, arthritis)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Balance | Baseline, week 4 and week 8 | Balance was assessed using the Berg Balance Scale (BBS) . The Berg Balance Scale is a 14-item clinical scale that measures static and dynamic balance. Scores range from 0 to 56, with higher scores indicating better balance and functional performance. |
| muscle strength | Baseline, week 4 and week 8 | Muscle strength was assessed using the Medical Research Council (MRC) Manual Muscle Testing scale. Muscle strength is graded from 0 to 5, where 0 indicates no muscle contraction and 5 indicates normal muscle strength. Higher scores indicate better muscle strength. |
| Activities of Daily living (ADL) | Baseline , week 4 and week 8 | Activities of daily living were assessed using the Barthel Index (BI). The Barthel Index measures independence in activities of daily living. Scores range from 0 to 100, with higher scores indicating greater functional independence. |
Countries
Pakistan
Contacts
PRINCIPAL_INVESTIGATORRida Rao, MSPTN
The University of Lahore , Lahore
Outcome results
None listed