HANDLING OF THE PATIENTS. SPECIFIC DISEASES

GBS (Guillain-Barre Syndrome).

Training on the treadmill starts as soon as any voluntary activity in the lower limbs develops. This usually happens at a time when over ground walking is practically not possible, also due to paralysis of rump muscles. The initial amount of BWS is high (40-50%), therapist intervention depends on the needs of the patient and it might suffice to have only 2-3 sessions per week. Even if recovery is slow and often incomplete or remains poor, we eventually start walking patients over ground. If necessary, compensatory mechanisms are entrained like "locked" knee joints (full extension with weak quadriceps muscles) with flexion in the hip joints (thus only limited upright position), some body weight put via the arms on the rollator. Thisway only small steps are possible since the pelvis must not be brought before the vertical axis running through the shoulder and ankle joints in order to avoid unlocking of the knee joints. In fact, training of the best position of the pelvis should be optimized. Stair case walking with such patients usually is not possible, but has been achieved in some (supported by one person). One may argue that such unphysiological walking jeopardizes joints and ligaments. This is basically true, however, the amount of walking performed thisway is bound to be very limited and thus not dramatically harmful. On the other hand these few steps which can be made without foreign help are of enormous practical (and psychological) importance for the patient.

In summary: GBS patients can start locomotor training with suspension on the LB much earlier and less stressful for all involved. Apart from a possible earlier recovery of walking, there are considerable trophic (e.g. circulation) and obvious psychologic effects. For those with only poor recovery, strategies may be worked out which allow some limited an aided walking.