Issue link: https://www.massageandbodyworkdigital.com/i/766890
40 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 7 WHAT HAPPENS WHEN SOMEONE HAS GBS? The sequence of how a person progresses from an infection or trauma to GBS is not entirely clear. Researchers believe the triggering pathogen (Zika virus, C. jejuni, or whatever else) must have some proteins that resemble myelin in such a way that the immune system—especially certain lymphocytes and antibodies—launch a sudden and aggressive attack against it in patchy areas throughout the body. All peripheral nerves are vulnerable, including both spinal and cranial nerves. This is especially serious when the autoimmune attack affects the vagus nerve or nerves that supply the face. Myelin both speeds transmission of electrical nerve impulses and offers insulation that prevents the messages from jumping unintentionally from one neuron to another. Nerve fibers with damaged myelin cannot send messages as efficiently as unaffected nerve fibers: without myelin, we are vulnerable to slow messages and "short circuiting" of the impulses. This is similar to the etiology of multiple sclerosis (MS), except that GBS affects nerves of the peripheral nervous system, where MS is restricted to the central nervous system. The net result of the damage to myelin covering on peripheral nerve tissue is a rapid onset of any combination of pain, numbness, tingling, and weakness in the affected areas. Some people report early symptoms in their face, but a more typical progression moves from mild tingling in fingers or toes to full, or nearly full, weakness or flaccid paralysis, often with the need for a ventilator, within a few days. This is followed by a recovery period that tends to be long and slow—it can take up to 18 months for a GBS patient to regain full or nearly full function, and some people end up with permanent weakness. TREATMENT Treatment for GBS is aimed at shortening the immune system attack and keeping the patient safe while they recover. This involves interrupting the activity of the rogue white blood cells and antibodies that are tearing up the myelin, while making sure the patient is able to breathe during recovery. Patients are usually hospitalized, and treatments can include any combination of plasma exchange, immunoglobulin injections, ventilator assistance if breathing is very weak, anticoagulants, and painkillers. After the acute phase has passed, some GBS patients need help to recover full muscular function. Speech therapy may also be called for if the patient has weakness in the muscles that control healthy swallowing. Occupational therapy, physical therapy, and massage therapy can be useful at this point. IMPLICATIONS FOR MASSAGE The implications of massage for GBS are complex and not easily generalizable. An excellent story of how one MT worked with one patient with GBS is told in the October 2010 and January 2011 editions of Massage Therapy Canada. These articles tracked how a massage therapist began working with a patient with GBS in the hospital. The articles provide a snapshot into a single case where massage therapy appeared to be helpful, but they also emphasize how variable this disease is, and how much it calls for massage therapists to be flexible and adaptable to unexpected changes in the client's condition. Although it usually has a good prognosis, GBS can be a distressing and painful experience. The autoimmune attack on the myelin sheaths can affect both motor and sensory neurons, so while some level of weakness or paralysis is common, the pain involved with these attacks on spinal nerves can be excruciating.