Gyakorlatok Guillain-Barré-szindrómánál (GBS) — fázis-orientált rehabilitáció: ICU pozicionálás → plató mobilizáció → felépülés ellenállás (Khan 2010 + Bersano 2006)

Hughes 2014 + Willison 2016 + van Doorn 2008 + EFNS/PNS 2019 + Leonhard 2019 framework. Guillain-Barré syndrome is an acute post-infectious autoimmune polyradiculoneuropathy — the ACUTE counterpart to chronic CIDP (rapid progression peaking ≤4 weeks distinguishes them). Classic presentation: ASCENDING SYMMETRIC weakness (lower extremities first, progressing upward) + areflexia + minimal sensory loss + cytoalbuminergic dissociation in cerebrospinal fluid (high protein with normal cells, classic finding) + approximately 2/3 of cases preceded by an infection: Campylobacter jejuni (~30%, AMAN association), cytomegalovirus, Mycoplasma pneumoniae, Zika virus, SARS-CoV-2 (post-vaccine very rare), Epstein-Barr virus, influenza, HIV. Major variants: AIDP (acute inflammatory demyelinating polyneuropathy, classic Western form), AMAN (acute motor axonal neuropathy, Asian / post-Campylobacter, no sensory involvement), AMSAN (severe axonal sensorimotor), Miller Fisher syndrome (ophthalmoplegia + ataxia + areflexia, anti-GQ1b antibody). FIRST-LINE TREATMENT: IVIg OR plasma exchange (PLEX) within 2-4 weeks of onset; CORTICOSTEROIDS ARE NOT EFFECTIVE in GBS (in stark contrast to CIDP). ICU + mechanical ventilation may be required if respiratory weakness develops (~25-30% of patients). Mortality 3-7%. Recovery 6-12 months but ~20% have permanent disability. Post-GBS fatigue is chronic in 60-80%. PHASE-AWARE REHAB per Khan 2010 + Bersano 2006: (1) ICU/acute phase: positioning + passive range-of-motion + respiratory care, AVOID active strengthening (denervation reduces motor unit reserve); (2) plateau phase: gradual mobilization + bed-to-chair + sitting balance; (3) recovery phase: active assistive → resistive within tolerance + aerobic + balance training; AVOID EXHAUSTION across all phases (post-GBS fatigue is the dominant chronic symptom).

Volya's catalogue carries the foundation moves: supported-glute-bridge for posterior chain low-intensity activation (proximal weakness pattern + early recovery), cat-cow for spinal mobility, supine-knee-to-chest for low-back release + hip flexor stretch, diaphragmatic-breathing as the central respiratory training (intubation + respiratory weakness common — diaphragm strength is the ventilator-weaning + chronic respiratory function determinant), pursed-lip-breathing for dyspnea + respiratory muscle endurance, seated-march for cardio without joint impact + safer than treadmill given sensory loss + ataxia (Miller Fisher) risk, ankle-pump for circulation + distal-muscle ROM + DVT prevention (high VTE risk during immobility), sit-to-stand for functional + bone-loading + balance during plateau→recovery transition, chin-tuck for cervical posture + dysphagia swallow training (bulbar variants + SLP coordination). The AI coach also knows the nutrition side — phase-aware: ICU/acute high-protein 1.5-2.0 g/kg + adequate caloric (ICU catabolism), plateau/recovery 1.4-1.6 g/kg + leucine 2.5-3 g per meal, IVIg-supportive hydration + B12/folate, anti-inflammatory Mediterranean + omega-3, B12 + MMA + homocysteine check (deficiency mimics + worsens), post-GBS fatigue management (pacing + iron + B12 + thyroid screen), respiratory adequate caloric/protein, dysphagia Miller Fisher SLP + soft moist textures + chin-tuck, vit D + Ca for bone (prolonged ICU immobility), autonomic dysfunction salt-conservative + cardiology, AVOID ultra-processed + caffeine excess + alcohol + restrictive fad diets. CRITICAL: GBS/CIDP Foundation International + Foundation for Peripheral Neuropathy + Neuropathy Action Foundation + neurology (GBS-experienced, IDEALLY with rapid IVIg/PLEX access within 2-4 weeks) + ICU team if respiratory + nerve conduction confirmation + pulmonology + SLP if dysphagia + physiatry for graded rehab + dietitian + post-GBS fatigue counseling if chronic. This is NEVER a replacement for GBS-experienced multidisciplinary care.