Effect of PNF + Core Strengthening Exercise in Sub-acute Guillain Barre Syndrome

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.

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)