Inpatient Rehabilitation for Return to Work for a Patient with Guillain-barre Syndrome Secondary to Vaccine Administration: A Case Report

Case Diagnosis: A 34-year-old male with recent history of Guillain-Barre Syndrome, necessitating disability insurance.

Case Description or Program Description: Patient is 2 years post Guillain-Barre Syndrome (GBS), secondary to vaccine administration, with bilateral neuropathy, chronic pain, diabetes, and alcoholic cirrhosis. GBS initially characterized by profound weakness and inability to ambulate, with significant decrease in ADLs and IADLs, and resignment from two busy and demanding jobs. Initial treatment included intravenous immunoglobulin and outpatient therapy, with return to minimal assistance at the wheelchair level for ADLs and IADLs, requiring family support, and inability to maintain prior level of employment, now requiring disability services.

Setting: Tertiary rehabilitation hospital.

Assessment/Results: Patient was evaluated outpatient by PM&R and admitted to inpatient rehabilitation, with focus on technical aspects of independent living, ADLs and IADLs, and returning to employment in bar and restaurant industry and politics. Mobility improved from manual wheelchair to independent without device, including transfers and stairs. 6-minute walk test improved from 490 feet with rolling walker to 1087 feet without assistive device, and able to climb 30 steps without handrail use. Timed Up and Go improved from 23 seconds with rolling walker, to 8.2 seconds without assistive device. Discharged independent in all ADLs with return to similar level of employment.

Discussion (relevance): About 14 percent of noninstitutionalized people report an inability to participate fully in social roles, maintain a household, work, and pursue hobbies. Long term, only 28 percent of those on disability insurance will return to work. The economic burden of disability to society is dramatic; with projected costs being unsustainable to Social Security and Medicare programs.

Conclusions: This report demonstrates the role that intensive inpatient rehabilitation plays in community re-entry, returning to work, and meeting the health and social needs of the expanding population of people with disabilities. Additionally, it highlights the importance of other metrics of functional gains, not solely limited to ADLs.