Clinical Course of Dysautonomia, Motor Impairment, and Disability and the Impact of Physiotherapy in a Case of Pediatric Guillain–Barre Syndrome: A Case Report

A bstract Guillain–Barre syndrome (GBS) is an auto-immune disorder that damages the myelin sheath of peripheral nerves, leading to muscle weakness and paralysis. Nearly two-thirds of GBS cases involve autonomic symptoms. This case study describes the recovery of a 2.5-year-old girl with GBS following several months of intensive physiotherapy. Initially hospitalized due to tachycardia and profound muscle weakness, she required ventilatory support for respiratory failure. After stabilization and various treatments, she was discharged after 81 days but still remained unable to walk independently. Physiotherapy commenced during hospitalization, focusing on progressive resistance exercises and functional training, which were continued post-discharge. Recovery was assessed using heart rate variability (HRV), the GBS disability index, and muscle strength (MS), monitored at 10-day intervals. Over 7.5 months of follow-up, the patient demonstrated significant improvements in MS, disability index, and autonomic modulation. Within a month of therapy, she transitioned from wheelchair dependence to assisted walking, ultimately achieving full independence. Upper- and lower-extremity MS showed parallel recovery, underscoring the role of structured physiotherapy in functional restoration. HRV metrics indicated improved autonomic regulation, with Poincaré plots reflecting the transition from limited to enhanced variability. This case highlights the importance of early physiotherapy in pediatric GBS recovery, demonstrating the interplay between MS, functional ability, and autonomic balance. HRV monitoring may serve as a valuable tool for guiding treatment strategies, warranting further research in larger pediatric GBS populations.