From Paralysis to Play: A Case Report on Neurorehabilitation and Robotic Assisted Training in Paediatric Guillain-Barré Syndrome

Guillain-Barré Syndrome (GBS) is a post-infectious, immune-mediated polyneuropathy affecting motor, sensory, and occasionally autonomic nerves. Paediatric GBS is rare, with limited literature on advanced rehabilitation strategies. The present case highlights the role of hybrid rehabilitation, including robotic-assisted therapy, in a four-year-old female child with GBS. The rehabilitation timeline, referenced from symptom onset, included early hospital presentation, initiation of inpatient physiotherapy, emergence of motor recovery and transition to outpatient rehabilitation services from Day 25 onwards where the child presented with generalised hypotonia, muscle wasting (notably in the thenar, hypothenar, and quadriceps), and diminished deep tendon reflexes. Breathing was thoracic with pectus carinatum and reduced bilateral air entry. No sensory deficits or cranial nerve involvement were observed on the 25th day of assessment. Nerve conduction studies revealed absent F-waves in the right median, ulnar, and bilateral peroneal and tibial nerves, indicating a generalised non length-dependent pure motor axonal polyradiculopathy, consistent with the Acute Motor Axonal Neuropathy (AMAN) variant of GBS. Differential diagnoses such as transverse myelitis and poliomyelitis were ruled out. A 20-week phased rehabilitation protocol was implemented, consisting of conventional physiotherapy, task-specific strength training, and robotic-assisted therapy using the Rymo mobi-L device. The program included five stages: initial strengthening and advanced Neurodevelopmental Treatment (NDT), gait training, robotic-assisted training, dynamic balance, and endurance training. Progressive improvements were seen in tone (normalised by week 9), reflexes, and muscle strength. Functional mobility improved significantly, with the child returning to school by week 20. The present case demonstrates that early, structured, and technologically supported rehabilitation can significantly enhance recovery in paediatric GBS, especially in severe motor variants like AMAN.