Intuitively, it can be said that hope plays a significant role in the process of rehabilitation. However, a central question is whether or not this emotion can be explicitly supported and integrated by a rehabilitation team to achieve better outcomes in the rehabilitation process.

This case study aims to illustrate the intersection of hope and rehabilitation, showing how one patient suffering from the debilitating Guillain-Barré Syndrome (GBS) and her hopes, both realistic and less realistic, were focused, adapted and integrated for effective rehabilitation management. The study offers one positive example of an intervention that both built upon a patient’s hopes and worked constructively with those hopes that were less realistic.

Hope – a state of being characterized by an anticipation of a continued good state, an improved state or a release from a perceived entrapment.1

Hope is a multidimensional construct that provides comfort while enduring life threats and challenges. In general, it is future-oriented with a positive essence 23 and comprises an “essential state of mind,” having an impact upon a given individual’s attitudes towards both life and functioning.2

Overall, hope may support goal-directed training particularly when focused on realistic expectations. It may carry patients through struggle and lead to personal growth as a motivational factor promoting positive outcomes.4 A person’s willpower provides the energy and strength in the hoping process and is the basis of an individual’s “power of hope.”3

Qualitatively, hope can be thought of as being comprised by two forms: generalized hope that is an intrinsic quality of an individual and may serve as a positive coping strategy, and particularized hope that refers to the substance of hoping and contains specific expectations which may be realistic or unrealistic.

Additionally, people hope in negatively experienced situations, hoping for things or conditions that are important to them but have a low likelihood of being realized.4

Integrating Hope Into Rehabilitation Management for GBS

Given the uncertainty surrounding the progression of GBS, rehabilitation management should be based on a dynamic procedure that can be continuously adapted and adjusted to a patient’s actual stage. 1112 Both health professionals and patients are constantly searching for new possibilities within the experience of illness and suffering.3 Given an uncertain and insecure condition such as GBS, hope contributes by inspiring and stimulating the process of recovery and works against a patient’s desire to “give up.” Hope also motivates patients to persevere with their training, which may stimulate improvements.

Thus there is a reinforcing feedback cycle: hope and the hoping process drive training, which leads to improvements that result in more hope.3 Health professionals should therefore work to integrate a patient’s hopes into the rehabilitation approach, promoting those that are realistic and minimizing those that are not.

Box 1 | Guillain-Barré Syndrome – A Complex Disease and Its long Road to Recovery

The rare condition known as Guillain-Barré Syndrome (GBS), a common cause of rapidly acquired paralysis, is an acute inflammatory disorder of the peripheral nervous system.5 It is brought about by a person’s own immune response to foreign antigens that is misdirected to a person’s peripheral nerve cells, where the cells are stripped of their myelin sheathes that are critical to nerve functioning.6 This type of disease is sometimes referred to as an autoimmune disease and is often (though not always) triggered by a viral or bacterial infection.7 From a medical perspective, the process of GBS is divided into three phases:8

  • Initial phase (lasting up to 4 weeks): from the start of symptoms until there is no further decline of symptoms
  • Plateau phase (lasting a few days to weeks): there is a stabilization of physical status
  • Recovery phase (up to 2 years or longer): a gradual decrease of symptoms

Although the prognosis for GBS is usually favorable, it is a serious condition that results in mortality in about 10% of cases and permanent severe disability in 20%.8 The initial symptoms include varying degrees of weakness or “tingling” sensations in the legs, which can then spread to the upper torso and arms and increase in intensity until the muscles can no longer be used, sometimes leaving a person almost completely paralyzed.

Given this, all cases should be considered a medical emergency; GBS can be a serious threat to life. In cases where the lungs are paralyzed, GBS may result in death and artificial ventilation is required. Other associated symptoms may include loss of sensitivity, bladder and bowel disturbances, weakness of voice, respiratory function, ingestion and visual function (due to affected muscles), pain and fatigue. However, it should be noted that even in the severest cases of GBS, recovery is possible, albeit to varying degrees.8