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Myasthenia gravis rehabilitation

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management strategy of myasthenia gravis

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Myasthenia gravis rehabilitation

  1. 1. Myasthenia Gravis
  2. 2. Introduction • Myasthenia gravis (MG) is a neuromuscular disease that leads to fluctuating muscle weakness and fatigue • Caused by a breakdown in the normal communication between nerves and muscles • There is no cure for myasthenia gravis, but treatment can help relieve signs and symptoms
  3. 3. Signs and symptoms • Initial complaint is a specific muscle weakness • Extraocular muscle weakness or ptosis • Bulbar muscle weakness is also common, along with weakness of head extension and flexion • Limb weakness may be more severe proximally than distally • Weakness is typically least severe in the morning and worsens as the day progresses
  4. 4. • Weakness is increased by exertion and alleviated by rest • Weakness progresses from mild to more severe over weeks or months, with exacerbations and remissions • About 87% of patients have generalized disease within 13 months after onset • Difficulty breathing, chewing, swallowing
  5. 5. • Factors that worsen MG symptoms : – Fatigue – Illness – Stress – Extreme heat – Some medications (chloroquine, procaine, lithium, phenytoin, beta-blockers, procainamide, statins)
  6. 6. Diagnosis • Neurological examination • Edrophonium test • Ice pack test • Blood analysis • Repetitive nerve stimulation • Single-fiber electromyography (EMG) • Pulmonary function tests
  7. 7. Treatment • Cholinesterase inhibitors • Corticosteroids • Immunosuppressant • Plasmapheresis • Intravenous immunoglobulin (IVIG) • Surgery
  8. 8. Physical Rehabilitation
  9. 9. Introduction • MG symptoms tend to progress over time, usually reaching their worst within a few years after the onset of the disease • Muscle weakness caused by MG worsens as the affected muscles are used repeatedly, therefore symptoms usually improve with rest
  10. 10. Factors limiting daily physical function in stable MG • Neuromuscular fatigue • Low CV fitness levels (20% below normal) • Diminished physiological fitness reserve (high energy cost of walking at peak fitness level) • Percent body fat 2-X normal (45%) and poor fitness contribute to mobility disability
  11. 11. Potential benefits of physical therapy in MG • Weight reduction • Decrease in risk of hypertension, diabetes, cholesterol • Decrease in risk of cardiac diseases • Decrease in risk of osteoporosis • Mood elevation ; improve cognitive function • Enhance baseline functional capacity, improved mechanical efficiency
  12. 12. Management Strategy • There is a lot of variance between patients with MG • No one exercise program is same and treatment strategies may vary • Evaluation- – Strength – Flexibility – Mobility – Balance – Gait
  13. 13. Exercise Goals • Enhance ability to function daily • Decrease risk of falling • Completion of functional tasks and maintenance of independence • Smoothness and coordination of activities • Once MG is stable, consistent exercise will elevate baseline functional capacity which will diminish the effect of MG exarcebation
  14. 14. Exercise Considerations • The dollar per day rule • Exercise at the best time of day • Exercise at peak dose of medication (pyridostigmine) • Exercise large, proximal muscle groups for short periods of time building up only to moderate intensity • Do not exceed moderate intensity exercise level
  15. 15. Moderate Exercise Intensity • HR should not elevate greater than 30 bpm from resting baseline • Patient should not become short of breath at peak of exercising • MG symptoms should not become worse during exercise (drooping of eyes) • Patient should not be tires after 2 hours of exercise • Patient should not have severe residual muscle soreness the day post exercise
  16. 16. Types of Exercise used in MG • Aerobic Exercises • Strength exercises • Swimming • Postural exercise • Breathing exercise
  17. 17. • Strength Exercise – – Should be done progressively – Range of motion (flexibility) to light resistance to full resistance – Start with lower prescription : 3 sets of 5 reps – If significant weakness is present, active assist exercises may be necessary (therapist help) • The primary goal of therapy is to build the individual's strength to facilitate return to work and activities of daily living • Do not overdo resistive training to the point of fatigue
  18. 18. • Swimming – Patients should swim in water where they can touch the bottom – Deep water is dangerous and may cause patient to over exert
  19. 19. • Postural Exercises- – Important in assisting with breathing, speaking and swallowing – Keeps bones and joints in the correct alignment so that muscles are being used properly – Prevents fatigue because muscles are being used more efficiently, allowing the body to use less energy
  20. 20. • Breathing exercises - – Help improve lung function – Include inspiratory muscle training • Pursed lip breathing • Diaphragmatic breathing – These exercises can improve respiratory endurance as many people with MG have affected respiratory muscles
  21. 21. Reference • http://www.myastheniagravis.org/ • Myasthenia Gravis foundation of America http://www.myasthenia.org/ • http://www.mdguidelines.com/ • http://www.pivotalphysio.com/ • http://www.livestrong.com/

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