Myasthenia gravis
Myasthenia gravis is a neuromuscular disorder characterized by weakness and fatiguing of some or all muscle groups, weakness worsening on sustained exertion, or towards the end of the day, relieved by rest.
Myasthenia gravis is a neuromuscular disorder characterized by weakness and fatiguing of some or all muscle groups, weakness worsening on sustained exertion, or towards the end of the day, relieved by rest.
Aetiopathology
- In humans MG cause reduction of acetylcholine
receptor sites in the postsynaptic folds
- Antibodies bind to the receptor sites resulting in
their destruction. These antibodies are referred to as acetylcholine
receptor antibodies.
- Reduced receptor synthesis and increased receptor
destruction as well as well as the blocking of receptor response to acetylcholine
is responsible for the disorder.
Clinical features:
 |
| Myasthenia gravis |
Fatigue
Muscle
wasting
Weakness of
facial muscles
Ptosis
Nasal quality
to speech
Weakness of
jaw muscle – mouth remain open
Dysarthria
Dysphonia
Dysphagia
Weakness of
neck muscle
Most commonly
proximal muscle are affected
Sub division
of clinical features:
Class
1- ocular muscle only
Class
2- mild generalized weakness
Class
3- moderate generalized and mild
to moderate ocular-bulbar
weakness
Class
4- severe generalized and
ocular-bulbar
weakness
Class
5- Myasthenic crisis
Total: Class 1 (20%)
Class 2,3,4,5 (80%)
Management
Medical treatment:
Anticholinesterase
drugs
Steroids
Immunosuppressants
other than steroids
Thymectomy
Physiotherapy
treatment
(a) Goals
- Myasthenia
patient should find optimal balance between the physical activity and rest
- It’s not
able to cure the weakness by active physical training, so low to medium
intensity training is recommended
- Enhance ability to function daily
- Decrease risk of falling
- Completion of functional tasks and maintenance of
independence
(b)General
exercise programs
- Should be done progressively
- Range of motion (flexibility) to light resistance to
full resistance – Start with lower prescription : 3 sets of 5 reps
- 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
Type
of exercise for strength are as follows :
Aerobic Exercises
Strength exercises
Swimming
Postural exercise
Breathing exercise
(c)Postural exercise
-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
(d)Breathing
exercise
- 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
(e)
Exercise intensity
- The
therapist has to look for the vitals after each sets of exercise
- During the
time of exercise the symptoms should not be worsen
- Exercise
peak dose is taking pyridostigmine
