June is Myasthenia Gravis Awareness

Myasthenia gravis is an autoimmune disease that affects the muscle, specifically resulting in fluctuations in strength with worsening upon exertion and improvement with rest. This feature is critical in the management of the disease and directs rehabilitative efforts to support functional recovery and optimize return to muscle function. Exercise-based interventions have been assessed on individuals with motoneuron disease, peripheral nerve disease, neuromuscular transmission disease, and muscle disease (Cun et al, 2007).  Critically, interventions that targeted specific muscle groups by implementing strategic exercises and modalities resulting in improvement in bodily functions, activities, and participation as defined by the International Classification of Functioning, Disability and Health (ICF) (Cun et al., 2007). Therefore, addressing disease which impact the neuromuscular junction may consider the role of rehabilitative professionals in physical and occupational therapy to optimize recovery according to the ICF model (Cun et al., 2007).  Exercises that have proven most impactful include a combination of aerobic and resistance training (Westerberg et al., 2018).  Additional research is needed to investigate the benefits of modalities, such as ultrasound. However, the measurements for success in treatment reviewed elements of fall risk and safety in transferring positions (Westerberg et al., 2018). Myasthenia gravis is a disease process with 5 main classifications which identify specific areas of the body most affected (Trouth et al., 2012).  While classes 3 and 4 may most benefit from physical and occupational therapy, classes affecting oropharyngeal and respiratory muscles, 2 and 5, may benefit from speech pathology to aid in strategies for safe swallowing (Trouth et al., 2012). The role of therapy in supporting functional outcomes is critical in any phase of myasthenia gravis which impacts the patient’s ability to engage in activities of daily living.  

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