Exercise prescription in the physiotherapeutic management of Myasthenia Gravis: a case report

INTRODUCTION Myasthenia Gravis (MG), a slowly progressive neuromuscular disorder, can be classified as either ocular or generalised. MG affects between 5 – 12 people per 100,000 (Muscular Dystrophy Association, 2004).Ocular involvement is often the fi rst sign of MG with patients complaining of ptosis and diplopia. Seventy-fi ve to ninety percent of patients with ocular involvement then progress to having generalised MG (Kernich and Kaminski 1995; Evoli et al., 1996). Muscle weakness and fatigue are signifi cant problems for patients, with proximal muscles frequently more affected than distal muscles (Walton, 1989). The specifi c role of exercise prescription in the management of MG has not yet been established; however some research has been conducted into the effects of exercise prescription in other slowly progressive neuromuscular disorders (NMD) having similar symptomatology. These conditions include myotonic muscular dystrophy, limb-girdle syndrome and fascioscapulohumeral dystrophy, and other conditions where fatigue is an important or primary symptom, such as multiple sclerosis and chronic fatigue syndrome (Aitkens et al., 1993; Petajan et al., 1996; Wright et al., 1996; Fulcher and White, 1997; Whiting et al., 2001). This case report discusses exercise prescription for people with MG and the implementation and outcome of a specifi c exercise programme prescribed to a patient with MG. Leona Davidson*, BPhty, MCSP Leigh Hale, PhD, MSc (Physiotherapy), BSc (Physiotherapy), Lecturer, School of Physiotherapy, University of Otago