Joined: March 14, 2001
From: St. Augustine, FL USA
I'm a PT student and am involved with a group progect on Myasthenia Gravis for neuropathology class. None of us have ever seen or treated this disease, and we were wondering if anybody could share with us any interesting experiences they have had in treating patients with this disease. Any stories, articles, tips, or info would be greatly appreciated. Thank you.
Joined: January 29, 2001
From: Coral Gables, FL USA
As far as I know, physical therapists are not routinely called upon to "treat" patients with mysastenia gravis. This condition is, as you've probably already discovered, an auto-immune disease where the body makes antibodies to its own acetylcholine receptors at neuromuscular junctions. Treatment is primarily directed at improving neuromuscular junction transmission using anti-cholinesterase medication. When appropriate doses are found, patients do well. However, the word "gravis" in the name of the disease indicates that the condition can be fatal. Respiratory arrest, which can be sudden (I once witnessed such an event in our neuromuscular disease clinic) requires immediate emergency attention, but that's another issue. Aristotle Onassis was an example of an individual who had the condition. He accomplished quite a bit in his lifetime, but died of it (if my memory serves me correctly). Hope this helps. Let us know if you find anything else as far as physical therapy treatment goes. Neil I. Spielholz
[QUOTE]Originally posted by chebrandon: I'm a PT student and am involved with a group progect on Myasthenia Gravis for neuropathology class. None of us have ever seen or treated this disease, and we were wondering if anybody could share with us any interesting experiences they have had in treating patients with this disease. Any stories, articles, tips, or info would be greatly appreciated. Thank you.[/QUOTE]
well from what i know physiotherapy does help to maintain joint integrity and muscle flexibility when the patients are in a poor motor control stage. Usually they recover quite well with IV Ig treatment. but this seems to be progressive in the patients that i see... a number of them actually come back with acute on chronic MG.... acute respiratory distress and all... but the main thing we physiotherapists can help is to treat their condition symptomatically... you may want to look into their gait pattern, balance and ex tolerance (usually they fatigue easily)
Joined: January 9, 2001
I have seen several cases in my 20+ years and agree it is somewhat rare. I have a recent referral of a 13 year old female that presented with proximal weakness, fatigue, knee joint contractures and balance problems. She first noticed her problem when she was unable to hold up her violin during her practice sessions. It took several months of diagnostic tests to confirm the diagnosis. Rehab has a very definite role in the management of the indivdual. Often because of the sometimes lengthy diagnostic process the patient is often seen with contractures and balance issues. Although you must take into account the fatique factor, and many variable affect this, theraputic exercise is indicated as well as energy conservation techniques. Patients ususally do better in the morning and when there medication magement is stabalized. Occupational therapy also has a role form the standpoint of ADL's Aquatic therapy is great as the elimination of gravity aids in exercise. Perhaps the greatest benifit is the connection to graded activity, as this is a lifelong problem that needs constant management. With this disease you may see a multitude of problems and as with any patient careful evaluation combined with realistic goals are the key. If you need any clarification of the above please feel free to post back and good luck.
Joined: August 25, 2000
Patients with mysasthenia gravis have fluctutating sypmtoms of weakness, fatigue, blurred vision, a snarling appearance when they laugh and dysphagia. They may hold their head up because neck muscles are weak. With prolonged activity, you see these symptoms more. They have remissions and relapses in cranial nerves, limbs and trunk musculature. As a muscle is used more during exeercise, you see this even more because the receptor sites are affected and acetlycholine cannot be taken up at the junction. With periods of rest, it tends to replace itself and replenish itself. So don't push them, take everything slow and allow for ample rest periods.