Abstract
Miyastenia Gravis (MG), nöromusküler iletimin bloke olduğu ve nöromusküler kavşak fizyolojisinin etkilendiği otoimmün bir hastalıktır. MG’de temel özellik, egzersizle kötüleşen ve dinlenme ile iyileşen kas gruplarının değişen kas güçsüzlüğü ve yorgunluğudur. İlerleyen dönemlerde kas zayıflıklarının ortaya çıkmasıyla MG’de yürüme etkilenmektedir. Bu durum denge ve yürüme problemlerine neden olur. Hastaların çoğunda düşme ve düşme korkusu şikâyetleri vardır. MG tedavisi uygulanırken miyastenik belirtileri azaltılıp kişinin günlük yaşam aktivitelerinin rahatladığı stabil klinik tablo elde edilmelidir. Bu çalışmanın amacı MG’de rehabilitasyon uygulamalarının yürümeye etkisinin anlaşılması ve hangi egzersizlerin etkili olduğunu belirlemektir. Sonuç olarak fizyoterapi ve rehabilitasyon yaklaşımları, hastaların şikayetlerine semptomatik de olsa çözüm getirebilir. Egzersiz programında aktif dirençli egzersizler, aerobik egzersizler, denge strateji eğitimleri, endurans egzersizleri, postür egzersizleri, germe egzersizleri ve aktif–pasif eklem hareket açıklığı egzersizleri yapılmalıdır. Ayrıca ritmik işitsel stimülasyonun ve cerrahi öncesi respiratuar fizyoterapinin de yürümeye olumlu etkileri vardır.
Keywords
References
- 1. Kılınç M, Savcun Demirci C, Ayvat E, Aksu Yıldırım S. Nöromusküler Hastalıklar. In: Karaduman AA, Tunca Yılmaz Ö, ed(s). Fizyoterapi ve Rehabilitasyon Cilt 3. 1st ed. Ankara: Hipokrat Kitabevi; 2017:49-61.
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- 4. Lindstrom JM, Seybold ME, Lennon VA, Whittingham S, Duane DD. Antibody to acetylcholine receptor in myasthenia gravis: Prevalence, clinical correlates, and diagnostic value. Neurology. 1976;26(11):1054-1054.
- 5. Aydın Ş. Miyastenia gravis. Güncel Göğüs Hastalıkları Serisi. 2020;8(3):70-80.
- 6. Carr AS, Cardwell CR, McCarron PO, McConville J. A systematic review of population based epidemiological studies in myasthenia gravis. BMC Neurology. 2010;10:1-9.
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- 12. Tovazhnyanska O, Klimova O, Samoilova H, et al. Rehabilitation of the patients with myasthenia gravis as an integral part of the patient’s treatment algorithm in the postoperative period. Acta Balneologica. 2021;64(3):155-159.
- 13. Utsugisawa K, Suzuki S, Nagane Y, et al. Health‐related quality‐of‐life and treatment targets in myasthenia gravis. Muscle & Nerve. 2014;50(4):493-500.
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- 15. Mohamed RA, Mohamed ESH, Basiouny MA, et al. Effect of two different rehabilitation approaches on pulmonary functional tests, neuromuscular functions and quality of life in juvenile myasthenia gravis: A randomized controlled trial study. Medicina. 2022;58(3):374.
- 16. Sinanović O. Rehabilitation in neuromusuclar diseases. Neurologica Croatica. 2005;54(Suppl 2):80-83.
- 17. Farrugia ME, Di Marco M, Kersel D, Carmichael C. A physical and psychological approach to managing fatigue in myasthenia gravis: a pilot study. Journal of Neuromuscular Diseases. 2018;5(3):373-385.
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- 19. Fasano A, Bloem BR. Gait disorders. Lifelong Learning in Neurology. 2013;19(5):1344-1382.
- 20. Westerberg E, Molin CJ, Nees SS, Widenfalk J, Punga AR. The impact of physical exercise on neuromuscular function in myasthenia gravis patients: A single-subject design study. Medicine. 2018;97(31).
- 21. Wong SH, Nitz JC, Williams K, Brauer SG. Effects of balance strategy training in myasthenia gravis: a case study series. Muscle & Nerve. 2014;49(5):654-660.
- 22. Rahbek MA, Mikkelsen EE, Overgaard K, Vinge L, Andersen H, Dalgas U. Exercise in myasthenia gravis: A feasibility study of aerobic and resistance training. Muscle & Nerve. 2017;56(4):700-709.
- 23. Andersen LK, Witting N, Vissing J. Effects of rhythmic auditory stimulation on walking during the 6-minute walk test in patients with generalised myasthenia gravis. European Journal of Physiotherapy. 2022;24(6):333-338.
- 24. Fil Balkan A, Ceren AN. Myastania gravis. In: Bayar K, ed. Fizyoterapi ve Rehabilitasyonda Olgu Çözümlemeleri. 1st ed. Ankara: Hipokrat Kitabevi; 2023:95-104.
Abstract
Myasthenia Gravis (MG) is an autoimmune disease in which neuromuscular transmission is blocked and neuromuscular junction physiology is affected. The main feature in MG is altered muscle weakness and fatigue of muscle groups that worsens with exercise and improves with rest. With the emergence of muscle weakness in the following periods, walking is affected in MG. This causes balance and walking problems. Most of the patients have complaints of falling and fear of falling. While applying MG treatment, myasthenic symptoms should be reduced and a stable clinical picture should be obtained in which the daily activities of the person are relieved. The aim of this study is to understand the effect of rehabilitation practices on gait in MG and to determine which exercises are effective. As a result, physiotherapy and rehabilitation approaches can provide solutions to patients' complaints, albeit symptomatically. Active resistance exercises, aerobic exercises, balance strategy training, endurance exercises, posture exercises, stretching exercises and active–passive range of motion exercises should be performed in an exercise program. In addition, rhythmic auditory stimulation and pre-surgical respiratory physiotherapy also have positive effects on walking.
Keywords
References
- 1. Kılınç M, Savcun Demirci C, Ayvat E, Aksu Yıldırım S. Nöromusküler Hastalıklar. In: Karaduman AA, Tunca Yılmaz Ö, ed(s). Fizyoterapi ve Rehabilitasyon Cilt 3. 1st ed. Ankara: Hipokrat Kitabevi; 2017:49-61.
- 2. Patrick J, Lindstrom J. Autoimmune response to acetylcholine receptor. Science. 1973;180(4088):871-872.
- 3. Gilhus NE, Verschuuren JJ, Hovland SIB, Simmonds H, Groot F, Palace J. Myasthenia gravis: do not forget the patient perspective. Neuromuscular Disorders. 2021;31(12):1287-1295.
- 4. Lindstrom JM, Seybold ME, Lennon VA, Whittingham S, Duane DD. Antibody to acetylcholine receptor in myasthenia gravis: Prevalence, clinical correlates, and diagnostic value. Neurology. 1976;26(11):1054-1054.
- 5. Aydın Ş. Miyastenia gravis. Güncel Göğüs Hastalıkları Serisi. 2020;8(3):70-80.
- 6. Carr AS, Cardwell CR, McCarron PO, McConville J. A systematic review of population based epidemiological studies in myasthenia gravis. BMC Neurology. 2010;10:1-9.
- 7. Marx A, Willcox N, Leite MI, et al. Thymoma and paraneoplastic myasthenia gravis. Autoimmunity. 2010;43(5-6):413-427.
- 8. Marx A, Pfister F, Schalke B, Saruhan Direskeneli G, Melms A, Ströbel P. The different roles of the thymus in the pathogenesis of the various myasthenia gravis subtypes. Autoimmunity Reviews. 2013;12(9):875-884.
- 9. Karceski S. Myasthenia gravis: which type of surgery is best? Neurology. 2021;97(4):433-435.
- 10. Hehir MK, Silvestri NJ. Generalized myasthenia gravis: classification, clinical presentation, natural history, and epidemiology. Neurologic Clinics. 2018;36(2):253-260.
- 11. McDonald CM. Physical activity, health impairments, and disability in neuromuscular disease. American Journal of Physical Medicine & Rehabilitation. 2002;81(11):108-120.
- 12. Tovazhnyanska O, Klimova O, Samoilova H, et al. Rehabilitation of the patients with myasthenia gravis as an integral part of the patient’s treatment algorithm in the postoperative period. Acta Balneologica. 2021;64(3):155-159.
- 13. Utsugisawa K, Suzuki S, Nagane Y, et al. Health‐related quality‐of‐life and treatment targets in myasthenia gravis. Muscle & Nerve. 2014;50(4):493-500.
- 14. Losen M, Martínez‐Martínez P, Phernambucq M, Schuurman J, Parren PW, De Baets MH. Treatment of myasthenia gravis by preventing acetylcholine receptor modulation. Annals of the New York Academy of Sciences. 2008;1132(1):174-179.
- 15. Mohamed RA, Mohamed ESH, Basiouny MA, et al. Effect of two different rehabilitation approaches on pulmonary functional tests, neuromuscular functions and quality of life in juvenile myasthenia gravis: A randomized controlled trial study. Medicina. 2022;58(3):374.
- 16. Sinanović O. Rehabilitation in neuromusuclar diseases. Neurologica Croatica. 2005;54(Suppl 2):80-83.
- 17. Farrugia ME, Di Marco M, Kersel D, Carmichael C. A physical and psychological approach to managing fatigue in myasthenia gravis: a pilot study. Journal of Neuromuscular Diseases. 2018;5(3):373-385.
- 18. Zhang Y, Yu H, Dong R, Ji X, Li F. Application prospect of artificial intelligence in rehabilitation and management of myasthenia gravis. BioMed Research International. 2021;1-6.
- 19. Fasano A, Bloem BR. Gait disorders. Lifelong Learning in Neurology. 2013;19(5):1344-1382.
- 20. Westerberg E, Molin CJ, Nees SS, Widenfalk J, Punga AR. The impact of physical exercise on neuromuscular function in myasthenia gravis patients: A single-subject design study. Medicine. 2018;97(31).
- 21. Wong SH, Nitz JC, Williams K, Brauer SG. Effects of balance strategy training in myasthenia gravis: a case study series. Muscle & Nerve. 2014;49(5):654-660.
- 22. Rahbek MA, Mikkelsen EE, Overgaard K, Vinge L, Andersen H, Dalgas U. Exercise in myasthenia gravis: A feasibility study of aerobic and resistance training. Muscle & Nerve. 2017;56(4):700-709.
- 23. Andersen LK, Witting N, Vissing J. Effects of rhythmic auditory stimulation on walking during the 6-minute walk test in patients with generalised myasthenia gravis. European Journal of Physiotherapy. 2022;24(6):333-338.
- 24. Fil Balkan A, Ceren AN. Myastania gravis. In: Bayar K, ed. Fizyoterapi ve Rehabilitasyonda Olgu Çözümlemeleri. 1st ed. Ankara: Hipokrat Kitabevi; 2023:95-104.
Details
| Primary Language | English |
|---|---|
| Subjects | Physiotherapy |
| Journal Section | Articles |
| Authors | |
| Early Pub Date | April 27, 2024 |
| Publication Date | April 30, 2024 |
| Acceptance Date | March 13, 2024 |
| Published in Issue | Year 2024 Issue: 22 |
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