EVALUATION AND TREATMENT OF A PATIENT REFERRED TO PHYSICAL THERAPY WITH MYASTENIA GRAVIS: An experimental 3-phase programme

Background. This study presents a case report of a patient affected by Myastenia Gravis (MG) treated on the basis of an experimental program. There are currently only a few references available in literature which suggest the most valid and reliable tools to assess outcomes and thus, no therapeutic recommendations exist at all. The aim of this work is to verify the efficacy of a physical therapy program composed of three phases on a clinical case. Diagnosis The subject was diagnosed as an MG patient when he was 20 years old. At the age of 40, he had his first myasthenic crisis with respiratory implications which obligated him to undergo invasive mechanical ventilation (MV). The patient stayed in an intensive care unit and in a neurology unit for nine months. At the end of this period he was transferred home, where he was followed by a medical team from the National Health Care System. Assessment Gli outcomes individuati sono la saturazione dell\u2019ossigeno, il Test Muscolare, il Motricity Index e il Trunk Control Test, che vengono somministrati all\u2019inizio del trattamento e alla fine del percorso terapeutico riabilitativo. Discussion The outcomes assessments used were the Dyspnea Medical Research Council, the Borg Scale, the Muscle Test, the Motricity Index and the Trunk Control Test, which were administered to the patient at baseline and at the end of the rehabilitation program. Methods The patient carried out a program composed of three phases: in the first, the rehabilitative treatment was oriented to the recovery of neuromuscular activity and to improve breathing. He did active and passive respiratory exercises until he was able to maintain a sitting position for a long interval, as well as a standing position for a short interval. In the second phase, the aim was full recovery of the respiratory muscles, in which the patient was MV-free for increasingly longer periods. In this phase, he also practiced walking up stairs. In the third phase, we used a treadmill and elastics. The goal was full neuromuscular recovery, being able to roll to both sides or reach the prone position from the supine position autonomously. Results and Discussion The patient consistently improved his performance both in respiratory and neuromotor functions. There are some limitations to the study due to the design, the lack of an outcome for the quality of life and the absence of a specific evaluation of the importance of the physiotherapist\u2013patient relationship as a potential bias. Conclusion This study shows the importance of neuromotor and respiratory rehabilitation in patients with MG. The three-phase program used was dedicated to the full recovery of the patient\u2019s complete independence. He is now able to live autonomously without respiratory support. His quality of life and psycho-physical well-being have significantly improved, along with a decrease in social discomfort