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Myasthenia Gravis

enabling occupation 4
by

Alyce Berry

on 7 June 2013

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Transcript of Myasthenia Gravis

Alyce and Jess Myasthenia Gravis Goal Setting Assessments The Condition Signs and Symptoms Etiology and Risk Factors Diagnosis and Prognosis Implications for Occupational Performance Medical and
Surgical Management Walking to the Shops Playing Golf Walk to Local Coffee Shop Occupational Therapy Intervention Conclusion Walter Myasthenia gravis is highly variable between people and the condition fluctuates over time, signs and symptoms include:
muscle weakness and fatigue that gets worse with use
Ptosis or droopy eye,
Droopy jaw
Shortness of breath or breathing difficulties
Changed facial expression.
Burning eyes
Myasthenic crisis
Swallowing, speaking and chewing difficulties (1) Early-onset MG: age at onset <50 years. Thymic hyperplasia;
(2) Late-onset MG: age at onset >50 years. Thymic atrophy;
(3) Thymoma-associated MG;
(4) MG with anti-MuSK antibodies;
(5) OcularMG: symptoms only from periocular muscles;
(6) MG with no detectable AChR and MuSK antibodies; Australia 2009: 2574 prevalent cases
117 per 1 million residents presenting with MG.
Women were more likely than men to present with MG between the ages of 1 and 64 years.
Above 64 years men were more likely to have myasthenia gravis than women (Gattellari, M Goumas, C & Worthington, JM 2012). Diagnosed through a Tensilon test, serum antibodies test, chest radiography and CT scan
Therapeutic considerations differ for early-onset MG, late-onset MG, and MG associated with the presence of a thymoma (Keesey 2004).
Many people with MG are now able to live independently, with appropriate management and supports (Grobar-Murray et al. 1998)
85% of people diagnosed with Ocular MG will degenerate to generalized MG within 2 years (Sathasivam 2008; Kupersmith, Latkany & Homel 2003). 1) Anticholinesterase drugs
2) Immunosuppressants
3) Thymectomy
4) Plasmapheresis
5) Corticosteroids Complications 1) Thymoma

2) Cholinergic crisis

3) Myasthenic crisis Myasthenia Gravis has many impacts on the person that tend to fluctuate depending on several factors including medication and levels of exertion.
Activities of daily living
activities that require repetitive movements e.g. hanging out the washing
Extended strength e.g. carrying shopping baskets.
Vocal volume
Difficulty with large meals
Difficulty swallowing
Fatigue
Frequent rest breaks
Incontinence
The time of day
Work
Environmental Temperatures (Grobar-Murray et al. 1998)
Any other stressors (Kempton 1972) By the end of 10 weeks, Walter will be able to walk to and from the shops, 700m away four times per week. By the end of 4 weeks, Walter will be able to walk to the local coffee shop, 400m away and back. By the end of 5 weeks, Walter will be able to hit a bucket of 100 balls at the driving range
By the end of 10 weeks, Walter will be able to play 9 rounds of golf with the use of a golf cart. Education Walter needs to know more about his condition and how to manage it to be able to go home and remain there. Goal Prioritization 1) Education
2) Walking to shops
3) Walking to local cafe to see friends
4) Playing golf Frames of Reference The frames of reference used to guide this intervention are the biomechanical and rehabilitative frames of reference (Edmans 2010).

These were chosen to incorporate both physical rehabilitation and compensatory elements Environmental Factors Playing Golf
walking
holding and swinging a golf club
vision and ability to aim to hit ball with club
strength to hit ball an appropriate distance
Fine motor skills for putting
Methods for transporting the golf clubs need to be considered
Possibility of driving a golf cart? Walking to the Local Shops or Cafe
walk up approximately 5 steps
walk 400 metres to cafe
walk 700 metres to reach shops
must be able to return home the same way
Money handling skills
Carry items for extended periods of time.
As he goes to the cafe to meet friends, he must be able to talk or communicate once there. Occupational Performance Alternate traveling methods
Stairs
Footpaths - paved
Opportunities for rest breaks (public seating?)
Flat area
Possible use of walking frame? Strengths and Resources Walter:
Lives with his wife who is able to help with many ADLs
Has two children who may also be able to provide support
Has good cognitive capacity
Was previously physically fit and able to do his desired activities
Knows how to send e-mails (could be an alternate communication method)
Goes golfing with a friend who is able to drive Initial Assessment
Home Assessment
Environmental Assessment of road to shops and local cafe
Re-evaluation of goals
Informal discussion concerning Walter's knowledge of his condition Education MG symptoms have been shown to be increased by stress, extreme temperatures, high humidity and activity (Grobar-Murray et al. 1998)
People with Myasthenia Gravis are often capable of living at home with the right management (Grobar-Murray et al. 1998).
Education about these areas is important for Walter to be able to live at home and manage his own condition effectively. Condition Fatigue Management Stress Management Energy Conservation Activity Scheduling Golf Intervention Walking Intervention The 10 week intervention plan we have outlined is aimed at gradually increasing the amount of activity that Walter can do during a day without over-tiring him. It also aims to provide him with enough information to be able to self manage his condition as much as possible. Weather dependent
Socialising with others
Uneven ground
Possible fall risk?
Other golfers References References Images
Eyes http://astronlife.wordpress.com/astron-articles/myasthenia-gravis-an-autoimmune-neuromuscular-disorder/
Neuromuscular Junction http://www.chop.edu/healthinfo/myasthenia-gravis-1.html
Walter http://www.vectorstock.com/royalty-free-vector/cartoon-man-holding-sign-vector-533416
Cartoon people shaking hands http://www.empowernetwork.com/geraldcyr1/blog/4-simple-steps-to-marketing-online/cartoon-two-people-shaking-hands-2/
Cartoon house http://vectorianart.blogspot.com.au/2010/10/house-cartoon-vector.html
Cartoon eyes http://www.staceyreid.com/news/
Cartoon Street http://us.123rf.com/400wm/400/400/anastasiiaku/anastasiiaku1112/anastasiiaku111200140/11780429-cartoon-street-in-winter.jpg Canadian Association of Occupational Therapists 2000, Occupational Therapy Now, viewed 6 June 2013 <http://www.caot.ca/otnow/sept00-eng/sept00-students.cfm>.
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Edmans, J 2010, Occupational Therapy and Stroke, (2nd ed.), Wiley-Blackwell, West Sussex, pp. 24-48.
Faces of myasthenia gravis: a bad day 2010, video, YouTube, 7 May, viewed 6 June 2013, <
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Kempton, J 1972, Living with Myasthenia Gravis: a bright new tomorrow, Charles C Thomas, Illinois, USA.
Kupersmith, M Latkany, R & Homel, P 2003, ‘Development of generalized disease at 2 years in patients with ocular myasthenia gravis’, Archives of Neurology, vol. 60, no. 2, pp. 243-248.
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Mott Hardy, E & Rittenberry, K 1994, ‘Myasthenia Gravis: an overview’, Orthopaedic Nursing, vol. 13, no. 6, pp. 37-42.
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Sathasivam, S. 2008, Steroids and immunosuppressant drugs in myasthenia gravis. Nature Clinical Practice Neurology, vol. 6, no. 4, pp. 317-327.
Tawil, R & Venance, S 2011, Neuromuscular disorders, Wiley-Blackwell, Chichester, West Sussex, UK.
Wilkinson, I & Lennox, G 2005, Essential Neurology, Blackwell Publishing, Massachusetts, USA. Questions?
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