Technology Platform for Tele-Rehabilitation Implementation in Mysathenia Gravis at the Point-of-Care

Abstract

Myasthenia gravis (MG) is a rare neuromuscular condition characterized by weakness. Fatigue with exertion in this population provokes caution with exercise. There no consensus on how to implement safe and effective exercise to promote cardiovascular and muscular health in MG. To address this gap, we developed an MG specific, progressive exercise program that focuses on muscles that are most affected. The program combines aerobic conditioning, muscular endurance, and pulmonary rehabilitation to improve functional performance, energy efficiency, and cardio-pulmonary capacity. Our Interactive Video Exercise Tele-rehabilitation (IVET) platform embeds our MG specific exercises, adapted to each client's capacity. A video avatar guides home exercise with adjustable metronome pacing, while video capture of client's performance enhances coach feedback, leading to unprecedented gains in body mechanics. This two-way interactive wireless platform increases access to expert oversight and enhances safety. IVET is pilot tested at the point-of-care in neurology and infusion clinics to assess clients' acceptance of the technology, as well as client and coach/therapist ratings on safety and performance competency for each exercise. Twelve clients with a broad range of age (52.8±17.4 yr.; range 25-73) and MG severity were enrolled. Client survey of technology acceptance for home exercise using a nominal ten-point scale demonstrated high mean rating for enjoyment, interest, confidence, safety,