The Effect of Spinal Stabilization Exercises in Patients With Myasthenia Gravis
The Effect of Spinal Stabilization Exercises in Patients With Myasthenia Gravis
Myasthenia Gravis (MG) is an autoimmune disease characterized by increased exercise-induced
 fatigue and muscle weakness. MG is a disease caused by impaired receptor function due to
 antibodies to nicotinic acetylcholine receptors in postsynaptic region in voluntary skeletal
 muscles.Spinal stabilization exercises, which use the basic principles of motor learning,
 aiming to improve the coordination, contraction rate and endurance of the body muscles by
 increasing kinesthetic awareness, can be used to strengthen body stability.

 The aim of this study was to investigate the effects of spinal stabilization exercises on
 fatigue, muscle strength, pulmonary functions and functional capacity in patients with MG.
Myasthenia Gravis (MG) is an autoimmune disease characterized by increased exercise-induced
 fatigue and muscle weakness. MG is a disease caused by impaired receptor function due to
 antibodies to nicotinic acetylcholine receptors in postsynaptic region in voluntary skeletal
 muscles. The disease usually begins with ptosis from ocular symptoms. With the progression of
 the disease, symptoms of bulbar muscles and extremity muscles are added to the ocular
 symptoms. Bulbar symptoms occur when speaking, swallowing, chewing difficulties and
 difficulty breathing, while the symptoms in the extremity muscles arise as the difficulty of
 raising the arms uphill and the strain of climbing stairs.

 The weakness of the limb muscles is proximal and distal in the arms and more proximal muscles
 in the legs. As the disease progresses, weakness occurs in most striated muscles. This causes
 weakness in the trunk muscles.

 In the literature, the physiotherapy methods used in MG patients include breathing exercises,
 aerobic exercises and resistant exercises.Spinal stabilization exercises enable activation of
 the trunk muscles.

 Spinal stabilization exercises, which use the basic principles of motor learning, aiming to
 improve the coordination, contraction rate and endurance of the body muscles by increasing
 kinesthetic awareness, can be used to strengthen body stability. Spinal stabilization
 exercises are a type of exercise that aims more smooth limb movements with a strong spine,
 ensuring smoothness and stability of the spine. In the literature, there is no study using
 spinal stabilization exercises in MG patients. The aim of this study was to investigate the
 effects of spinal stabilization exercises on fatigue, muscle strength, pulmonary functions
 and functional capacity in patients with MG.

 Method The study was planned as randomized, single-blind and cross-over. Randomization will
 be done with closed envelope system. Group 1 will be written on five sheets and group 2 will
 be written on another five sheets.

 Then, these papers will be placed on the envelopes, these envelopes will be mixed in a box
 and patients will be asked to withdraw from these envelopes.

 Thus, patients will be divided into 2 groups. Assessments will be made by Yeliz Salcı and
 Ebru Kütük Çalıkçı. The assessors will not know who is in the which group. Treatment
 intervention will be done by Ali Naim Ceren. The assessors will evaluate patients without
 knowing the patients' groups. So the work will be single blind. Group 1, 3 days per week for
 6 weeks so that it will be taken to the physiotherapy program consisting of spinal
 stabilization exercises. Also the treatment will be supported by home program exercises. The
 patients will be rested for 4 weeks to eliminate the effects of the spinal stabilization
 program. After this period, only the home program will be given for 6 weeks. In Group 2;
 treatment will start with a 6-week home program, followed by a 4-week break.

 At the end of this period to be 3 days a week for 6 weeks spinal stabilization exercise
 program will be implemented. In addition to this exercise program, patients will be given a
 home program. The home program will include breathing exercises tailored to the patient's
 needs, calisthenic exercises, and MAT activities.

 Assessments will be made at the beginning of the treatment, after 6 weeks of treatment, at
 the end of 4 weeks of rest and at the end of 6 weeks of treatment.
Inclusion Criteria:

 -  Being diagnosed with MG by a neurologist,

 -  Aged between18-65 years,

 -  To be in Stage II or III according to the Clinical Classification of the Medialia
 Gravis Functional Assessment (MGFA),

 -  The Mini Mental Test score should be over 24 in order to be cooperative to the
 physiotherapist's instructions,

 -  To volunteer to participate in the study.

 Exclusion Criteria:

 -  Having a cognitive problem and having a Mini Mental Test score below 24

 -  To have had myasthenic crisis in the last month,

 -  Modification of medical treatment and dose in the last month,

 -  Systemic, orthopedic and neurological disease in addition to the disease

 -  Participation in physiotherapy program in the last six months.