What it is
A short, honest summary.
- —An autoimmune condition where the immune system disrupts the signal between nerve and muscle.
- —The hallmark is fatigable weakness — muscles work at first, then fade with use, and recover with rest.
- —It commonly affects the eyes, face, swallowing and limbs; severity fluctuates day to day.
What families notice
The signals worth taking seriously.
- 01Drooping eyelids or double vision, often worse in the evening
- 02A weak, tired voice or difficulty chewing toward the end of a meal
- 03Arms that tire quickly with overhead tasks
- 04Weakness that improves after rest and worsens with activity or heat
- 05Breathlessness with exertion in more significant cases
My approach
How the work is structured.
- —Energy-conservation and activity-pacing strategies built around the daily fatigue pattern.
- —Carefully dosed strengthening — enough to maintain function, never to exhaustion.
- —Breathing and postural work, coordinated with the treating neurologist.
- —Education for the family on recognising a hard day and adjusting accordingly.
What recovery looks like
A plain-language picture.
“With medication and sensible pacing, most people with myasthenia gravis lead full lives. Rehabilitation keeps function steady and helps you spend energy on what matters.”
FAQ
Common questions, answered briefly.
- Should I exercise if it makes me weaker?
- Yes — but dosed carefully. The aim is steady, sub-maximal activity that maintains strength without triggering a fatigue crash. We find that line together.
- Why is it worse in the evening?
- Repeated muscle use through the day depletes the nerve-muscle signal. Rest restores it — which is why mornings often feel near-normal.
For clinicians
Clinical detail, assessment and evidence.
Clinical summary
The picture in clinician register.
Myasthenia gravis is an autoimmune disorder of neuromuscular-junction transmission, producing fatigable weakness that fluctuates diurnally and with use. Rehabilitation centres on activity pacing and carefully dosed sub-maximal exercise; respiratory monitoring and the recognition of a developing crisis are essential safety functions.
Terminology
Terms worth being precise about.
- Fatigable weakness
- Weakness that worsens with sustained or repeated use and recovers with rest.
- Myasthenic crisis
- Respiratory failure from severe weakness — a medical emergency.
- Ocular vs generalised MG
- Whether weakness is confined to the eyes or more widespread.
- Diurnal variation
- The characteristic morning-to-evening swing in strength.
Assessment & measures
What the first sessions measure.
- —A baseline of fatigable strength, tested before and after exertion.
- —Respiratory function where indicated.
- —Functional and pacing assessment mapped to the daily fatigue pattern.
Red flags
Signs that need urgent escalation.
- Increasing breathlessness, a weak cough, or bulbar weakness — impending myasthenic crisis; emergency.
- A marked generalised deterioration.
Referral & MDT
When and to whom to refer.
Neurology for immunotherapy and crisis planning. Respiratory monitoring; coordinate exercise dosing around medication timing.
Evidence
References and guideline anchors.
- Sub-maximal exercise in myasthenia gravis — PLACEHOLDER — verify against current guidelines before launch.