Technology platform for tele-rehabilitation implementation in Mysathenia gravis at the point-of-care

Myasthenia gravis (MG) is a rare neuromuscular condition characterized by weakness and fatigue. Exertional fatigue in MG provokes caution with exercise advice. There is no consensus on how to implement safe and effective exercise or rehabilitation for MG. To address this gap, we developed an MG specific, progressive exercise program that focuses on the muscles that are most affected. The program combines aerobic training, muscular endurance, and pulmonary rehabilitation to improve function, 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 exercises with adjustable metronome pacing, while video capturing the client's performance for unprecedented understanding of desired body mechanics and to enhance coach feedback. This two-way interactive wireless platform increases access to expert oversight and enhances safety. IVET was pilot tested at the point-of-care in neurology and infusion clinics to assess clients' acceptance of this technology, as well as client and coach/therapist ratings on client safety and competency for each exercise. Twelve clients with a broad range of age and MG severity were enrolled. Survey of client's technology acceptance for home IVET exercise used a nominal 10-point scale and demonstrated high rating for enjoyment, interest, confidence, safety, perceived value, and increased frequency of structured exercise. Further studies are needed to determine the treatment fidelity, safety, and efficacy of IVET as a virtual therapist in the home to improve function and health for individuals with MG.