Question:

I have a 19 year old male client with a rare condition called congenital myasthenia. This is causing muscular weakness, particularly in his legs. He is in a wheelchair but can just about stand up and walk a few steps. He has been referred by a physiotherapist to strengthen his muscles. Could you please advise me on a suitable program?

Answer:

Congenital myasthenia is a disorder in which neuromuscluar transmission is affected. The severity varies among individuals and ranges from mild limb weakness to severe disability with life threatening conditions. Once diagnosed and treated, symptoms usually get better over time.

Here are some exercises that would be good to try with a client who has congenital myasthenia and has been cleared to exercise. Start slowly with one or two sets of these exercises two to three days per week. Pick a few of the exercises, do only what is tolerated and progress to more exercises and more reps. Proper warm up and cool down as well as stretching should be incorporated. As always, follow doctor’s orders and avoid any contraindicated movements.

• Quad Flexes - From a sitting or supine position with legs straight, tighten each quad and hold for a few second, then release (strengthens quadriceps).
• Heel Slides - From a supine position with legs straight, slide each heel toward the glutes and straighten (strengthens hamstrings).
• Leg Lifts - From a supine position with legs straight, tighten quad and raise leg as high as possible, then return to starting position. Repeat on other side. Next, do the same movement from the prone position and lying on each side. Progress to using light ankle weights or resistance bands if tolerated (strengthens quadriceps, hamstrings and abductors).
• Adductor Lifts - Lie on side and cross top leg over bottom leg. With the top leg bent 90 degrees and the bottom leg straight, raise the bottom leg toward the ceiling and slowly lower to the ground. Repeat on the other side (strengthens adductors).
• Ball Squeezes - From supine position, place a foam or rubber ball between legs just above the knees. Squeeze the ball, hold a few seconds and release (strengthens adductors).
• Bridges - From supine position with knees bent 45 degrees, draw in belly button and lift hips off the ground. Hold two to three seconds and lower hips to ground. Make sure he does not do a pelvic tilt. Progress to doing the same movement with legs straight and feet on an exercise ball. Another progression would be curling the ball toward the glutes (strengthens low back, abs, glutes and hamstrings).
• Sit to Stands - With wheelchair in locked position behind the client, have him stand up and then sit back down. Repeat as tolerated. Use chair arms to help stand at first if needed. Spot him from behind (strengthens quadriceps).
• Step Touches - Stand between balance bars or two chairs to use for support if needed. Lift one foot to touch the top of a six inch step. Alternate legs. Increase step height for added difficulty (strengthens quadriceps).
• Total Gym Leg Press - Perform leg presses on a Total Gym if one is accessible. Start with the seat on a low setting and increase the angle to add difficulty. Hold a ball between legs if necessary to ensure proper form (strengthens quadriceps and glutes).

Perform normal exercises with cable pulleys, resistance bands and/or dumbbells for upper body exercises. These can be done standing or sitting.

Water aerobics are also a great way to start since the water supports body weight. One study I read from the Medicine and Science in Sports and Exercise showed positive results in increased muscle mass from five grams of creatine supplementation per day in addition to resistance exercise.