{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T06:04:47Z","timestamp":1781071487420,"version":"3.54.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Rehabil. Sci."],"abstract":"<jats:p>Myasthenia gravis is an autoimmune disorder of the neuromuscular junction characterized by fatigable muscle weakness. Myasthenic crisis is a life-threatening condition characterized by acute respiratory failure resulting from severe weakness of the respiratory muscles. Currently, no established guidelines exist for physiological assessment at the time of mobilization, or for the content and intensity of exercise therapy, in patients with severe myasthenia gravis presenting with myasthenic crisis. We report a case of newly diagnosed myasthenia gravis with myasthenic crisis wherein exercise therapy was initiated in the intensive care unit, with careful monitoring of vital signs and muscle fatigability, ultimately leading to discharge. A 67-year-old woman presented with a dropped head, gait disturbance, and respiratory failure, and was diagnosed with myasthenia gravis at our hospital. On the same day, the patient developed hypoxemia, underwent endotracheal intubation, and was admitted to the intensive care unit for mechanical ventilation. Exercise therapy was initiated on hospital day 3, and the exercise workload progressively increased while vital signs and fatigability were monitored. Standing training began on day 12; and ambulation training while receiving mechanical ventilation was introduced on day 17 without adverse events. The patient was successfully weaned off mechanical ventilation on day 24, and exercise therapy was continued thereafter. Physical function improved after steroid pulse therapy and a thymectomy; she achieved independent ambulation with a cane on day 64 and was discharged on day 78. Early exercise therapy guided by monitoring and muscle fatigue assessments may facilitate functional recovery without clinical deterioration. However, larger studies are required to evaluate its safety and efficacy.<\/jats:p>","DOI":"10.3389\/fresc.2026.1791183","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T05:40:13Z","timestamp":1781070013000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Early rehabilitation initiated in the intensive care unit for myasthenic crisis"],"prefix":"10.3389","volume":"7","author":[{"given":"Akiyuki","family":"Okamoto","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Wakayama Medical University","place":["Wakayama, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Gifu Municipal Hospital","place":["Gifu, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuto","family":"Mizutani","sequence":"additional","affiliation":[{"name":"Division of Rehabilitation, Wakayama Medical University Hospital","place":["Wakayama, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiaki","family":"Nakayama","sequence":"additional","affiliation":[{"name":"Department of Neurology, Wakayama Medical University","place":["Wakayama, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoko","family":"Yorozu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Wakayama Medical University","place":["Wakayama, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohei","family":"Hori","sequence":"additional","affiliation":[{"name":"Department of Neurology, Wakayama Medical University","place":["Wakayama, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Kouda","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Wakayama Medical University","place":["Wakayama, Japan"]},{"name":"Division of Rehabilitation, Wakayama Medical University Hospital","place":["Wakayama, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1590\/0004-282X20130108","article-title":"The myasthenic patient in crisis: an update of the management in neurointensive care unit","volume":"71","author":"Godoy","year":"2013","journal-title":"Arq Neuropsiquiatr"},{"key":"B2","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1002\/mus.27832","article-title":"Myasthenic crisis","volume":"68","author":"Claytor","year":"2023","journal-title":"Muscle Nerve"},{"key":"B3","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1212\/WNL.0000000000002790","article-title":"International consensus guidance for management of myasthenia gravis: executive summary","volume":"87","author":"Sanders","year":"2016","journal-title":"Neurology"},{"key":"B4","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.nmd.2020.12.004","article-title":"Physical training and exercise in myasthenia gravis","volume":"31","author":"Gilhus","year":"2021","journal-title":"Neuromuscul Disord"},{"key":"B5","doi-asserted-by":"publisher","first-page":"100591","DOI":"10.1016\/j.ensci.2025.100591","article-title":"Rehabilitation for functional enhancement of myasthenia gravis: a systematic review and meta-analysis","volume":"41","author":"Xiangxiang","year":"2025","journal-title":"eNeurologicalSci"},{"key":"B6","doi-asserted-by":"publisher","first-page":"5650","DOI":"10.1007\/s00415-024-12478-y","article-title":"Myasthenic crises are associated with negative long-term outcomes in myasthenia gravis","volume":"271","author":"M\u00fcck","year":"2024","journal-title":"J Neurol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1007\/s10072-014-1659-y","article-title":"Predictors of outcome of myasthenic crisis","volume":"35","author":"Kalita","year":"2014","journal-title":"Neurol Sci"},{"key":"B8","doi-asserted-by":"publisher","first-page":"739","DOI":"10.3390\/cells14100739","article-title":"The role of complement in the pathogenesis and treatment of myasthenia gravis","volume":"14","author":"Martinez Salazar","year":"2025","journal-title":"Cells"},{"key":"B9","doi-asserted-by":"publisher","first-page":"2008","DOI":"10.1111\/j.1582-4934.2008.00431.x","article-title":"Atrophy of type II fibres in myasthenia gravis muscle in thymectomized patients: steroid-induced change with prognostic impact","volume":"13","author":"Zamecnik","year":"2009","journal-title":"J Cell Mol Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e11510","DOI":"10.1097\/MD.0000000000011510","article-title":"The impact of physical exercise on neuromuscular function in myasthenia gravis patients: a single-subject design study","volume":"97","author":"Westerberg","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1002\/mus.25493","article-title":"Physical exercise in myasthenia gravis is safe and improves neuromuscular parameters and physical performance-based measures: a pilot study","volume":"56","author":"Westerberg","year":"2017","journal-title":"Muscle Nerve"},{"key":"B12","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1186\/s12890-025-03733-7","article-title":"Inspiratory muscle training and aerobic exercise for respiratory muscle strength in myasthenia gravis post-hospitalization- a randomized controlled trial","volume":"25","author":"Chang","year":"2025","journal-title":"BMC Pulm Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1186\/s12883-018-1150-0","article-title":"Marathons and myasthenia gravis: a case report","volume":"18","author":"Birnbaum","year":"2018","journal-title":"BMC Neurol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1591","DOI":"10.1001\/jama.2013.278481","article-title":"Acute skeletal muscle wasting in critical illness","volume":"310","author":"Puthucheary","year":"2013","journal-title":"JAMA"},{"key":"B15","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.mpsur.2020.11.005","article-title":"Long-term outcomes from critical care","volume":"39","author":"Morgan","year":"2021","journal-title":"Surgery (Oxford)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1663","DOI":"10.4187\/respcare.01931","article-title":"Early physical rehabilitation in the ICU and ventilator liberation","volume":"57","author":"Mendez-Tellez","year":"2012","journal-title":"Respir Care"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1589\/jpts.30.1193","article-title":"Rehabilitation and early mobilization in the critical patient: systematic review","volume":"30","author":"Arias-Fern\u00e1ndez","year":"2018","journal-title":"J Phys Ther Sci"},{"key":"B18","doi-asserted-by":"publisher","first-page":"120280","DOI":"10.1016\/j.jns.2022.120280","article-title":"Influence of inpatient rehabilitation after crisis in patients with myasthenia gravis: a retrospective cohort study using a nationwide administrative database in Japan","volume":"438","author":"Otaka","year":"2022","journal-title":"J Neurol Sci"},{"key":"B19","volume-title":"Clinical Practice Guideline for Myasthenia gravis and Lambert-Eaton myasthenic Syndrome 2022","year":"2022"},{"key":"B20","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1002\/mus.25552","article-title":"Exercise in myasthenia gravis: a feasibility study of aerobic and resistance training","volume":"56","author":"Rahbek","year":"2017","journal-title":"Muscle Nerve"}],"container-title":["Frontiers in Rehabilitation Sciences"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fresc.2026.1791183\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T05:40:15Z","timestamp":1781070015000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fresc.2026.1791183\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,10]]},"references-count":20,"alternative-id":["10.3389\/fresc.2026.1791183"],"URL":"https:\/\/doi.org\/10.3389\/fresc.2026.1791183","relation":{},"ISSN":["2673-6861"],"issn-type":[{"value":"2673-6861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,10]]},"article-number":"1791183"}}