Rehabilitation in Juvenile Myasthenia Gravis: Strategies and Challenges in Enhancing Pediatric Patient Quality of Life

Abstract

Juvenile Myasthenia Gravis (JMG) is a rare autoimmune disorder characterized by impaired neuromuscular transmission, resulting in fatigable weakness and significant functional limitations in pediatric patients. Despite growing recognition of rehabilitation's importance in JMG management, there remains a critical need to synthesize current evidence and establish standardized approaches. This comprehensive review examines the pathophysiology of JMG, focusing on autoantibody-mediated disruption of acetylcholine receptors (AChR) and muscle-specific kinase (MuSK) at the neuromuscular junction. We evaluate evidence-based rehabilitation strategies including (1) tailored exercise programs combining resistance (30-50% 1RM) and aerobic training; (2) targeted bulbar and respiratory interventions; and (3) integrated psychosocial support. The analysis highlights emerging technologies such as telerehabilitation and robotic exoskeletons while identifying persistent challenges in care accessibility and disease variability. Current evidence demonstrates rehabilitation's crucial role in optimizing functional outcomes for JMG patients, though significant knowledge gaps remain. The review underscores the urgent need for JMG-specific clinical trials, precision rehabilitation approaches, and standardized care protocols. Future research should prioritize biomarker-guided interventions and technology-enhanced therapies to advance pediatric JMG management globally.