Objective:

To test the feasibility of a novel method for remote evaluation of individuals with possible myasthenia gravis

Background:

Myasthenia gravis (MG), the most common neuromuscular autoimmune disorder, is traditionally evaluated by a neurologist in the examining room with the patient. However, infectious diseases, international conflicts, and other catastrophes may prevent evaluation of patients in-person. We propose a novel protocol for the remote evaluation of people with possible MG.

Design/Methods:

We modified a low-cost quantitative continuous measurement of movements in the extremities of people with Parkinson's disease (McKay, et al., MethodsX 2019; 6:169-189 https://doi.org/10.1016/j.mex.2018.12.017) for remote administration to individuals with possible MG. Inertial measurement units (IMUs) are placed on the upper extremity to generate continuous signals to represent the three-dimensional positions in space for recording by a computer.

Results:

Each item is administered by a trained rater with output recorded by a trained technologist and videotaped by a cameraman for future analysis and remote scoring. The trained rater will score each item immediately after administration to the individual.
Each item will be administered to the individual with the instructions to perform the activity as fast and fully as possible. The rater will demonstrate each activity to the individual before asking the individual to perform the activity. The rater will additionally ask the individual to perform the activity as fast and fully as possible after starting the activity. The activity will be performed for two minutes or until the individual cannot continue:

● Shoulder abduction and adduction
● Elbow flexion and extension
● Wrist flexion and extension

The degree of deceleration corresponds to the severity of the disease.

Conclusions:

We present our protocol to our colleagues so that they may utilize the approach for the remote diagnosis and treatment of people with possible MG and related conditions.