Arches. Photo by Daniel Chia
HOPES: Huntington's Outreach Project for Education, at Stanford
Jun
26
2010

Physical Therapy and Huntington’s Disease Treatment and Management

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The onset of Huntington’s disease (HD) is heralded by a wide range of symptoms, from behavioral ones, such as depression and irritability, to physically visible ones, such as bodily tremors, bradykinesia, akinesia, and dysphagia. As the disease advances, symptoms become progressively severe. Physical symptoms, such as involuntary movements, worsen, potentially leading to frequent falls. Although there is currently no cure for HD, there are many treatment regimens that may help slow the progression of symptoms. While most research is aimed at developing drugs and medications to help alleviate HD symptoms, physical therapy interventions also have the potential to improve the quality of life for many patients.

There are three main types of physical therapy: physio-, occupational, and speech. Although there is overlap between these treatments, each type of therapy differs slightly in its goals and how it works.

Types of Physical Therapy^

Physiotherapy is physical therapy that focuses primarily on the control of larger bodily motions, such as walking and standing. Occupational rehabilitation aims for ‘adaptive’ improvement—learning new ways to accomplish day-to-day tasks involving fine motor skills made difficult by HD symptoms. Speech therapy deals with the patient’s physical difficulties involving mouth and throat muscles, and the process of speaking. Below is a table summarizing some of the major components that each type of therapy addresses:

Physiotherapy Occupational Therapy Speech Therapy
  • Gait and balance
  • Fall prevention
  • Aerobic capacity
  • Muscle strength
  • Wheelchair prescription and training
  • Respiratory function
  • Task-specific reach, grasp, and manipulation
  • Personal hygiene
  • Grooming and dressing
  • Eating and drinking
  • Toileting
  • Work restructuring
  • Driving assessment
  • Memory training
  • Provision of adaptive devices
  • Speech intelligibility- control of rate and volume
  • Intonation
  • Speech rhythm
  • Swallowing
  • Eating
  • Respiration
  • Language comprehension

Physiotherapy involves several large areas of rehabilitation. It may focus on gait, balance transfers, general strengthening, coordination, and postural stability. Many different types of exercises are performed in this type of treatment, as each patient’s individual exercise regime will vary depending on his or her specific needs. The different exercises focus on training different areas of the body, but all aim to prevent falls, promote correct walking and body control, build coordination, and encourage a positive and confident attitude towards the body. Exercises are done in a variety of positions—lying down, sitting, and standing. Some exercises make use of common gym props and machines such as exercise bicycles, treadmills, weighted balls, and dumbbells, while others focus on flexibility or posture training. In posture training, exercises help patients maintain good form and balance while moving and staying still. For example, a patient may be asked to focus on transferring body weight from one leg to the other or to walk with hands clasped behind the back.

Like physiotherapy, occupational therapy is individually tailored. This type of rehabilitation integrates both mental and physical exercises to aid patients in learning new strategies to accomplish tasks that become more challenging as HD progresses. Activities focus on memory stimulation and concentration as patients learn approaches for completing common tasks such as walking or standing safely, dressing, and personal hygiene. Oftentimes, an occupational therapist will also aid in assessing whether or not it is practical and safe for a patient with HD to continue driving, and also in recommending changes in the work environment to better accommodate the progressive symptoms of HD.

Speech therapy attempts to help patients regain or maintain verbal adeptness, and other skills related to the mouth and throat. Respiratory exercises such as blowing up balls and blowing on tissues at different distances aim to increase the efficiency of breathing. On the cognitive side of speech rehabilitation, patients complete exercises which test and strengthen their ability to understand, interpret, and use metaphors, synonyms and other figures of speech.

Effectiveness of Physical Therapy^

One study tracked 40 patients with HD over two years as they followed a comprehensive rehabilitation program. The regime included both the physical and cognitive aspects from physiotherapy, occupational therapy, and speech therapy. The findings showed that over time, physical therapy had positive effects on motor and functional performance. Moreover, cognitive abilities did not decline as would be otherwise expected. These results indicate that patients are able to, at the very least, maintain a constant level of functional, motor, and cognitive performance over two years with the help of physical therapy This is important because HD is characterized by a deterioration of these abilities. However, the problem with this type of study is the lack of control groups, and difficulty in quantifying progress in the absence of any common standards.

Despite the evidence indicating that physical therapy can help people with HD maintain independence and functional capacity, recent research suggests that it is not always routinely provided. One survey revealed that only 24% of patients with HD had worked with an occupational therapist, only 8% had been seen by a physiotherapist, and close to none had been contacted by a speech therapist. Although it is unknown why physical rehabilitation services are so rarely used by patients, several explanations have been proposed. One reason may be the fact that there are very few studies that quantify the effectiveness of such treatments. Another possible reason for the limited use of rehabilitation services is reluctance in the community of service providers to accept people who are afflicted with a progressive condition, because it is thought that their chances of improvement are exceedingly low.

If more rigorous studies are completed that definitely demonstrate the effectiveness of physical therapies in slowing disease progression and improving patient quality of life, perhaps these types of treatments will be recommended to HD patients in the future.

Further reading:^

  • Bilney, B., M. Morris, and A. Perry (2003). “Effectiveness of Physiotherapy, Occupational Therapy, and Speech Pathology for People with Huntington’s Disease: A Systematic Review.” Neurorehabilitation and Neural Repair 17:12-24.
    Less technical review which outlines many of the current treatments. Provided inspiration for the table in the “Types of Physical Therapy” section.
  • Busse, M.E, and A.E. Rosser (2007). “Can directed activity improve mobility in Huntington’s disease?” Brain Research Bulletin 72:172-174.
    Short, less technical review which summarizes some of the research that has been done in the field so far.
  • Zinzi, P., D. Salmaso, R. De Grandis, G. Graziani, S. Maceroni, A. Bentivoglio, P. Zappata, M. Frontali, and G. Jacopini (2007). “Effects of an intensive rehabilitation programme on patients with Huntington’s disease: a pilot study.” Clinical Rehabilitation 21:603-613.
    A technical paper which outlines a study on how rehabilitation affected patients over a longer time span. Data mentioned in the “Effectiveness of Physical Therapy” section was drawn from this study.

- A. Pipathsouk, 4/12/2009