Objective: To assess the effects of an intensive, multidisciplinary rehabilitation program for patients with early to mid-stage Huntington’s disease. Design: A prospective intervention study. Setting: Two Norwegian inpatient rehabilitation centers. Subjects: 37 patients, with early- to midstage Huntington’s disease Interventions: A one year rehabilitation program, consisting of three admissions of three weeks each, and a five-day evaluation stay approximately 3 months after the last rehabilitation admission. Focus was on physical exercise, social activities, and group/teaching sessions. There was also emphasis to implement of coordinated health care and social services for the patients. Main outcome measures: standard measures for motor function, including gait and balance, cognitive function, including MMSE and UHDRS cognitive assessment, anxiety and depression, activities of daily living (ADL), health related quality of life and Body Mass Index (BMI). Results: Significant improvements were observed in gait function, balance, in physical quality of life, anxiety and depression, as well as in BMI. ADL-function remained stable with no significant decline. Only one cognitive measure (SDMT) showed significant decline, while no decline was observed for the remaining cognitive measures. Conclusion: A multidisciplinary intensive rehabilitation program in patients with early and mid stage HD is associated with improved balance, gait function, physical quality of life and with reduced depressive and anxiety symptoms. Longer follow-up is needed to assess if these positive effects are sustained. There should be emphasis to establishment of long term and coordinated health care services for the HD patient

Objective: To assess effects of a two year intensive, multidisciplinary rehabilitation program for patients with early- to mid-stage Huntington’s disease. Design: A prospective intervention study. Setting: One inpatient rehabilitation center in Norway. Subjects: 10 patients, with early- to mid-stage Huntington’s disease. Interventions: A two year rehabilitation program, consisting of six admissions of three weeks each, and two evaluation stays approximately three months after the third and sixth rehabilitation admission. The program focused on physical exercise, social activities, and group/teaching sessions. Main outcome measures: Standard measures for motor function, including gait and balance, cognitive function, including MMSE and UHDRS cognitive assessment, anxiety and depression, activities of daily living (ADL), health related quality of life (QoL) and Body Mass Index (BMI). Results: Six out of ten patients completed the full program. Slight, but non-significant, decline was observed for gait and balance from baseline to the evaluation stay after two years. Non-significant improvements were observed in physical QoL, anxiety and depression, and BMI. ADL-function remained stable with no significant decline. None of the cognitive measures showed a significant decline. An analysis of individual cases revealed that four out of the six participants who completed the program sustained or improved their motor function, while motor function declined in two participants. All the six patients who completed the program reported improved or stable QoL throughout the study period. Conclusion: Our findings suggest that participation in an intensive rehabilitation program is well tolerated among motivated patients with early to mid-stage HD. The findings should be interpreted with caution due to the small sample size in this study.

This randomized clinical trial assesses the effects of robot-assisted treadmill training in persons with chronic incomplete spinal cord injury acquired > 2 years earlier. Due to recruitment challenges, it was possible to recruit only 63% of the planned number of participants. The intervention group received gait training 3 days per week for a period of 6 months and the control group received usual care with their local physical therapist. The intervention group showed improvements in lower extremity strength and balance, but no change in walking function. Significant between-group difference was found only in postural control, favouring the control group. Because the target number of study participants was not reached, the study was underpowered and nonsignificant, and thus the findings are inconclusive. This training method may have benefits, but the robotic device is expensive and training effects are limited when the person's baseline function is poor and the training starts late in incomplete spinal cord injury. Objective: To assess the effects of robot-assisted locomotor training in patients with chronic incomplete spinal cord injury. Design: Randomized single-blind controlled clinical trial. Setting: The intervention site was an outpatient clinic, and pre-and post-evaluations were performed in a rehabilitation hospital. Patients: A total of 24 subjects with American Spinal Injury Association Impairment Scale grades C or D, > 2 years post-injury. Interventions: Subjects were randomized to 60 days of robot-assisted locomotor training, or to usual care. Methods: Walking function, lower extremity muscle strength and balance were assessed single-blinded pre-and post-intervention. Results: After a 9-year recruitment period, only 24 of the planned 30 subjects had been enrolled (mean time since injury 17 (standard deviation (SD) 20) years for all subjects). Walking function, lower extremity muscle strength and balance improved modestly in both groups, with no statistically significant group difference in walking function or muscle strength, whereas postural control declined significantly in the intervention group, compared with controls (p = 0.03). Conclusion: Late-onset robot-assisted locomotor training did not re-establish independent walking function. A modest, but non-significant, effect was seen on muscle strength and balance. However, significant between-group differences were found only in postural control in the control group.

LAY ABSTRACTThis randomized clinical trial assesses the effects of manually assisted body-weight supported treadmill training in patients with chronic functionally incomplete spinal cord injury acquired > 2 years earlier. Due to recruitment challenges, it was only possible to recruit twothirds of the planned number of study participants. The intervention group received gait training 5 days per week over 12 weeks, and the control group received usual care with their local physical therapist. Subjects with no baseline gait function did not regain walking ability. Compared with the control group, the intervention group showed modest improvements in walking speed, lower extremity strength, and body control. However, all between-group differences were non-significant. Because the target number of study participants was not reached, the study was underpowered and non-significant, and thus the findings are inconclusive. It does, however, seem that this training method has benefits, but it is labour-intensive and requires large amounts of human resources. Objective: To assess the effects of manually assisted body-weight supported locomotor training in subjects with chronic incomplete spinal cord injury. Design: Randomized controlled clinical trial. Subjects: Twenty subjects with American Spinal Injury Association Impairment Scale grades C or D and > 2 years post-injury. Methods: Random allocation to 60 days of bodyweight supported locomotor training, or usual care, which might include over-ground walking. Walking function, lower extremity muscle strength and balance were blindly evaluated pre-/post-intervention. Results: A small, non-significant improvement in walking function was observed (0.1 m/s (95% confidence interval ( 95% CI) -0.2, 0.4)), but subjects without baseline gait function, did not re-establish walking. The effect on lower extremity muscle strength was 2.7 points (95% CI -1.4, 6.8). No difference was observed in balance measures. Conclusion: Subjects with chronic incomplete spinal cord injury without baseline walking function were unable to re-establish gait with manually assisted body-weight supported locomotor training. A modest, non-significant, improvement was found in strength and walking speed. However, due to study recruitment problems, an effect size that was smaller than anticipated, and large functional heterogeneity among study subjects, the effect of late-onset body-weight supported locomotor training is not clear. Future studies should include larger numbers of subjects with less functional loss and greater functional homogeneity. Intensive training should probably start earlier post-injury.

No abstract

Background:Studies of physical therapy and multidisciplinary rehabilitation programs for Huntington’s disease (HD) have shown improvements in gait function, balance, and physical quality of life. There is a gap in the literature on effects of cognitive interventions and the potential to improve cognitive performance.Objective:To assess changes in cognitive performance among patients with early to middle stage HD as secondary analyses from a one-year multidisciplinary rehabilitation program. The program included cognitive stimulation as a non-specific cognitive intervention in addition to physical interventions.Methods:A one-year rehabilitation program that included comprehensive neuropsychological assessments was completed by 31 out 37 participants with early to middle stages of HD. Socio-demographic and clinical information was recorded. A battery of neuropsychological tests was used to measure cognitive functions before and after the intervention. Descriptive statistics was used for sample characteristics. Paired sample t-tests and nonparametric Wilcoxon Signed ranked tests were used to compare cognitive measures at both time points.Results:Scores on the Symbol Digit Modalities Test (SDMT) were significantly lower post intervention. There were no significant differences in all other measures. Scores on the Stroop color naming and California Verbal Learning Test-II (CVLT-II) long-term delayed recall tasks showed tendencies towards lower scores post intervention.Conclusions:An intensive multidisciplinary rehabilitation program for patients with HD was generally well tolerated and feasible, with no indication of negative effects on cognition. Neuropsychological measures overall remained stable following an intensive multidisciplinary rehabilitation program, however continued progression of cognitive impairment was evident on the SDMT, suggesting that disease progression is not halted. Randomized controlled trials are needed to verify these findings.

BackgroundPersons with Huntington's disease (HD) may benefit from intensive rehabilitation.AimTo assess effects of an intensive, multidisciplinary rehabilitation programme in subjects with early to mid-stage HD.Methods37 subjects completed a 1-year rehabilitation programme at two in-patient rehabilitation centres. The programme consisted of three stays, three weeks each, and a 5-day evaluation stay. Focus was on daily physical exercise, social activities and teaching sessions. Baseline characteristics: Mean age: 52.4 years; 51.4% women; mean TFC: 8.9; mean UHDRS motor score: 35.6; mean MMSE score: 25.4.ResultsEffects were observed in gait function, from baseline to the evaluation stay: 6 Minute Walk Test (6MWT): +71 m, p<0.01; 10 Meter Walk Test (10MWT):–0.9 s, p<0.01; Timed Up and Go (TUG) test:–1.5 s, p<0.01. A significant proportion of subjects improved or had unchanged walking function respectively; 6MWT 80.7% (25/31) (p=0.001), TUG 80.7% (25/31) (p=0.001) and 10MWT 87.1% (27/31) (p=0.001). Improvement in balance function was observed: Berg balance scale (BBS): +1.1 points, p<0.05; Mean Activity Specific Balance Confidence Scale: +2.3, p=ns. There was no significant improvement in cognitive function as measured by mean change in MMSE score: +0.67 (p

Background Studies suggest that persons with Huntington's disease (HD) benefit from intensive rehabilitation. Aims To assess preliminary results of a multidisciplinary rehabilitation programme on quality of life, cognitive and motor function. Methods 12 patients with early and middle stage (stages I–III of the Shoulson and Fahn Rating Scale) HD underwent a 3 week rehabilitation programme of up to 8 h 5 days per week including cognitive training, speech, physical and occupational therapy, group discussions and lectures on topics such as nutrition. A family member participated during the first week of the programme. Inclusion criteria: mild or moderate grade of HD, age 18+ years, no severe psychiatric illness, none/slight reduction in cognitive function and full/mostly full independence in Active Daily Living functions. Results Mean age was 48 years with an average of 6 years since symptom debut. Mean total functional capacity (TFC) score was 9 (not working and in need of light assistance i ADL function), mean Mini-Mental State Examination indicated a reduced general cognitive function (24 of 30) and mean Hospital Anxiety and Depression Scale score of 9 showed slight depression. Mean on Activity Specific Confidence scale showed 81% confidence to maintain balance in different situations. All subjects showed improvement in gait (6 min walking test (mean change +31.42 m (p=0.03); 10 m walking test (mean change −0.80 s (p=0.02); stand up and go test (mean change −1.24 s (p=0.003)). Bergs Balance Scale showed significant improvement (mean change 2 points, p=0.03). Conclusion A multidisciplinary intensive rehabilitation programme is associated with improved balance and walking function in persons in the early and middle stages of HD.