Effects of a One Year Intensive Multidisciplinary Rehabilitation Program for Patients with Huntington’s Disease: a Prospective Intervention Study

Abstract

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

Neuroendocrine and neurotrophic signaling in Huntington’s disease: Implications for pathogenic mechanisms and treatment strategies

“…Studies evaluating the utility of multidisciplinary therapy have documented significant changes in grey matter volume, as well as improvements in memory, processing speed, balance and gait, mood and quality of life in patients with manifest HD (144)(145)(146)(147). Recent data from our research programme has shown, in particular, that multidisciplinary therapy increases grey matter volume in the caudate tail and dorsolateral PFC in patients with manifest HD (147).…”

The effects of physiotherapy with PNF concept on gait and balance of patients with Huntington's disease – pilot study

“…So far, none of the mentioned methods has been regarded as a gold standard of gait or balance assessment. The methods of gait and balance assessment applied in this study provide reliable and multidimensional information on gait and balance disturbances [1] and have been previously used in the assessment of a therapeutic interventions on gait or balance [29,30].…”

Effects of multidisciplinary therapy on physical function in Huntington's disease

“…5 There are no proven neuroprotective agents for HD and although symptomatic therapies exist, impairments in physical function continue to develop and worsen as the disease progresses. [13][14][15][16][17][18] Such interventions have the capacity to therapeutically address motor and cognitive aspects of the disease, which has been robustly demonstrated in HD mouse models using environmental enrichment. The effects of multidisciplinary therapy interventions, encompassing both physical and cognitive therapy, have been less well studied in patients with HD.…”

“…The effects of multidisciplinary therapy interventions, encompassing both physical and cognitive therapy, have been less well studied in patients with HD. 15,17,18 Research from our team has additionally shown that outpatient multidisciplinary therapy, a more cost-effective and accessible means of delivering multidisciplinary therapy, increases grey matter volume in the caudate nucleus and dorsolateral prefrontal cortex and improves verbal learning, memory and body composition in patients with HD. [19][20][21] Preliminary, uncontrolled trials on inpatient multidisciplinary therapy have reported positive effects on physical function, mood and quality of life.…”