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

Abstract

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.

A Classification System to Guide Physical Therapy Management in Huntington Disease: A Case Series

“…Studies in HD animal models suggest that exercise improves motor function, 6 delays the progression of cognitive dysfunction, 6 and provides neuroprotection in the form of delayed disease onset. 7,8 In recent years, several small scale feasibility studies have investigated the effects of exercise and physical therapy in HD [9][10][11][12][13][14][15] with improvements observed in dynamic balance, 9,1010,11 gait speed, function and level of physical activity, 10,14 fitness, 13 cognitive function, 16 neuroplasticity, 16 and self-reported quality of life measures. 11,12 These studies included early to mid-stage participants, and although they demonstrated proof-of-concept, were underpowered to establish efficacy.…”

Clinical recommendations to guide physical therapy practice for Huntington disease

“…The initial search yielded 2,377 records that ultimately resulted in 18 quantitative articles and 2 qualitative included articles [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] ; a flowchart is available in our published systematic review. 5 The updated search included 5 additional quantitative articles [31][32][33][34][35] and 1 additional qualitative article, 36 resulting in a total of 23 quantitative and 3 qualitative studies reviewed.…”

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. [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. [19][20][21] Preliminary, uncontrolled trials on inpatient multidisciplinary therapy have reported positive effects on physical function, mood and quality of life.…”