Rhythmic Haptic Cueing Using Wearable Devices as Physiotherapy for Huntington Disease: Case Study

Abstract

Background Huntington disease (HD) is an inherited genetic disorder that results in the death of brain cells. HD symptoms generally start with subtle changes in mood and mental abilities; they then degenerate progressively, ensuing a general lack of coordination and an unsteady gait, ultimately resulting in death. There is currently no cure for HD. Walking cued by an external, usually auditory, rhythm has been shown to steady gait and help with movement coordination in other neurological conditions. More recently, work with other neurological conditions has demonstrated that haptic (ie, tactile) rhythmic cues, as opposed to audio cues, offer similar improvements when walking. An added benefit is that less intrusive, more private cues are delivered by a wearable device that leaves the ears free for conversation, situation awareness, and safety. This paper presents a case study where rhythmic haptic cueing (RHC) was applied to one person with HD. The case study has two elements: the gait data we collected from our wearable devices and the comments we received from a group of highly trained expert physiotherapists and specialists in HD. Objective The objective of this case study was to investigate whether RHC can be applied to improve gait coordination and limb control in people living with HD. While not offering a cure, therapeutic outcomes may delay the onset or severity of symptoms, with the potential to improve and prolong quality of life. Methods The approach adopted for this study includes two elements, one quantitative and one qualitative. The first is a repeated-measures design with three conditions: before haptic rhythm (ie, baseline), with haptic rhythm, and after exposure to haptic rhythm. The second element is an in-depth interview with physiotherapists observing the session. Results In comparison to the baseline, the physiotherapists noted a number of improvements to the participant’s kinematics during her walk with the haptic cues. These improvements continued in the after-cue condition, indicating some lasting effects. The quantitative data obtained support the physiotherapists’ observations. Conclusions The findings from this small case study, with a single participant, suggest that a haptic metronomic rhythm may have immediate, potentially therapeutic benefits for the walking kinematics of people living with HD and warrants further investigation.

Using rhythm for rehabilitation: the acceptability of a novel haptic cueing device in extended stroke rehabilitation

“…Some improvements, in relation to gait asymmetry, over baseline occurred immediately after, rather than during, haptic cueing suggesting some lasting effect (Georgiou, 2018;Georgiou et al, 2020a). Similar immediate benefits for walking were also observed in case study with individuals with Huntington's diseasebenefits which may potentially extend the period of their independent mobility (Georgiou et al, 2020b).…”

“…This research was part of a larger project to improve gait symmetry after stroke and related neurological conditions; findings related to this wider research are explored elsewhere Georgiou et al, 2020aGeorgiou et al, , 2020b. A pragmatic but rigorous approach was selected for the study that is the focus of this paper as we were not aiming to generate theory but more to look at the utility and insights of the Haptic Bracelets for stroke survivors (Cheesboro and Borisoff, 2007).…”

Physical therapy management of middle and late stage of Huntington’s disease

“…Physiotherapy intervention should include motor, mental and breathing exercises in order to achieve best functioning. PNF, dance, music, use of RCH, RAC and aids are effective methods to improve gait and balance and seem to have positive effects in treating the symptoms of the disease [7][8][9][10] . Exercise appears to be beneficial for patients with HD in improving cardiovascular and mitochondrial function and neuroplasticity [1,[11][12][13][14][15] .…”

“…The researchers concluded that PNF is effective and safe in a patient with HD for short-term improvement of gait and balance. In another study, Georgiou et al [8] investigated the effect of a rhythmic haptic cueing (RHC) signal to improve gait coordination. The research included the evaluation of gait before, during and after the intervention while at the same time qualitative characteristics were studied in terms of the feelings of the participants about the treatment through an interview regarding the course of the session.…”

Rhythmic Haptic Cueing for Gait Rehabilitation of People With Hemiparesis: Quantitative Gait Study

“…An approach similar to the one adopted in this study for survivors of hemiparetic stroke and brain injury could be applied to investigate these other conditions. An initial case study with a single participant living with Huntington disease provided some encouraging results [37].…”