Update of Rehabilitation in Huntington’s Disease: Narrative Review

Exercise capacity and performance

Aerobic and resistance exercises are recommended. A moderate exercise intensity, within 50%–70% of maximal heart rate, paired with upper and lower body strengthening, three times per week for 12 weeks, should be prescribed to improve exercise capacity and performance [9].

Planning and performing of tasks for movement

Patients with HD would present the impairment of motor function in early stage. Task-specific training such as strategy training, sensory stimulation, cueing, and chaining are recommended as an occupational therapy [7, 9].

Mobility, balance, and risk of falls

Task-specific mobility training should be prescribed as individualized gait training with supervision to improve spatiotemporal function [9].

Preventing the secondary musculoskeletal changes and deconditioning

HD would cause secondary musculoskeletal changes owing to the progressive motor symptoms. Patient education, maintenance exercise program, and gait and balance training are needed to prevent the secondary musculoskeletal changes and deconditioning [9, 21].

Cognitive training

Multidisciplinary rehabilitation approaches show positive effects on the preservation of striatal shape, particularly the putamen, on cognitive domains such as verbal learning, memory, attention, cognitive flexibility, processing speed, and social cognition [22].

Psychological management

Multimodal daycare rehabilitation shows significant effects on both anxiety and depression [16].

Planning and performing of tasks for movement

In middle stage of HD, patients would aggravate the impairment of movement such as apraxia, chorea and bradykinesia. Task-specific therapy such as strategy training, sensory stimulation, cueing, chaining, and occupational therapy are recommended [7, 9].

Postural control, alignment in sitting mobility, balance, and risk of falls

Task-specific rehabilitation approaches such as fall risk assessment, proper positioning for mobility, seating and wheelchair evaluation, balance and gait training should be prescribed for supervised gait training to improve spatiotemporal abilities. In addition, patients with mid-stage HD may be prescribed, at a moderate frequency and intensity, individualized exercises to improve balance function [9].

Adapting the secondary musculoskeletal changes and deconditioning

Education for the patient and caregiver is needed for maintaining the exercise program and gait and balance training to adapt secondary musculoskeletal changes and follow deconditioning [9.19].

Respiratory exercises

Functional respiratory exercises should be prescribed such as positioning, breathing exercises, airway clearance methods, and respiratory muscle relaxation techniques [9, 19].

Cognitive training

Multidisciplinary rehabilitation shows a positive effect on the preservation of striatal shape, particularly the putamen, on cognitive domains such as verbal learning and memory, attention, cognitive flexibility, processing speed, and social cognition [22].

Psychological management

Multimodal daycare rehabilitation shows a positive treatment effect on both anxiety and depression [23].

Postural control and alignment in sitting

The risk of falling is markedly increased in the late stage of HD. So, evaluation and prevention strategies should be focused on safety, with fall risk assessments, seating and wheelchair evaluations and proper timed sit positioning [9].

Respiratory exercises

In the late stage, functional respiratory exercises and ADL training should be prescribed: positioning, breathing exercises, airway clearance methods, and respiratory muscle relaxation techniques. The progressive decline in respiratory function may cause severe (even fatal) complications. Therefore, patients with late-stage HD should be trained with regular breathing exercises, such as inspiratory and expiratory breathing training, to enhance respiratory muscle strength and coughing function [9, 21].

Physical exercise to prevent complications in patients with severely impaired mobility

Physical exercise to prevent complications in patients with severe impaired mobility at late-stage HD is essential. Patients should be prescribed with bed positioning, passive range of motion, and active movement exercises [9].

However, some interventions may not be fully supported by evidence regarding the late stage of HD. Nevertheless, those interventions should be considered based on the patient’s condition.

Interventions for consideration in late stage of HD

Each step of rehabilitation management based on the stage of the disease is shown in Table 1.

Table 1
Rehabilitation management strategies according to the stage of Huntington’s disease

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