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February 04, 2020; 94 (5) Views & ReviewsOpen Access

Clinical recommendations to guide physical therapy practice for Huntington disease

View ORCID ProfileLori Quinn, View ORCID ProfileDeb Kegelmeyer, View ORCID ProfileAnne Kloos, View ORCID ProfileAshwini K. Rao, View ORCID ProfileMonica Busse, View ORCID ProfileNora E. Fritz
First published January 6, 2020, DOI: https://doi.org/10.1212/WNL.0000000000008887
Lori Quinn
From the Department of Biobehavioral Sciences (L.Q.), Teachers College, Columbia University, New York, NY; Physical Therapy Division (D.K., A.K.), School of Health and Rehabilitation Sciences, The Ohio State University, Columbus; Program in Physical Therapy (A.K.R.), Department of Rehabilitative and Regenerative Medicine, G.H. Sergievsky Center, Columbia University, New York, NY; Centre for Trials Research (M.B.), College of Biomedical and Life Sciences, Cardiff University, United Kingdom; and Program in Physical Therapy (N.E.F.), Wayne State University, Detroit, MI.
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Deb Kegelmeyer
From the Department of Biobehavioral Sciences (L.Q.), Teachers College, Columbia University, New York, NY; Physical Therapy Division (D.K., A.K.), School of Health and Rehabilitation Sciences, The Ohio State University, Columbus; Program in Physical Therapy (A.K.R.), Department of Rehabilitative and Regenerative Medicine, G.H. Sergievsky Center, Columbia University, New York, NY; Centre for Trials Research (M.B.), College of Biomedical and Life Sciences, Cardiff University, United Kingdom; and Program in Physical Therapy (N.E.F.), Wayne State University, Detroit, MI.
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Anne Kloos
From the Department of Biobehavioral Sciences (L.Q.), Teachers College, Columbia University, New York, NY; Physical Therapy Division (D.K., A.K.), School of Health and Rehabilitation Sciences, The Ohio State University, Columbus; Program in Physical Therapy (A.K.R.), Department of Rehabilitative and Regenerative Medicine, G.H. Sergievsky Center, Columbia University, New York, NY; Centre for Trials Research (M.B.), College of Biomedical and Life Sciences, Cardiff University, United Kingdom; and Program in Physical Therapy (N.E.F.), Wayne State University, Detroit, MI.
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Ashwini K. Rao
From the Department of Biobehavioral Sciences (L.Q.), Teachers College, Columbia University, New York, NY; Physical Therapy Division (D.K., A.K.), School of Health and Rehabilitation Sciences, The Ohio State University, Columbus; Program in Physical Therapy (A.K.R.), Department of Rehabilitative and Regenerative Medicine, G.H. Sergievsky Center, Columbia University, New York, NY; Centre for Trials Research (M.B.), College of Biomedical and Life Sciences, Cardiff University, United Kingdom; and Program in Physical Therapy (N.E.F.), Wayne State University, Detroit, MI.
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Monica Busse
From the Department of Biobehavioral Sciences (L.Q.), Teachers College, Columbia University, New York, NY; Physical Therapy Division (D.K., A.K.), School of Health and Rehabilitation Sciences, The Ohio State University, Columbus; Program in Physical Therapy (A.K.R.), Department of Rehabilitative and Regenerative Medicine, G.H. Sergievsky Center, Columbia University, New York, NY; Centre for Trials Research (M.B.), College of Biomedical and Life Sciences, Cardiff University, United Kingdom; and Program in Physical Therapy (N.E.F.), Wayne State University, Detroit, MI.
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Nora E. Fritz
From the Department of Biobehavioral Sciences (L.Q.), Teachers College, Columbia University, New York, NY; Physical Therapy Division (D.K., A.K.), School of Health and Rehabilitation Sciences, The Ohio State University, Columbus; Program in Physical Therapy (A.K.R.), Department of Rehabilitative and Regenerative Medicine, G.H. Sergievsky Center, Columbia University, New York, NY; Centre for Trials Research (M.B.), College of Biomedical and Life Sciences, Cardiff University, United Kingdom; and Program in Physical Therapy (N.E.F.), Wayne State University, Detroit, MI.
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Clinical recommendations to guide physical therapy practice for Huntington disease
Lori Quinn, Deb Kegelmeyer, Anne Kloos, Ashwini K. Rao, Monica Busse, Nora E. Fritz
Neurology Feb 2020, 94 (5) 217-228; DOI: 10.1212/WNL.0000000000008887

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Abstract

Objective In the past decade, an increasing number of studies have examined the efficacy of physical therapy interventions in people with Huntington disease (HD).

Methods We performed a mixed-methods systematic review using Joanna Briggs Institute (JBI) methodology and included experimental and observational study designs. The search resulted in 23 quantitative studies and 3 qualitative studies from which we extracted data using JBI standardized extraction tools. Results of this review suggested that physical therapy interventions may improve motor impairments and activity limitations in people with HD. Here, we expand on the review findings to provide specific recommendations to guide clinical practice.

Results We recommend the following specific physical therapy interventions for people with HD: aerobic exercise (grade A evidence), alone or in combination with resistance training to improve fitness and motor function, and supervised gait training (grade A evidence) to improve spatiotemporal features of gait. In addition, there is weak (grade B) evidence that exercise training improves balance but does not show a reduction in the frequency of falls; inspiratory and expiratory training improves breathing function and capacity; and training of transfers, getting up from the floor, and providing strategies to caregivers for involvement in physical activity in the midstages of HD may improve performance. There is expert consensus for the use of positioning devices, seating adaptations, and caregiver training in late stages of HD.

Conclusions There is strong evidence to support physical therapy interventions to improve fitness, motor function, and gait in persons with HD.

Glossary

EHDN=
European Huntington Disease Network;
HD=
Huntington disease;
HSG=
Huntington Study Group

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • The Article Processing Charge was funded by the Huntington Study Group and the Griffin Foundation.

  • Received July 17, 2019.
  • Accepted in final form November 8, 2019.
  • Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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