An example of an involuntary movement problem is akathisia, or restlessness. This is difficulty maintaining one position, or engaging in constant movement. Another is dystonia, muscle spasms or contractions, typically in the arms, head, or trunk. But the most common involuntary movement problem in Huntington’s is chorea, or jerking or twisting movements.
An example of a voluntary movement problem is bradykinesia, or very slow movement. Another is difficulty controlling the force of movement, which leads to big bursts of movement when a person intends small bursts. This is common in later stages of Huntington’s. Still another problem is a delayed start to movement. There’s also uncoordinated movement. This leads to alterations in rhythmic, repetitive movements, such as walking, chewing, and even breathing.
Physical therapy, also known as physiotherapy, has the potential to improve Huntington’s patients’ quality of life by improving their movement.
What physical therapy can do
Although the exercises recommended for Huntington’s patients train different areas of the body, all aim to prevent falls, promote correct walking and body control, build coordination, and encourage a positive and confident attitude toward the body.
During the early stages of the disease, therapists can teach patients to use exercise to maintain a high energy level. The typical program includes aerobic exercise to improve overall health and fitness, stretching to keep muscles from getting tight, strengthening the muscles that are important to posture and keeping the body steady, and balance exercises.
In the middle stages of the disease, therapists can recommend exercises to improve balance and prevent falls, equipment such as wheeled walkers or wheelchairs to help a person move safely, and ways to make the home safe, such as reducing clutter or slippery surfaces that can cause falls.
To help people in the late stages of Huntington’s be as active as possible, physical therapists can suggest ideas such as using special chairs to help patients eat. They can also teach caregivers how to help a patient get in and out of a bed or car, and how to help them do exercises that keep their muscles loose and promote general well-being.
Studies on the benefits of physical therapy
One survey revealed that only 8 percent of Huntington’s patients had met with a physical therapist. One reason may be that few studies have measured exercise’s effectiveness.
A two-year study dealing with a comprehensive approach to treatment concluded that physical therapy was beneficial. It helped patients maintain their ability to function, plus their movement and cognitive abilities, researchers said. But the study was not conclusive because of lack of control groups and of common standards for measuring movement functioning, scientists said.
In contrast, a study of 12 Huntington’s patients who received physical therapy focusing on posture and walking for six weeks used what scientists considered objective measures to determine movement capabilities. Researchers used a GAITRite mat, which assesses gait, or how a person walks, and a force plate, which measures the force a person lands with when jumping. Other barometers were the Unified Huntington’s Disease Rating Scale Total Motor Score, which measures the severity of movement impairment; the Timed Up & Go test, which assesses the risk of falling; and the Berg Balance Scale, which, as its name implies, assesses balance.
Patients showed significant improvements in GAITRite measures after physical therapy. Improvements were also seen in the Timed Up & Go test and Berg Balance Scale. Force plate measures and total movement scores did not change. The results suggested that physical therapy improves patients’ walking. Researchers called for larger studies using objective measures to confirm the results.
A review of studies about the benefits of physical therapy and exercise suggested they can improve patients’ movement, walking speed, and balance, as well as offer them additional physical and social benefits. The researchers who did the review called for additional studies to confirm its findings.
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