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A classification system to guide physical therapy management in Huntington’s disease: a case series

Fritz, Nora, Busse-Morris, Monica, Jones, Karen, Khalil, Hanan and Quinn, Lori 2017. A classification system to guide physical therapy management in Huntington’s disease: a case series. Journal of Neurologic Physical Therapy 41 (3) , pp. 156-163. 10.1097/NPT.0000000000000188

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Abstract

Background and Purpose: Individuals with Huntington’s disease (HD), a rare neurological disease, experience impairments in mobility and cognition throughout their disease course. The Medical Research Council Framework (MRC) provides a framework that can be applied to the development and evaluation of complex interventions, such as those provided by physical therapists. Treatment-based classifications, based on expert consensus and available literature are helpful in guiding physical therapy management across the stages of HD and contributing to the development and further evaluation of well-defined complex interventions in this highly variable and complex neurodegenerative disease. The purpose of this case series was to illustrate the use of these classifications in the management of two individuals with late-stage HD. Case Description: Two females, ages 40 and 55, with late-stage HD participated in this study. Both experienced progressive declines in ambulatory function and balance as well as falls or fear of falling. Both individuals received daily care in the home for ADLs. Intervention: Physical Therapy Treatment based classifications for HD guided the interventions and outcomes. Eight weeks of in-home balance training, strength training, task-specific practice of functional activities including transfers and walking tasks, and family/carer education was provided. Outcomes: Both individuals demonstrated improvements that met or exceeded the established minimal detectible change (MDC) values for gait speed and Timed Up and Go performance. Both also demonstrated improvements on Berg Balance Scale and Physical Performance Test performance, with one of the two exceeding the established MDCs for both tests. Reductions in fall risk were evident in both cases. Discussion: These cases provide proof-of-principle to support usage of Treatment Based Classifications for physical therapy management for individuals with HD. Traditional classification of early-, mid-, and late-stage disease progression may not reflect patients’ true capabilities; those with late-stage HD may be as responsive to interventions as those at an earlier disease stage.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Healthcare Sciences
Medicine
Subjects: R Medicine > R Medicine (General)
Uncontrolled Keywords: Huntington’s disease, gait, balance, falls, mobility; case series
Publisher: Lippincott Williams
ISSN: 1557-0576
Date of First Compliant Deposit: 27 January 2017
Date of Acceptance: 18 January 2017
Last Modified: 26 May 2019 21:23
URI: http://orca.cf.ac.uk/id/eprint/97799

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