The broad overall aim is to maintain function and independence.
For example, the ability to:
Transfer with or without assistance.
Walk with minimal assistance.
Maintain some degree of hand function in order to encourage independence (e.g., dressing, toilet, feeding) for as long as possible.
Try and save themselves if or when they fall, i.e., the reinforcement of equilibrium reactions and protective extension.
The specific aims are to:
Assess initially and at regular six-month follow-ups.
Maintain and/or improve lung function.
Teach relaxation techniques.
Maintain full range of movement and prevent long-term contractures.
Maintain/strengthen muscle groups as needed.
Reinforce and/or improve equilibrium and righting reactions.
Facilitate normal movement patterns.
Improve gait pattern – to keep patient mobile for as long as possible.
Reinforce and/or maintain perceptual skills.
Maintain/improve balance and postural control.
Assist with healing pressure areas if necessary.
Maintain some hand function for which head control, symmetry, eye/hand co-ordination, the ability to grasp and release, and sitting balance are all necessary.
General Rehabilitation Treatment Programme
The most comprehensive treatment programme is undertaken with persons in the early stage of HD. Work is done on an individual basis and in small groups which offer the opportunity for the socialisation, support and stimulation which may be lacking in the outside community where many may feel and be isolated.
Individual Muscle Re-education
Rolling, bridging prone on elbows, four foot kneeling, crawling, kneel standing, etc.
Using compression, elastic bands, tapping, rhythmic stabilisations, resistance, etc.
During these activities, rotation, strengthening of weak muscle groups, balance, equilibrium and righting reactions, as well as maintenance of function and independence, are emphasized (e.g., teaching the patient to get up from the floor after a fall).
In the more advanced stages of HD, the emphasis is on the basic changes of body position with some passive/assisted active movements where possible.
Balance and Gait Training
Each patient has an individual gait pattern and one or more of a number of techniques may be used in treatment:
Sailor’s gait, canes, etc., to emphasise rotation and normal rhythm and flow.
Clasping of his/her hands together in front or behind body if involuntary movements are upsetting balance.
Practise sidewards and backwards walking for weak hip abductors/extensors – with resistance or assistance.
Compression and emphasis on a ‘heavy’ (stamping) gait pattern.
Transference practice and training. Reduced rotation, perceptual problems and involuntary movements cause problems in this area.
Standing – encouragement of balance reactions and weight bearing.
Even if persons are not ambulant, they are all assisted and encouraged to bear their weight and even walk with maximum assistance. The policy at the Arthur Preston Centre is to keep all patients mobile with or without assistance for as long as possible.
A normal exercise programme is often substituted with general activities for variety and fun (in many ways they fulfill much the same aims as an exercise programme).
Ball games – tunnel ball, cross ball.
Work with hoops.
Table tennis (ping pong).
The treatment program has been directed at attempting to improve:
The following methods/activities are used:
Felt face with removable parts.
Hoops – to reinforce up, down, in, out, through, left, right. Whilst performing this task, the person is encouraged to name the part of the body he/she is using at that time.
Activities – puzzles, stacks, etc.
Important Points in Any Treatment
Skills must be broken up into simple parts.
Repetition of exercise – with verbal reinforcement.
One-to-one supervision if necessary and possible.
Explain reasons behind activities (e.g., hoop work will help with dressing, maze will help with doorways, obstacles, etc.).
Equipment Used in General Rehabilitation Treatment Programme
Weighted cuffs and belts.
Large 120cm diameter exercise ball (for vestibular stimulation).
Octagonal roller 86cm diameter (for strengthening activities and encouraging equilibrium and righting reactions).
Stools – solid, height of chair seat approx. 40cms.
Obstacle course (for balance and perceptual training).
Balls (varying weights).
Stairs (to encourage weight transference and reciprocal leg movement).
Games and puzzles (for hand activities and perceptual training).