SPECIAL REHABILITATION PROGRAMMES
Where there is infection – postural drainage with vibrations and percussion, coughing and deep breathing. In the later stages, persons with HD are unable to cough or deep breathe on command and so vibration and percussion often help stimulate a cough.
Breathing exercises – usually incorporated into the general exercise class.
Blowing balloon off the palm of the hand.
Blowing ping pong balls across a table – races, etc.
Blowing a tissue (held by one corner) at different distances from mouth.
Counting, vocalising during expiration.
Encouragement of correct lip positioning during exercises.
General mouth and tongue exercises.
A controlled study was undertaken by physiotherapists at the Arthur Preston Centre in an attempt to evaluate the short-term effects of physiotherapy on the respiratory function of Huntington’s Disease persons. A significant improvement was noted in a number of respiratory function tests in an experimental group of five patients treated with chest physiotherapy over a two-week period. It was also shown in Huntington’s Disease persons that various respiratory functions were reduced when compared with normal values.
It was interesting to note that during this respiratory study persons with Huntington’s Disease who smoked did considerably better in the lung function tests that the non-smokers. They smoked on average 15 to 20 cigarettes a day, inhaling deeply and thus supposedly exercising their chest and lungs. However, to balance this, the only ones who showed signs of chest infection when examined medically were these smokers.
The main problems are:
Difficulty in swallowing
Lack of tongue control
Facial massage, including stretching of facial muscles (direction of stretch is toward the lips).
Voluntary holding of lips together after stretches, while encouraging nose breathing and swallowing. Correct position of head and neck is necessary as extension of the head may result in re-opening of the mouth.
Ice and swipe to sternomastoid muscles and below the cricoid cartilage, particularly before all drinks and meals.
A high staff/patient ratio is necessary (one to one is preferable) for safety as much as for quality of treatment.
The main benefits of hydrotherapy are:
Recreation, fun and enjoyment.
Psychological – can do more in the water than on land, can still ‘swim’ and enjoy water.
Increase or maintenance or range of movement and muscle strength.
Physical contact with water and with helper.
Sensory stimulation and awareness.
A variety of exercises and activities are performed using vertical, prone and supine positions. The water properties of warmth, viscosity and buoyancy aid in relaxation, assistance and resistance during exercises.
Rubber rings and tyres of various sizes.
Bars/rails around edge of pool.
This is a very important part of the treatment programme as it provides many obvious benefits to the Huntington’s Disease person as well as being a most enjoyable experience. Sessions are best conducted individually or in groups with a high staff/patient ratio. General physical relaxation is accompanied by rhythmical massage and, where appropriate, rhythmical passive and/or assisted techniques.
The aims of the relaxation group are to:
Provide an atmosphere which is conductive to relaxation, e.g. rugs and pillows on the floor, subdued lighting, a quiet environment without conversation and an accompaniment of slow, non-obtrusive music.
Reduce both mental and physical tension.
Reduce involuntary movements. (This becomes very obvious as the person with HD relaxes and is often able to sleep).
Improve breathing patterns – a more co-ordinated breathing pattern resulting in greater air entry with less effort (also becomes obvious as the patient relaxes).
Increase body awareness and improve self-image through the tactile sense.
Decrease involuntary movements around the face and tension around the tempero-mandibular joint by facial massage.
Enable the Huntington’s Disease person to gain pure pleasure through the tactile sense rather than experiencing touch only when he/she is dependent on staff for being washed, dressed, showered etc.
Gain fuller joint range through relaxation.
Gain pleasure from being a member of a group (even if active group participation is no longer possible).
Involve volunteers and staff from all areas in a positive and beneficial experience with their Huntington’s Disease residents.
Enable nursing and other staff to see how relaxation can be used at other times for the benefit of persons with Huntington’s Disease, e.g., when having difficulty sleeping or when distressed.
Enhance the sensitivity of both staff and Huntington’s Disease persons to the power of non-verbal communication.
The Physical Aims are to:
Improve body awareness and achieve a realistic body image.
Improve joint flexibility, muscular strength and exercise tolerance.
Improve weight transference and balance.
Improve postural awareness.
Gain muscular relaxation.
Improve gross motor skills such as rolling, crawling and walking.
Increase physical stamina and fitness.
Improve co-ordination and control of movement.
Encourage enjoyment of physical activity.
Improve breathing patterns.
Enhance space perception.
Increase sensory input and awareness to all the senses (kinesthetic, tactile, vestibular, proprioceptive, visual and auditory).
Improve rhythm in movement.
The Emotional and Self-Expressive Aims are to:
Develop greater levels of self-confidence, self-image and self-esteem.
Experience greater feelings of success, accomplishment and achievement in a non-competitive atmosphere.
Become more independent and self-directing.
Assert self as an individual by taking initiative.
Have fun and enjoy participation.
Gain pleasure from expressing self through movement.
The Social Aims are to:
Experience greater degrees of acceptance and belonging as an individual respected by the group.
Experience being a leader or follower.
Increase the capacity to trust others.
Increase awareness of non-verbal communication through the kinesthetic sense and body language.
The Intellectual Aims are to:
Promote imagery skills and verbalisation by constantly reinforcing word with action.
Plan actions and make decisions.
Increase pattern recognition.
Improve understanding of spatial concepts and directions.