Clinical recommendations to guide physical therapy practice for Huntington disease

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.