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Balancing function and independence in Huntington's Disease
Lori Quinn, EdD, PT and Donna
Sukboonlue, SPT
Lori Quinn has been the physical therapist at the HD Center
at Columbia since 1997; Donna Sukboonlue is
a student physical therapist at New York Medical College.
She, along with several fellow classmates, are conducting a community
service project at the HD Center to help develop education materials
for patients and families.
Be sure to ask about these at your next appointment.
People with HD often have problems with walking and balance. This
is due to damage to parts of the brain that control movement and
coordination, specifically the basal ganglia. Walking difficulties
can result from subtle changes in coordination, involuntary movements
and the presence of dystonia (awkward posturing of the body).
Individuals with HD can experience overall fatigue, and difficulty
walking long distances. They may also begin to walk more slowly than
other people. They may begin to lose their balance while walking,
which can lead to accidents or falls. It is important that falls
be prevented, because they can lead to fractures or other injuries
that can compound the problems directly caused by HD.
There are a variety of ways that balance and walking ability can
be helped for people with Huntington's Disease:
- Exercising 3-5x/week is essential. This can include
such simple activities as walking outdoors for 15-20 minutes,
or riding a stationary bike. Exercise classes such as Yoga or Tai
Chi can also be very helpful.
- Eating well and maintaining your weight. It is important
to have adequate nourishment and hydration to fend off fatigue
and even improve motor function.
- Get adequate reset. HD is a very demanding disease,
and a full night of peaceful rest is critically important to
help the body maintain its ability to fight off the disease as
best it can.
- Use adaptive or assistive devices. Assistive devices
can prove to be critically important to help people with HD maintain
their independence as much as possible, while minimizing risk
of injury and limiting fatigue.
Some people are very reluctant to begin using any type of assistive
or adaptive device. In many ways, this is understandable. Some people
may feel as if it is an "acknowledgement" of the progression of the
disease. Others may simply not want to call attention to themselves
while using a cane or wheelchair. Still others may even feel that
if they use a wheelchair, for example, they will become dependent
on it and will not walk any longer. At the HD Center at Columbia
, use of walkers, canes and wheelchairs have enabled people with
HD to continue to walk, shop, take trips and enjoy the important
things in life. Without the use of certain equipment, some people
would begin to be very limited in what they could do. A walker or
cane, for example, may provide just the needed support to allow someone
to shop in the mall with her spouse or children. Just as important,
however, is the safety that this equipment can provide. Walkers and
canes, for example, provide additional support when someone's balance
is impaired.
Below is a listing of some of the types of assistive devices that
are commonly recommended at the HD Center. You may consider use of
some of these devices for you or for a loved one.
Canes
Function : to widen base of support and
improve balance.
Disadvantage : does not provide much stability.
Types of Canes (shown left to right) :
standard cane, standard adjustable cane, offset cane, small base
quad cane, large base quad cane. |
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Walkers
Function : to improve balance, provide
greater stability, and helps to maintain natural walking pattern
Disadvantage : can be cumbersome, cannot
be used safely on stairs, and can be difficult or awkward to maneuver
through some areas.
Modification to standard designs : 4-wheeled
walkers with folding mechanism, hand brakes, seats with back rest,
and basket (to carry personal items)
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Wheelchairs
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Standard Wheelchair |
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The standard wheelchair can be modified with a seat cushion to promote
better sitting posture or padding for the armrests and footrests
to prevent bruising. For proper support during extended seating a
lumbar roll maybe also be beneficial. Below are some examples of
pictures for modifying a wheelchair.
Armchair features
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Seat Cushion |
Armrests |
Footrests |
Most of this equipment can be purchased at a medical equipment supply
store. Small pharmacies will often not carry these items. For those
people who feel like they will need a wheelchair for occasional use,
the standard wheelchair can also be rented from your medical equipment
supply company. If you decide to rent a wheelchair, you should look
for a firm and sturdy cushion (not just a sling bottom). The wheelchair
should also be foldable and lightweight if you plan to take it in
and out of a car.
Summary
Choosing the right kind of wheelchair and seating equipment is a
collaborative process. Balancing independence and safety requires
special consideration for each person's individual needs. Use of
certain devices and equipment, such as those described above, may
provide the necessary support to maximize a person's functional abilities.
And this is certainly an important goal for everyone. We encourage
you to speak further with HD Center's physical therapist, Lori Quinn,
if you have any questions or would like additional information about
any adaptive equipment or assistive devices.
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