Rehabilitation and Falls in Huntington's Disease

Abstract

The effectiveness of rehabilitation and the identification of those most likely to benefit are critical questions in Huntington’s Disease (HD).

This is particularly important for those at risk of falls given its impact on quality of life. The literature review showed that falls are linked to gait and balance impairment which begin in the pre-manifest stage and worsen with disease progression. Rehabilitation was shown to improve functional outcomes, with a retrospective clinical audit of 124 participants demonstrating median gain of 8 (p<0.001) in the Functional Independence Measure (FIM) and 7 (p<0.001) in FIM motor sub scores. Those with moderate admission FIM scores demonstrated greatest improvement, with a median gain of 15. Further exploration of the relationship between FIM scores and clinical and biomechanical characteristics was conducted in a prospective cohort of 63 rehabilitation participants. It showed that individuals with lower FIM scores performed worse across cognitive, motor, and biomechanical gait measures; however, there were no significant between-group differences in the proportion of fallers. Rehabilitation outcomes were predicted with AUC 0.70 (95% CI: 0.65-0.75) with a model that included FIM motor, Stroop Word Reading Test (SWRT), Timed Up and Go and Montreal Cognitive Assessment. New fallers were predicted with AUC 0.79 (95%CI = 0.73-0.84) with a model that included United Huntington Disease Rating Scale Total Motor Score (UHDRS-TMS), finger tap speed on UHDRS-TMS, Symbol Digit Modality Test and SWRT. These findings show that rehabilitation improves functional outcomes in people with HD. Furthermore, motor and cognitive measures can help predict both those who may benefit from rehabilitation and those at risk of becoming fallers, who may benefit from early intervention.