Chapter 3-Phsyician's Guide to Management of HD

Movement Disorder

Falls

Falls are common in persons with HD, and can be a source of significant morbidity. Usually seen more in the moderate to advanced stages, they often result from the combination of spasticity, rigidity, chorea, and loss of balance.

Pharmacotherapy to prevent falls could include treatment of chorea, rigidity, spasticity and dystonia, while minimizing the use of drugs such as neuroleptics and benzodiazepines, whose side effects include sedation, ataxia, or parkinsonism.

Most efforts at prevention, however, involve not drugs, but modification of the environment and behavior of the patient.

• Occupational and physical therapists can instruct patients in how to sit, stand, transfer, and walk more safely.
• Installing handrails in key locations, and minimizing the use of stairs can help to reduce falls.
• Some families convert a ground floor office or den into a bedroom.
• Furniture such as tables and desks, particularly items with sharp corners, should be arrayed along the periphery of the room, where they will present less of an obstacle.
• Floors should be carpeted to lessen the impact when falls do occur.
• Patients who fall out of bed may have a mattress placed beside the bed at night, or may sleep on a mattress placed directly on the floor.

HD patients will eventually become unable to walk and will need to be transported in a wheelchair. A weighted and padded chair, perhaps with a wedge to keep the hips tilted, or a pommel between the legs, may minimize the chance of a severely choreic or dystonic patient falling or sliding out, or knocking over the chair (see Appendix 3).

Use of a wheelchair is not an all or nothing proposition. Mobility may be extended by using the wheelchair for longer excursions and using other assistive devices such as a walker for shorter distances, or in the home.

Walkers with front wheels may be particularly useful when rigidity or loss of balance is a problem. Patients who are particularly prone to falls sometimes wear helmets, or elbow and knee pads to minimize injury. Physical therapy may also help by teaching patients how to minimize injury in a fall and how to get up again after a fall.

General Safety Measures

A number of other environmental interventions may reduce the risk of injury.

• Patients who smoke should do so in a room without flammables, such as rugs, curtains and overstuffed furniture.
• Patients may need to stop using sharp knives and to switch to microwave cooking to prevent burns and spills.
• Falls in the bathroom are particularly dangerous, but there are a variety of assistive devices that can be installed.
• Consultation with a visiting nurse, or a visit from a physical or occupational therapist may be very helpful for any mid-stage HD patient being cared for in the home.
• A sample home visit consultation form is provided in Appendix 4.  (not available on line)

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University of Iowa Health Care

Huntington's Disease Center of Excellence
Home Safety

Bathroom Tips Install grab bars in the bathroom and shower stall. Textured strips can be glued onto the bottom of the shower stall or bathtub to improve traction. Toilet seats can be elevated with spacer blocks and handles can be attached either permanently or temporarily around the toilet to give the person something to hold on to. Floor Coverings People who have trouble walking have difficulty making transitions between different floor surfaces. Throw rugs should be avoided. They can bunch up, leaving an obstacle that is easy to trip over. Furniture If the person with HD stumbles frequently, look to see if your furniture is strong enough to help them prevent falling when they reach out to grab it. Table lamps are easily knocked over. Try to move them to the corners of the room. Fire Safety Smoke detectors and carbon monoxide detectors should be installed close to your bedrooms and tested monthly to make certain that they are in working order. In many cities in the US you can place a reflective sticker in the windows of bedrooms where children, elderly, and those with disabilities sleep. These stickers alert firefighters to look for people in those rooms in case of fire. Check with your local fire department before placing them in your windows. Source:  Iowa HD Center of Excellence http://www.uihealthcare.com/depts/huntingtonsdisease/