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Mobility Devices for Huntington’s disease

A range of Assistive Devices (ADs) have been developed to reinforce HD patients’ balance and assist with maneuverability. Patients must work with their physicians and physical therapists to choose from devices such as canes, walkers, rollators, and wheelchairs. Based on the stage of the disease, patients can select devices that provide enough support to prevent injury, but do not create unnecessary restrictions on physical activity. Devices should also compensate for chorea and the cognitive deficits associated with HD.

Note: each image below is a representative image of the type of device described; none of the models have been endorsed by medical professionals. Please consult your doctor when choosing which mobility device is right for you.

Cane
A cane is a single-legged support commonly used for HD patients who need support walking but are still mobile. Canes offer relatively less stability compared to other ADs, but they are unobtrusive. They are more commonly used for early-stage HD because they require greater degrees of motor and cognitive function than other ADs.

Different types of canes can be used to further enhance stability, speed, and maneuverability. These variations include weighted canes and quad canes. Surprisingly, even though weighted canes were predicted to be safer, a study by the the Ohio State College of Medicine found that standard canes and weighted canes perform similarly in terms of patient safety and maneuverability. Quad canes, which have a square base, are a popular alternative to provide more stability.

Types/models

Standard cane

Adjustable offset cane: to accommodate different heights and center the patient’s weight

Quad cane:to provide greater support for balance.

Walker
Walkers are four-legged devices that offer more stability than canes, but are also larger and potentially more cumbersome. Rollator walkers, which have wheels attached to the legs, have been recommended by the HDSA as the safest option for HD patients.

According to one study, four-wheeled walkers maximize safety and maintain the patient’s natural gait pattern. In the study, the front-wheeled walker, which only has two wheels, caused more falls and more difficulty turning as compared to three-wheeled and four-wheeled versions.

Types/models

Standard walker

4-wheel rollator walker: recommended by the HDSA

Wheelchair:
Wheelchairs are reserved for later-stage patients who can no longer walk safely, since decreasing physical activity may harm the patient. The HDSA recommends using a hemi-height wheelchair, which allows patients to propel themselves by pushing off the ground with their feet (63). If necessary, gait belts can be use to transfer patients safely into and out of the wheelchair. Cushion modifications, adjusted seat angles, and seat belts may be used to further ensure safety. When selecting a wheelchair, it is important to remember that overly restricting a patient’s movement can be more unsafe than providing too little support.

Types/models

Standard Wheelchair

Hemi-height wheelchair: for patients to propel with their feet.

For later-stage patients

Carefoam Rollabout chair: used for later-stage patients with extensive side-to-side motion

Broda Wheelechairs: known for comfort and reclining capabilities.

For further research on the effects of assistive devices on gait patterns, please refer to this study.

Sources:

The HDSA provides a number of in-depth resources for caregivers. The two sources below are guides for caregivers and for families, and cover many topics including assistive devices.
http://hdsa.org/wp-content/uploads/2015/04/CaregiverGuide_Mid_Late_StageHD.pdf
http://hdsa.org/wp-content/uploads/2015/03/PhysicalOccupationalTherapy_FamilyGuide.pdf

From Columbia University medical center, an HDSA Center of Excellence, this article is a brief recommendation by a physical therapist for how to approach different types of assistive devices.
http://www.hdny.org/article-assistive_devices.html

This study investigates the safety and benefits of various assistive devices.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3281896/

For more information on Broad wheelchairs, check out:
https://www.brodaseating.com/conditions/?subtab=6

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