Objective: Identify the Evidence based Physicaltherapy available for HD and provide recommendations to physicians  

Background: In Huntington’s Disease (HD) Chorea is usually presented in any phase of disease and other motor impairments appears dystonia and hypokinesia and rigidity and increase the dependence level. Even with the ideal medical and surgical treatment, HD patients still present problems with functional activities, gait and balance. Physicaltherapy is often prescribe for this propose

Methods: We reviewed the literature 2000 to 2016 for pertinent evidence using Grading of Recomendations Assessment, Development and Evaluation Process and include randomized clinical trial, patient series and expert opinion

Results: The Main goals of physicaltherapy targeted on HD, were divided on 4 different stages. Pre-Manifest – Support for maintenance of an independent exercise program. No evidence to treatment. Early stage The motor functions should be assessed by a physical therapist.  There were a few protocols of exercises addressed to people with HD. They suggest some strategies to training gait, balance, functional activities and multi-sensory stimulation. Aerobic exercises are recommended in a frequency of 3-5/week, intensity of 65-85%. Exergaming, Yoga, Pilates, taichi and relaxation are also suggested. The benefits of regular physical activity for people with HD are widely recognized. Mid stage – facilitate independence (in activities of daily life and optimize participation in family, work, leisure) by education and specific advice on safety and risk management, modification of activities or environments, or the provision of assistive devices or wheelchairs. As the disease progresses, physiotherapy is frequently directed toward maintaining or retraining the reach to grasp movement, bed mobility, transfers, and walking. The prescription of gait aids may be useful for people with HD but the difficulty if chorea isn’t severe. Late stages Assistance to complete. Maintain Postural adjustments, mobility and prevention contractures; as well to teach the person how to clear sputum and cough effectively. Caregivers should be trained to assist airway clearance techniques such as deep breathing, postural positioning and supported coughing are used.

Conclusions: The efficacy of physiotherapy, randomized control studies in the published for HD is few, but there is evidence that exercise may be useful in specific impairments in each stage 

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MDS Abstracts - https://www.mdsabstracts.org/abstract/evidence-based-brazilian-physicaltherapy-guideline-for-huntingtons-disease/