Huntington’s Disease (HD) sometimes called Huntington’s Chorea or just Huntington’s, is a genetic brain disorder that is inherited by a person. The Huntington’s gene is a dominant gene, which means only one parent must carry the gene in order for it to be passed on. The child of a parent who has the Huntington’s gene will have a 50% chance of inheriting the same gene. And 100% of all people who have the Huntington’s gene will eventually show symptoms. The disease is fatal; death is generally due to other health complications and not Huntington’s itself. Death usually occurs 15-20 years after the onset of the symptoms.

Cause of Huntington’s Disease
This is a genetic disorder, which means that each child of a parent who has Huntington’s has a chance of getting it. It occurs equally between males and females and in all races. Symptoms usually occur between 30 and 50 years old, however the disease can appear in children and in senior citizens.  1 out of every 10,000 American’s has Huntington’s Disease.

Signs & Symptoms
The Huntington’s gene causes parts of the brain to progressively die, and as this occurs a person with Huntington’s becomes less able to control physical movements and emotions, and less able to remember events or make decisions.

A familial history of Huntington’s Disease is important for diagnoses. Gene testing, prior to symptoms present, is now also available. While there are significant variations in symptoms and not all patients present with the same symptoms, there is potential for Huntington’s patients to suffer emotional turmoil including depression and anxiety, cognitive impairment and physical deterioration.

During the early stages of the disease the cognitive symptoms are often subtle. The patient may have difficulty organizing routine details, or coping with new situations and as such these activities may become more time consuming. There is often difficulty in recalling information, decision-making and a lack of attention to details. Combined, these symptoms may also lead to and include general irritability. There may be slight physical changes also developing in the early stages, including fidgeting or twitching of the hands and/or feet, changes in handwriting, and difficulty with other daily tasks.

During the intermediate stages of this disease, the symptoms become worse. The physical symptoms gradually develop into more obvious involuntary movements such as jerking and twitching of the head, neck and arms. These movements (known as chorea, thus the name Huntington’s Chorea) interfere with walking, talking and swallowing. During this stage a person with Huntington’s Disease will walk with a stagger and their speech may become slurred.

During the advanced stages of Huntington’s Disease there are generally fewer involuntary movements and more rigidity. Outside care is required as a person is no longer able to communicate, has difficulty swallowing and maintaining weight.

Death usually occurs 15-20 years after the onset of the disease. It is often due to health complications such as choking, heart failure, infection or aspiration pneumonia.

Orthopedic Assessment
Some of the typical orthopedic assessment techniques a massage therapist may use when treating a Huntington’s patient are:

• Postural assessment
• Gait assessment
• Active and passive range of motion testing
• Pulse & Blood Pressure monitoring

Massage Treatment Goals
Therapeutic Massage is palliative care for patients with Huntington’s Disease. Massage therapy may be aimed at reducing sympathetic nervous system firing, which leads to a reduction in physical and emotional stresses. This can help reduce choric movements and spastic musculature as well as create a perception of decreased overall pain. Individual tissues may be assessed and treated to help ease areas of specific tension and/or pain. Postural dysfunction may be assessed and treated with the goal of slowing the progression of the disease – though there is no evidence that states massage therapy slows Huntington’s symptom progression. Quality of life may be enhanced by a regular regime of palliative care techniques, including massage therapy for patients with Huntington’s Disease.

Typical Massage Treatment
While massage treatment for patients with Huntington’s Disease can be incredibly variable and individual depending on the symptoms presenting, some things may be typical. The massage focus may be relaxation based, with the therapist offering a calming, rhythmic session focusing on reducing the sympathetic system firing. General Swedish Massage strokes may be combined with rhythmic kneading and tapotement to help relax tense tissue, increase circulation and reduce overall stress. Deep tissue techniques may be applied to areas of intense tension and stiffness, while the patient is asked to concentrate on deep breathing and relaxation. ROOD’s techniques may be used to help stimulate weakened muscles and sedate hypertoned muscles.

Massage treatment for patients with Huntington’s Disease may be palliative and relaxing.

Massage Contraindications & Precautions
In later stages of this disease communication may be difficult. The therapist must ensure that they have the patients consent to treat prior to treatment. In addition, a Huntington’s patient may be on strong pain-killers and/or anti-inflammatory medications. Health history should be detailed and include a list of medications. Side effects of these medications should be taken into consideration. Co-morbidities may exist with Huntington’s patients and may be contraindicated. Treatment depth and techniques may need to be modified accordingly. A massage therapist may want a doctor’s approval prior to treating the patient.

Typical Suggested Homecare
Diaphragmatic breathing may be recommended, in order to help reduce sympathetic nervous system firing and reduce stress. Active range of motion with the cardinal planes of any joint may also be suggested to help maintain joint and tissue health.