Mobility and Seating

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Mobility and Seating

From Nursing Care In Late Stage Huntington Disease

As Huntington's Disease is also a movement disorder there becomes changes in mobility that begins that begins in early and middle stages of the illness and continues into late stages.

Some of the noticeable physical changes in mobility is the wide - based dance - like gait, giving uneven weight bearing. This type of gait is related to hyper - extension at the hips which results in a more swaying gait and gives high risk chance to falling backwards, though there can also be flexation at the hips which rapidly causes accelerated walking in which the client is unable to control and gives increased risk of falling forwards.

Persons with Huntington's have a decrease in arm swing, have difficulty initiating walking and moving sideways and backwards is often difficult. Surprisingly, many people whose gait is so severely effected that they appear to be a danger to themselves and others have an amazing capacity to recover their balance when necessary, and some may function better if they walk alone, rather than with assistance. This does not mean that they do not need assistance or someone supervising their walking as they may still actually fall.

Some have difficulty judging distances and in differences in appearances and texture of floor surfaces, which may make them hostile going through doorways or moving between furniture.

This is where acceptable risk needs to be taken into consideration in order to help the person with Huntington's maintain their independence. It is important for caregivers, the client, their families and the doctor discuss the risks of allowing the person with Huntington's Disease to continue walking.

Even though there is such a high risk for them falling and getting hurt, not allowing them to mobilize will actually hurt them more by taking away their feelings of independence, thus taking away a part of their. It also increases their lose of muscle tone.

Persons with Huntington's Disease already know the progression of the disease will eventually take away their freedom of mobility but we as caregivers do not need to take it away too soon. A person with Huntington's Disease hangs onto their ability to walk as once they lose it, they know their disease is progressing to a more later stage.

As long as a person with Huntington's can walk unassisted or assisted we should allow them to do so. This needs to be discussed with everyone involved especially when a caregiver fears that if their client falls and injures themself they will be in a situation of a lawsuit. Acceptable risk is allowing the client to do something that you know is a high risk activity.

As the disease progresses the movements worsen and the person with Huntington's Disease will not only have more and more difficulty ambulating but also more difficulty sitting in a regular chair, even to the point of with the movements throwing themselves out of a chair or falling out.

A regular wheelchair or gerichair in late stages are not quite appropriate for persons with Huntington's as they need chairs with padding and angled seating such as a Broda semi reclining chair, which can be wheeled about and is fully padded to prevent injury.

The angled and padded chairs such as a Broda chair and Q- foam chairs are especially adopted for persons with Huntington's Disease and often reduce the need for other restraints, as using restraints on a person with Huntington's can cause more injury due to their increased chorea movements. This does not mean that no types of restraints can be used, seat belts are usually all that would keep a person in their chair.

Ensure all restraints are padded and used properly and as minimally as possible. Do not try to restrict all their movements as with the movement disorder when a person with Huntington's becomes stressed or anxious the movements worsen and if restraints are restricting any chorea movements your client can actually sustain an injury.

So minimize restraints as much as possible, they should be used only for safety not for difficult behavior or trying to control difficult behavior.

The angling of the Broda and Q-foam chairs is also a very helpful tool for the positioning of your client, as when positioned properly and comfortably, a person with Huntington's can be more relaxed, thus have a decrease in movements.

The padding and angling of the chair also aids in decreasing the chance of pressure sores, especially on the hips, buttocks and coccyx, as in these chairs the pressure is taken off these areas.

With the progression of Huntington's Disease and movements which eventually decrease mobility to a point where a person with Huntington's is at too high of a risk to walk anymore. This is the point in the disease when the person with Huntington's becomes more and more dependant on others for total care.

They will need assistance with positioning while in bed, assistance up to the bathroom, commode or to use the bed pan, assistance with transfer from their bed to a chair, increased assistance with personal care and eating.

This does not mean that they just go into bed and stay there, it is important to still get a person with Huntington's up in a comfortable chair and repositioning, just because they are unable to do most things for themselves does not mean we give up on them and leave them in bed all the time.

They will need help more then ever with doing their range of motion exercises and positioning to prevent and contractures. Your client will need more assistance overall and it is important to have someone help them that they can depend on and feel confident in.

Broda Chair

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Some Tips To Prevent Falls

Do not call out to a client from behind, which would cause them to turn around abruptly and possibly loose their balance

Do not interrupt a person abruptly

Do not give medications while they are standing and do not try to feed them standing up

Do not step in to try to prevent client from " bouncing off the wall " this could actually cause them to fall

Proper footwear is very important, in the later stages high top sneakers or light weight workboots are more likely to be helpful

Most common places for falls are in front of a chair, a toilet and/or a bed

Try " touch-turn-sit " strategy

Orient client to their surroundings and teach about any peculiarities of any of the equipment in their surroundings

Encourage your client not to get up or do transfers without someone present

Environmental Changes to

Prevent Falls

Stabilize the furniture so it can not move

Use chairs with armrests and high backs

Clear away any unused furniture, providing clear accessible paths

Remove any throw rugs and thick carpeting

Rearrange tables and lamps away from most frequently used paths

Place padding on frequent bumped furniture and doorways and/or have them rounded off

It is estimated that a person with Huntington's Disease needs twice the space than that of an average individual, thus it is important for no clutter and free of hazards

Side rails on a hospital bed

Tub rails and tub seats

Raised toilet seat