Occupational Therapy for Huntington's Disease

The provided report focuses on the use of occupational therapy to improve balance and reduce the risk of falls in individuals with Huntington's disease. It also explores the potential benefits of using medication such as Amantadine, Levetiracetam (Keppra), and Clonazepam (Klonopin) alongside occupational therapy. The report suggests that occupational therapy can be effective in reducing the symptoms of Huntington's disease and improving functional abilities. References to relevant literature are also provided.

Assessment

Table of Contents
INTRODUCTION...........................................................................................................................1
SEGMENT 1....................................................................................................................................1
SEGMENT 2....................................................................................................................................2
SEGMENT 3....................................................................................................................................4
CONCLUSION................................................................................................................................5
REFERENCES................................................................................................................................7

INTRODUCTION
Huntington's disease refers to a progressive of a brain disorder that is responsible for
causing uncontrolled movements emotional problems and loss of thinking ability. It can be
considered as an inherited disease that causes the progressive breakdown i.e. degeneration of
nerve cells in brain (Johnstone & Facn, 2019). However, it is observed that this health problem
has a broad impact on overall functional abilities of an individual and generally results into
movement, thinking (cognitive) and psychiatric disorders. Initially, movement disorders signs
consist involuntary jerking or writhing movements (chorea), muscle issues including rigidity or
muscle contraction (dystonia), slow or abnormal eye movements, impaired gait, posture &
balance and difficulty with physical production of speech or swallowing. Secondly, cognitive
disorders involves symptoms like difficulty organising, priority or focussing in tasks, lack of
flexibility, impulse control & awareness of own abilities and slowness of processing thoughts.
Thirdly, psychiatric disorders consist several symptoms like feeling irritability, social
withdrawal, insomnia, fatigue & loss of energy and frequent thoughts of death, dying or suicide.
There are number of early sign & symptoms which are observed in a person due to presence of
Huntington's disease such as depression, irritability, small involuntary movements, poor
coordination and trouble in learning new information or making proper decisions. The present
report is based on the given case scenario about a patient named Alejandro Diego Rodriguez (Al)
having age of 48 years. He has a problem of Huntington's disease due to which he become
aggressive many times and forget things. This assignment will focus on condition of given
patient to discuss in different segments.
SEGMENT 1
With the help of analysing case of given patients, it has been evaluated that he has 170cm
of height and weight 87 kg including past medical history of osteoarthritis which was managed
by heart packs and paracetamol PRN (Buchan, & et. al. 2015). It is essential to make an In
context of given case study, Alejandro Diego Rodriguez has been undergone medical check
which results into different outcomes.
Subjective – The given patients give wrong answers to several questions which facilitate
analyse bout his symptoms of forgetfulness. It consist the wrong information provided to
registered nurse by Alejandro Diego Rodriguez because of lost of memory. However, it has been
1

analysed that the patient is facing some problem of related to brain and then it is required to
determine overall issue to provide correct medications.
Objective – This involves to carrying out overall desired pathological tests in order to
determine actual health problems and its cause for addressing the same. It involves 36.7 °C
temperature, 65 bpm pulse which is strong & regular, respiration rate of 18 breathes per minute,
147/89 blood pressure and pain scale of 2/10 – Hx osteoarthritis. Meanwhile, nursing staff
prefers to conduct a bunch of tests of Alejandro Diego Rodriguez including MRI to ensure about
appropriate problem and cause of it.
Assessment – The assessment consist situation of selected patients is more than mood
swings according to statement of his daughter Jane. It has been assessed that he become
aggressive many times and accuses family members for hiding things from him along with
remaining depressed and state that it would be better to dead (Ojo, 2015). Moreover, it is also
determined that Alejandro Diego Rodriguez stay in messy room as he did not know to use things
and kept the same.
Plan – The early stage of Huntington's disease from which given patients is suffering is
required to be treated in more effective as well as efficient way. It includes to provide speech
therapy in order to conduct proper management of behavioural problems of an individual,
developing coping strategies, manage expectations during progression of the disease. However, it
also consist the utilisation of Xenazine (tetrabenazine) to treat problem of chorea and other
antipsychotics as well.
Implementation – The speech therapy can be carrying out twice a day which is helpful
to Alejandro Diego Rodriguez for improving his behaviour and actual medical situation. It
involves medication of Xenazine (tetrabenazine) once in a day in respect of reducing an issue of
chorea which has been faced by an individuals due to presence of Huntington's disease.
Evaluation – It has been evaluated that the carried out speech therapy impacts positively
earlier but not benefit much. However, the medication of Xenazine (tetrabenazine) is very
effective in order to reduce chorea in context of given case in stage 1.
SEGMENT 2
The intermediate stage of Huntington's disease can be described as a situation when
medical condition become little bit critical than initial stage. In context of this stage of
Huntington's disease from which Alejandro Diego Rodriguez is suffering become more worsen.
2

However, it has been analysed that he become aggressive outburst and argumentative with his
daughter, Jane. She states that he become extreme aggressive while calling him and it is very
difficult to redirect him (O'brien, 2017). In addition to this, it is observed that his gait is very
unsteady with marked chorea and dystonia.
Subjective – This involves observation of nurse that Alejandro Diego Rodriguez appears
wary and not recognise them. When nursing assistant introduced themselves to him then he
replied that he know then and his all speech is slurred and hesitant. However, it has been
analysed by views of Jane that patient makes sign of cross to a picture of Mary on the wall.
Moreover, he denies that about his fall as he did not remember for the same and he is a practising
catholic. Additionally, it is determined that Alejandro Diego Rodriguez refuses to use a medical
alert assist buzzer or forgets to wear it which create difficulty for him and Jane.
Objective – This can be described as to information gathered by carrying out proper
check of selected patient with intermediate stage of Huntington's disease. Meanwhile, it includes
temperature of 36.5 °C, pulse rate is determined to be 60 bpm which is regular and respiratory
rate is around 19 breathes per minute accordingly. Moreover, it involves 152/90 blood pressure
and pain scale 4/10 i.e. Hx osteoarthritis including recovering from a fall. He has height of 170
cm and 79 kg of weight while checked up.
Assessment – The assessment consist the analysis of overall situation of Alejandro
Diego Rodriguez which consist a level of worst symptoms as the aggressive behaviour of
patients become more complicated. However, it involves the opinion of patient about his
daughter the she want to kill him and become argumentative when she calls for something.
Additionally, he did prefer to utilise medical alert assist buzzer or forgets to wear the same (Kim,
2015). The selected has also faced a feel recently which he did not remember at all.
Plan – This involves to carrying out physical therapy fort welfare of given patient in
which physical therapist used to teach safe and appropriate exercises which are helpful to boost
up strength, flexibility, balance and coordination. However, it also consist the criteria of using
antipsychotic drug like Haldol (haloperidol) in order to treat the chorea by providing dose twice
a day on regular basis.
Implementation – The plan of action implemented in more appropriate way by
considering desired therapy and medication. However, the physical therapy is conducted twice in
a day which facilitate to improve actual situation of given patient in proper manner. Moreover,
3

the Haldol medication is also provided to him twice in a day to improve condition of chorea
appropriately.
Evaluation – It has been evaluated that physical therapy is helpful for Alejandro Diego
Rodriguez in order to improve his balance to reduce risk of falls and boost up coordination as
well. However, the Haldol seems to be effective to reduce the symptom of chorea in condition of
selected person.
SEGMENT 3
The advanced or end stage of Huntington's disease can be described as extreme critical
situation of an individual which can be considered as much difficult to be sort out (Rawlins & et.
al., 2016). It includes the observation of nursing assistant including crackling (rales) and
wheezing (rhonchi) in both lungs at the time of auscultation. In addition to this, the symptoms of
given patient become worst due to which his condition is not much stable.
Subjective – The subjective information regarding end stage of Huntington's disease
which has been faced by Alejandro Diego Rodriguez consist hospitalised situation of him.
However, it involves that condition of patient in which he get nutrition with the help of
percutaneous endoscopic gastrostomy feeding tube (PEG). In addition to this, the respiratory
sounds like rales and rhonchi are observed which facilitate to understand the extreme level of
complications in his medical situation. Meanwhile, rales refers to small clicking, bubbling or
rattling sounds in lungs whereas rhonchi consist low pitched & rattling sounds of lungs.
Objective – This involves information collected by conduct proper check of an
individual including temperature, pulse, heart rate etc. In context of given case scenario, it has
been analysed that temperature is 37.8 °C, pulse rate is 55 bpm which is considered as irregular
and respiration rate is 21 breathes per minute that is shallow & pt working. Moreover, the pin
scale consist pt is not capable to verbalised including family voice concerns of pt pain (Crotti &
Glass, 2015).
Assessment – Alejandro Diego Rodriguez is suffering from the Huntington's disease. In
this disease, his temperature is at 37.8 °C and it is higher. The pulse rate is irregular and its speed
rate is 55bpm. The respiration of Alejandro Diego Rodriguez is 21 breaths per minute- shallow
and pt working. The normal blood pressure rate is 120/80 and the blood pressure of Alejandro
Diego Rodriguez is 175/95, which is higher than the normal blood pressure. At this scale, body
pain is more. In this, Pt unable to verbalise- family voice that concern of pt pain.
4

Plan – In order to mange Al's health it is required for service provider to plan a effective
medication practices that assist in providing desired results easily. To procure Alejandro Diego
Rodriguez from the advance stage of Huntington's disease, it is required to implement procedure
therapy and medication that aid in providing step by step treatment to services user by on-going
care. On the basis of these practices, services provide information to patient about the plan that
they needs to follow through a wide range of treatment options that are existentially available for
them. It is usually an intensive practice at the outset of therapy practices in order to reducing
over time symptoms of particular disease (Carroll & et. al. 2015). Along with this, some of
medication that can be given are : Amantadine, levetiracetam (Keppra, others) and clonazepam
(Klonopin). At high doses, amantadine can worsen the cognitive effects of Huntington's disease.
It may also cause leg swelling and skin discoloration. Since the condition of Al is severe, it will
be required to give high doses in specified time frame whenever it is required to keep the body
normal.
Implementation – Occupational therapy is being given to three times to Al so that
percentage of Huntington's disease could be reduced. Along with this, it will be required to
diminish the cognitive effects through giving doses of Amantadine, levetiracetam (Keppra,
others) and clonazepam (Klonopin).
Evaluation - It has been evaluated that occupational therapy will be much more helpful
for Alejandro Diego Rodriguez in order to improve his balance to reduce risk of falls and boost
up coordination as well. On the other hand, Levetiracetam (Keppra), Amantadine, and
clonazepam (Klonopin) Haldol seems to be effective to reduce the percentage of high falls due to
Huntington's disease.
CONCLUSION
With the help of above mentioned report, it is being concluded that different range of
theories like procedure, therapy and medication need to be developed for overcome from arisen
issues. The operational therapy is better to prevent Huntington's disease. It is Allied health
profession performed through occupational Therapy Assistant and therapists. This kind of
therapy is required to be uses for intervention and assessment to create, recover and maintain
meaningful activities. On the other hand, occupational therapist can help Alejandro Diego
Rodriguez with Huntington’s disease on use of the assistive devices which help in improve the
functional abilities. The occupational therapy may consists, assistive devices for the activities
5

like dressing and bathing, handrails at home and drinking and eating utensils, which adapted for
people with the limited better motor skills. Therefore, all of the medication and therapies given
to Al, has helped in reducing the chances of body to become much more severe.
6

REFERENCES
Books and Journals
Johnstone, M. J., & Facn, P. B. R. (2019). Bioethics: a nursing perspective. Elsevier.
Buchan, J., & et. al. (2015). Policies to sustain the nursing workforce: an international
perspective. International nursing review. 62(2). 162-170.
Ojo, O. (2015). The challenges of home enteral tube feeding: a global
perspective. Nutrients. 7(4). 2524-2538.
O'brien, M. E. (2017). Spirituality in nursing. Jones & Bartlett Learning.
Kim, H. S. (2015). The essence of nursing practice: Philosophy and perspective. Springer
Publishing Company.
Rawlins, M. D., & et. al., (2016). The prevalence of Huntington's
disease. Neuroepidemiology. 46(2). 144-153.
Crotti, A., & Glass, C. K. (2015). The choreography of neuroinflammation in Huntington's
disease. Trends in immunology. 36(6). 364-373.
Carroll, J. B., & et. al. (2015). Treating the whole body in Huntington's disease. The Lancet
Neurology. 14(11). 1135-1142.
7