Huntington’s Disease Therapy
Huntington’s Disease (HD) therapy is used to treat a rare, inherited brain disorder that involves brain cells (neurons) progressively breaking down and eventually dying. This causes an individual with Huntington’s Disease to have involuntary movements and lose coordination.
People who have Huntington’s Disease often have a progressive decline in their ability to eat, speak, and swallow. Cognitive impairments and psychiatric disorders are also common in those who have Huntington’s disease.
Huntington’s Disease therapy, such as speech therapy is often recommended to those with the condition. Huntington’s Disease therapy can address speech and swallowing difficulties, and the earlier the individual starts receiving Huntingonton’s Disease therapy the better.
There isn’t a known cure for Huntington’s Disease, and symptoms cannot be reversed or slowed down. However, early detection of the disease is important.
Medication and Huntington’s Disease therapy, such as speech therapy, can help individuals with HD to manage some of their symptoms.
Speech therapists working with clients who have Huntington’s Disease should be aware of using the ICD-10 code G10 when documenting and billing services. It’s also important to know the additional codes to use when applicable, such as those for dementia with psychotic disturbance and others.
If you’re a speech-language pathologist working with a client who needs Huntington’s Disease therapy, here’s what you need to know about the characteristics of the disease, important coding guidelines, and recommended speech therapy treatment techniques.
Causes and symptoms of Huntington’s Disease
The cause of Huntington’s Disease is a genetic mutation of a protein known as huntingtin that occurs on chromosome number 4.
This causes excessive repetitions of the building blocks of DNA; cytosine, adenine, and guanine (CAG). This leads to a toxic protein accumulation in the brain, which damages certain neurons.
Blood tests can determine whether someone has the defective gene that causes HD. If an individual has a parent with Huntington’s Disease, he or she has a 50% chance of inheriting the disease.
Symptoms of Huntington’s Disease typically start presenting themselves when the client is in their 30s or 40s, which is referred to as Adult Huntington’s Disease.
In a second, more rare type of HD known as Juvenile Huntington’s Disease, symptoms appear in childhood.
Early signs of Huntington’s Disease typically include:
- Mild clumsiness
- Decreased balance
- Problems with motor movements
- Difficulties with cognition or emotions
- Changes in behavior
- Unusual eye movements
As the disease progresses, individuals with HD can also show the following symptoms:
- Chorea (sudden, unintentional & uncontrollable movements of the facial muscles, arms, and legs)
- Difficulty walking
- Akinesia (rigidity/loss of voluntary muscle movement)
- Dystonia (unusual fixed posture)
- Slurred speech
- Speech difficulties
- Cognitive changes
- Changes in behavior
An early diagnosis of Huntington’s Disease can lead to therapy and medication that can help the individual manage their symptoms.
ICD-10 coding for Huntington’s Disease therapy
Speech therapists working with clients who have a diagnosis of Huntington’s Disease should use the appropriate ICD-10 codes when completing documentation and billing. This can ensure consistency among other professionals and reduce insurance denials for reimbursement of services.
The ICD-10 code for Huntington’s Disease is G10.
These additional codes should be used when applicable to the client with Huntington’s
Dementia without behavioral disturbance
Dementia with behavioral disturbance
Dementia with psychotic disturbance
Dementia with mood disturbance
Dementia with anxiety
Mild neurocognitive disorder due to known physiological condition
Accurate coding on documentation while working with an individual with Huntington’s Disease is crucial for therapists.
Using the appropriate ICD-10 codes helps ensure compliance with HIPAA regulations and payment by Medicare, Medicaid, and private insurance companies. Insurance claims can be denied or delayed If the most accurate ICD-10 code is not used.
Huntington’s Disease therapy and speech
Speech-language pathologists play a critical role in helping individuals with Huntington’s Disease manage symptoms related to speech, cognitive, and swallowing abilities.
Common speech impairments that can be treated using Huntington’s Disease therapy may include:
- Dysarthria: Weakness, paralysis, or incoordination that impairs oral muscle movements, causing speech to be slurred, slow, and hard to understand.
- Dysphagia: Difficulty chewing and swallowing food and liquids. This is caused by the breakdown of automatic coordination of movements for these tasks.
- Cognitive-communication impairments: Progressive declines in verbal and written language skills. Worsening cognitive skills, such as memory and learning difficulties. This includes difficulties learning new information and retrieving information previously learned. Individuals have trouble concentrating on tasks, and impaired judgment.
- Apraxia of speech: Motor speech impairments and inconsistent speech errors are present. This is due to impairments to the brain’s ability to send signals for coordinating oral motor movements for intelligible speech production.
Speech therapy may be most effective when treatment is implemented early after an individual’s diagnosis of Huntington’s Disease. Early detection and intervention give the SLP and client the opportunity to create a treatment plan that anticipates changes in the client’s abilities.
Huntington’s Disease therapy using speech pathology techniques can help a client manage difficulties with speech, language, cognition, and swallowing. A unique treatment approach should be taken due to the progressive nature of the disease.
Respiratory muscle strengthening exercises
Clients with Huntington’s Disease are likely to show respiratory dysfunction. This can result in discoordination between speech and breathing, causing atypical vocal volume and unintelligible speech.
Examples of Huntington’s Disease therapy for speech could include:
- Breathing exercises in speech therapy to target strengthening respiratory muscles. Have the client practice breathing in through their nose and out through their mouth.
- Sustained phonation and pacing exercises to help target the client’s control over respiration and speech.
- Home-based inspiratory and expiratory muscle training (5 sets of 5 repetitions for each) with progressively increased resistance, according to one research study that showed improved pulmonary function.
Articulation and speech intelligibility exercises
An SLP can teach a client with Huntington’s Disease how to use compensatory strategies to improve his or her speech intelligibility. These might include exaggerating mouth movements while speaking, and finding quiet environments/trying to reduce background noise while having conversations.
Due to declines in the client’s voluntary control of lip, tongue, and mouth movements, individuals with HD often have articulation difficulties. Huntington’s Disease Therapy can target practicing sounds that are made in a certain manner. For example, bilabial sounds are made by putting the lips together for sounds such as /m/, /p/, and /b/.
SLPs should keep in mind that due to the progressive nature of Huntington’s Disease, individuals with the disease are not likely to continue improving their articulation skills long term.
Huntington’s Disease therapy can include focusing on swallowing. The SLP will also likely provide recommendations for diet consistency modification. One of the first signs of dysphagia in those with HD is often reduced chewing. Solid food may need to be modified to a moist ground consistency or pureed. Thickened liquids or modifications in what the client drinks from (i.e., open cup, straw) can help those who have difficulty swallowing liquids.
Safe swallow strategies should be taught in swallowing therapy (dysphagia therapy), including:
- Taking small bites
- Drinking small sips
- Chewing food thoroughly
- Swallowing before taking another bite
- Alternating bites of food with sips of liquid
Hearing abilities and auditory comprehension skills typically remain functional in those with HD. However, cognition and expressive language abilities show a progressive decline.
SLPs should focus on functional Huntington’s Disease Therapy goals that can improve the client’s quality of life.
Here are some strategies for helping clients with HD who have learning, memory, and other cognitive deficits:
- Using notes (written or auditory)
- Reviewing and repeating information repetitively
- Limiting sources of information
- Improving time management by allowing extra time to complete tasks, using calendars, and setting alarms
Augmentative and Alternative Communication (AAC)
It is common for clients with HD to eventually become nonverbal. AAC can provide clients with a means of communicating as their verbal speech production progressively declines.
High-tech AAC devices may be an option earlier in the course of the client’s Huntington’s Disease therapy. Speech generating devices (SGDs) can be accessed by touch. If motor impairments impede this, then alternate means of access to devices such as switches or eye gaze can be considered.
Due to visual impairments and motor deficits, low-tech AAC options such as a simple picture board or word board may be the most appropriate for a client with HD. Some may require caregiver assistance for pointing and eliciting yes/no responses from the client.
Family and caregiver involvement in the client’s Huntington’s Disease therapy can be instrumental to improving the client’s quality of life.
SLPs can review compensatory strategies that family members can use when interacting with the individual who has HD, such as:
- Asking simple, yes/no questions
- Speaking slowly
- Using a relaxed approach when interacting with the individual
- Looking for nonverbal cues to determine what the client is trying to communicate
- Facilitating AAC, such as pointing to pictures on low tech boards
A multidisciplinary approach should be used for Huntington’s Disease therapy.
It is important for speech therapists to collaborate with the rest of the client’s care team, which may include the following professionals:
- Occupational Therapist
- Physical Therapist
- Social worker
- Primary care physician
Through a coordinated treatment plan, speech therapists can develop and target treatment goals that are appropriate for the client’s current level of functioning.
For example, the SLP can work with the client’s dietician to modify the client’s diet to a safe consistency for swallowing, while also finding foods that the client still enjoys and is motivated to eat.
One in every 10,000 to 20,000 people in the U.S. has Huntington’s Disease. The disease results in progressive declines in an individual’s speech, cognition, and swallowing abilities. Therefore, Huntington’s Disease Therapy, including speech therapy is an integral part of their care.
Early diagnosis and intervention can help ensure the best outcomes and symptom management for those with HD. Accurate coding using the appropriate ICD-10 codes is important to reduce payment denials from insurance for therapy services.
SLPs working with individuals who have a diagnosis of Huntington’s Disease can utilize TheraPlatform, an EHR, practice management and teletherapy tool built especially for therapists. Consider starting with a free trial of TheraPlatform. No credit card required. Cancel anytime.
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