Background Chorea, rigidity, dystonia and muscle weakness are characteristic defects of Huntington’s disease (HD). These motor defects underlie the gradual loss of function and mobility for people with HD as the disease progresses. Provision of an individualised exercise programme is one of the principal physiotherapy interventions in the management of HD (Zinzi et al2007). Physiotherapy intervention should be tailored to the specific stage of the disease but also the address the specific signs and symptoms that effect functional performance and mobility (Quinn and Busse 2012)

Case histories We currently have six long term care residents: One of whom is in the early stage of the disease, four are in the mid stages and one is in the late stage of HD. Within this cohort, reduced motivation, behavioural problems and cognitive deficits are issues arising to varying degrees. To promote adherence and therapeutic effect, ongoing modification of exercise programmes is necessary. For most residents, the exercise programme is delivered on an individual basis, however some residents are able to attend group based sessions. Therapy settings also vary, e.g. ward based, physiotherapy gym or outdoors, in an attempt to provide the appropriate level of stimulation while suiting functional level. Alteration of exercise frequency, intensity, duration and mode is imperative as HD progresses while frequent review of the resident’s goals helps to enhance their motivation.

Conclusions Exercise regimes need continual progression within the limitations of the individual as Huntington’s disease progresses. This involves alteration of the many variables that underpin an individualised exercise programme.