Haemophilia and knee function: Are there differences between haemophilic and healthy children?
Kaiser-Karl-Klinik, Abt. Orthopädie, Graurheindorferstr. 137, 53117 Bonn. Hamostaseologie
(Impact Factor: 1.6).
10/2009; 29 Suppl 1:S69-73.
With early prophylactic treatment our haemophilic children grow up in good health. Nevertheless, we cannot prevent every bleeding. Those bleedings may be just subclinical but they could lead to overloading of the knee and more and more of the ankle joint in the long term. Motion analysis can help to understand this process and prevent it. A comparison of the gait function of haemophilic and healthy children of the age 3-18 years showed distinct functional differences especially in the youngest age group (3-6 years). Apparently, the coordination skill gait rhythm was significantly worse in the heamophilic group. All measured functional deficits can be treated with physiotherapy. Possible reasons for these early functional differences are overprotection and/or early subclinical bleedings.
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ABSTRACT: Rehabilitation and physical therapy in the sense of functional health is based on the international classification of function. It takes in two considerations: function and structure of the body and their influence on personal and social activity. The integrative concept of joint function translates the basic concept of body function and structure on to the motion of the locomotive system. Stability needs motoric control. Motoric control and the integrated neural components are to be influenced through regulation of muscle tonus (massage, manual therapy, medical training therapy, electrotherapy and thermotherapy). The stability of the joint is controlled by the passive components. Passive structures are optimised through passive therapies like joint mobilisation. Active components of joint function are optimised through activation (medical training therapy, stabilisation, mono or multisegmental levels). Emotional and neuronal components can be triggered through kinesthetic exercises like PNF, Jacobsen relaxation, biofeedback training, mental training. Exact examination of the locomotive system will help finding all symptoms. This is how we individualise the therapy of symptoms and structures. The motion pattern generator shows us how to use the possibilities of functional influence on the motion pattern. We have a lot of afferent signals that need individualised functional therapy. This is why we need functional measurements like motion analysis on the basis of ultrasound. An other tool is the kinetic superficial EMG measurement of muscle function. We can use it to determine the status of the joint and it will lead to therapeutical decisions. All functional measurements will help to improve quality control of the physical therapy process. Even if the haemophilic patient is healthy he is not fit at all. Measurements of fitness will help us to improve special skills and establish the human being as a subject in society and environment. The main skill to be improved in haemophiliacs is coordination, strength of the stomach muscles and the vastus medialis and the flexibility of the hamstrings.
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ABSTRACT: It is not the blood alone! Increased loading destroys cartilage and leads to arthrosis. Reduced mechanical stimulation leads to reduced cartilage nutrition and to cartilage degeneration, which leads to arthrosis. We know about the existence of functional disturbances that occur in early childhood before any structural changes are diagnosed. This is typical for haemophilia. Those disturbances and the way movement is disturbed has a strong influence on the loading of cartilage. This involves acceleration peaks, disturbed load distribution with reduction of contact area and a change of vector direction, which leads to increased cartilage loading. The disturbed function can be analysed very early with motion analysis. Easy physiotherapeutical interventions are able to optimise function again. On top of that we have a loss of muscle contraction pattern. Around the knee joint it is the weakening of the vastus medialis and the shortening of the knee flexors. The ankle joint suffers from a weakening of the tibialis anterior and a shortening of the calf muscles. During progression of the disease there will be a shortening of the weakened muscle and a weakening of the shortened muscle as well. Kinetic superficial EMG is able to quantify the status of the muscles and enables us to prescribe an individual therapy. Subclinical influences like microbleeds, in the beginning silent synovitis, later chronic synovitis, silent symptoms and overprotection are the cause of the functional overloading of the cartilage in patient with haemophilia. Silent symptoms can be discovered by clinical examination. Again this leads to the opportunity of a symptomatic therapeutic approach. All those facts could be the reason why there is an increasing incidence of haemarthrophathy of the ankle joint, even in patients with mild haemophilia in spite of adequate factor substitution.
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