Proprioception and isometric muscular strength in haemophilic subjects

Abstract

Haemophilia is characterized by intra-articular bleeding, often requiring immobilization, which may result in muscle atrophy and impaired proprioception. The aim of the study was to investigate differences in proprioceptive performance and isometric muscular strength of the lower limbs in haemophilic subjects compared with control subjects. Twelve subjects with severe haemophilia (11 haemophilia A; one haemophilia B) vs. 12 control subjects were matched for anthropometric data and tested for differences of proprioception (one-leg-stand, posturomed, angle-reproduction, and tuning fork tests) and isometric strength (leg press, knee extensor). The static proprioceptive performance of the haemophilic group, as measured by the one-leg-stand test (on hard or soft ground, with open or closed eyes; P < 0.05) was demonstrably impaired (by 41-363%). In contrast, the dynamic proprioceptive performance measured by the posturomed test did not show any difference between the groups. The local proprioceptive performance (angle-reproduction test) of the knee, (the most commonly affected joint in haemophiliacs) showed a trend to impaired function but was not distinctly different from that of controls. The quantitative sensory function (tuning fork) showed significant (P < 0.05) impairment of 9-10% in the haemophilic subjects. Additionally, the isometric muscular strength of the leg extensor was weaker (32-38%) in the haemophilic group when the limbs were tested individually as well as bilaterally (P < 0.05). In conclusion, the results suggest that global proprioceptive performance is impaired and that the isometric strength of the leg extensors is weaker in the haemophilic subjects. Therefore, specialized training for global proprioception would be helpful in order to compensate for proprioceptive deficits. This exercise regimen should also include safe strength-training for an optimal stabilization of the joints, but must be adapted to the individual needs and situations of the haemophilic subjects.p

Effectiveness of Physiotherapy in the Treatment of Hemophilic Arthropathy a Systematic Review

“…The literature discloses clinical studies in which, when administering physiotherapy interventions, the frequency of bleeding was reduced [29,30]. In this regard, although only three studies clearly indicate that none of the patients suffered bleeding episodes [20,22,23], the remaining studies report no bleeding complications.…”

Comparison of supervised physiotherapy program verses convensional exercises in the management of hemarthrosis in haemophilic patients

“…Since it is the most commonly affected joint in children. The bleeding may often require immobilization of the affected limb to reduce bleeding and pain which leads to loss in quadriceps strength and muscle atrophy 20 . Initially there is loss of extension leading to a knee flexion contracture followed by a posterior subluxation of the tibia with external rotation and valgus deformity 21 .Such patients may become severely handicapped.…”

“…J S Kale 20 Conclude that regular exercise regimes may not be followed by all patients on a day-today basis at the hospital clinic due to difficulties of traveling. Training patients and parents for home exercise schedules is important.…”

Comprehensive elements of a physiotherapy exercise programme in haemophilia – a global perspective

“…The resulting damage to the joint can lead to deficits in proprioception [64,70,71]. It is widely recognized that the benefits of exercise modulation that apply to the general population also apply to the haemophilic patient [64,72,73].…”

“…This process is also common in haemophilia [67,71,78]. The gradual decline in muscle strength and size has been attributed to an impairment of the central nervous system, the arthrogenous muscle inhibition [75] or reflex atrophy [79,80].…”