Static postural balance evaluation and an investigation of the relationship with joint health in children with severe haemophilia: a controlled cross‐sectional study

Abstract

Introduction: Recurrent hemarthroses disturbing force/movement control are likely to impair postural balance. Aim: To investigate the possible changes in static postural balance parameters in children with haemophilia (CwH) and to reveal its relationship with Haemophilia Joint Health Score (HJHS). Methods: Twenty-one CwH aged 6-18 who had haemophilic arthropathy in at least one lower limb joint and 21 healthy peers were evaluated by using a force platform. Centre of pressure (CoP) signals were displayed as a map in both anteroposterior direction (APD) and mediolateral direction (MLD) by statokinesigram. Accordingly, the amplitude, velocity and standard deviation of CoP displacements along with the perimeter and ellipse area were measured. Assessments were made under eyes opened and eyes closed in bipedal stance for 60 s. Joint health and muscle strength were evaluated with HJHS and digital dynamometer, respectively. Results: Velocity and amplitude of CoP displacements in MLD were increased in CwH (p˂0.05). It was also found that these parameters were moderate correlated with the clinical score of the lower limb joints (p˂0.05). In CwH, standard deviation of CoP displacements in the APD was significantly higher in eyes closed, while standard deviation in MLD was significantly higher in eyes opened (p˂0.05). Conclusion: Disturbances during bipedal stance reveal the need for balance evaluation in CwH. Increased mediolateral oscillations may be an early sign of disorders of the musculoskeletal system in CwH. In addition to improving joint health, postural balance exercises that increase MLD stability have to be included in the rehabilitation programme of CwH.

Postural Assessment Systems in the Prevention of Haemophilic Arthropathy: A Narrative Review

“…Increased mediolateral oscillations may be an early sign of musculoskeletal system disorders. The relationship between balance parameters and the clinical score of the lower limb joints suggests that static postural balance can improve by diagnosing balance disorders at an early age and by maintaining joint health through physiotherapeutic approaches [24].…”

“…In mature articulation, haemophilia has an important harmful effect on articular cartilage. As it progressively worsens, the joint function deteriorates [24]. All these conditions predispose the patient to defects in gait and load distribution.…”

“…For the postural assessment of haemophilia patients, in addition to the specific Haemophilia Joint Health Score (HJHS) [22] questionnaire, the same postural assessment tools for healthy people are often taken into consideration, including Gait Analysis [23], stabilometric examination [24], and baropodometric examination [25].…”

Hemophilic Arthropathy in Children: Pathophysiology, Diagnosis and Management

“…Aspiration of the joints in patients with higher degree of arthropathy is not indicated because of the benefits thought to be taken by this method is very limited. Today, the mostly accepted modality of management for the acute hemarthrosis in hemophilic patients includes; early factor replacement if possible, joint aspiration, splinting of the extremity to reduce the recurrent bleedings, E a r l y A c c e s s ice applications and cyclooxygenase-2 inhibitors to relieve pain in selected cases (37,38).…”