Balance dysfunction in adults with haemophilia

Abstract

The main focus of lower limb physical performance assessment in people with haemophilia (PWH) has usually been on function, muscle strength and joint flexibility. The impact of haemophilic arthropathy on balance and falls risk is relatively under-explored. The aim of this study was to evaluate balance and related performance in PWH compared with age and gender matched healthy controls. It involved a comprehensive suite of clinical and laboratory measures of static and dynamic balance, mobility, strength, physical activity and falls efficacy completed in 20 PWH (mean age 39.4, 100% male) and 20 controls. Fifty percent of PWH reported falls in the past 12 months. Moderate impairment of balance and related measures were identified in PWH compared with the controls, with an average 35% difference between groups. Significant differences were evident between groups on both clinical and laboratory measures, including measures of dynamic bilateral stance balance [limits of stability measures on the laboratory test, functional reach; (P < 0.001); dynamic single leg balance (Step Test, P < 0.001)], gait and mobility (gait speed, step width and turning measures on the laboratory test, timed up and go test; P < 0.001); muscle strength (timed sit to stand, P = 0.002; quadriceps strength, P < 0.001); and activity level and falls efficacy, (P < 0.004). The dynamic clinical and laboratory measures testing similar domains of balance, gait and mobility had moderate correlations (0.310 < r < 0.531, P < 0.01). Moderate impairments in balance, mobility and related measures were identified in PWH, compared with the control group. Clinicians should include assessments of balance and related measures when reviewing adults with haemophilia.

Hemofilia: ejercicio y deporte

“…Actualmente podemos decir que, en general, la condición física del paciente hemofílico adulto es baja, ya que hay estudios que muestran valores inferiores de resistencia aeróbica 49 , fuerza 37,50,51 , propiocepción y equilibrio 50,52,53 , respecto a los encontrados en sus pares sanos.…”

Postural Stability Is Affected in Older Males with Haemophilia—A Matched Control Study

“…Gallach et al [21] compared standing balance in a group of 50 adult PWH and 25 age-matched healthy non-haemophilic men and observed greater amplitude and velocity of postural sway in men with haemophilia during standing. In a study of twenty PWH aged 22-58 years, Fearn et al [22] reported that half of haemophilic men had experienced a fall within the previous 12 months. The underlying cause of the alterations in balance and greater frequency and risk of falling together with how best to identify those at risk of falling are not clear from the studies.…”

Influence of Sensorimotor Training on Balance and Pain Parameters in Children With Hemophilia

“…The chronic characters of hemophilic patients include musculoskeletal pain, muscle imbalance [7], reduced joint range of motion [8], and articular instability [9]. Balance performance is complex and multidimensional, involving not only the ability to maintain a static stance, but also the ability to maintain equilibrium under a range of dynamic conditions [10]. Few of studies have addressed the impact of musculoskeletal disorders in hemophiliacs on balance impairment or fall.…”

“…Results showed that patients with hemophilia displayed a worse balance and proprioception compared with healthy normal subjects [10][11][12][13].Authors hypothesized that because proprioception information is transmitted from receptors found in all tissues of the synovial joint, repeated joint bleeding into the target joint could be a contributory cause of impaired proprioception in patients with hemophilia. As the muscular function comprises not only the static control of the joint and the dynamic control of movement, but also the proprioceptive input to the central nervous system (CNS) .So further possible mechanism induced proprioception deficit in hemophilic patients may be related to the intramuscular bleeding and lower muscle strength [14,15].…”