The effects of repetitive haemarthrosis on postural balance in children with haemophilia

Abstract

Sensory information from visual, vestibular and proprioceptive systems is necessary to control posture and balance. Impairment in proprioception due to repetitive joints bleeding may lead to a deficit in postural balance which, in turn, leads to high joint stress and risk of bleeding recurrence. Despite the increase in attention in this field during the past few years, the data concerning to how bleeds can affect postural control in children with haemophilia (CWH) remain scarce. This study aimed to evaluate the postural balance in CWH. Twenty CWH Haemophilia Group (HG) and 20 age-matched children Control Group (CG) were recruited to this study. A force plate was used to record centre of pressure (COP) displacement under four different postural conditions during quiet standing: eyes open on firm surface, eyes open on foam surface, eyes closed on firm surface and eyes closed on a foam surface. Variables of COP as sway area and mean velocity and in anterior-posterior (y) medio-lateral (x) direction were processed and for each variable sensory, quotients were calculated and compared between groups. No differences were found in visual and vestibular quotients variables between groups. A higher value was found in sway area variable on proprioception quotient in the HG when compared with CG (P = 0.042). CWH with repetitive joint bleed on lower limbs showed differences in postural balance when compared with non-haemophiliac children. The identification of early balance impairments in CWH can help us understand better the effects of bleeds inside joints on postural control and plan a more effective preventive and rehabilitative treatment.

Balance evaluation in haemophilic preadolescent patients using Nintendo Wii Balance Board®

“…In a previous study on adult haemophiliacs [23,24], the group with haemophilia had a poorer balance than the control group. In this line, paediatric studies also show impaired balance in children with haemophilia compared to their age-peers [7,13,14].…”

Postural control during a transition task in haemophilic children, adolescents and young adults with haemophilic ankle arthropathy

“…It is reasonable to assume that doing the same in the perspective of the TTJ and STJ haemophilic arthropathy pathophysiological cascade in children and adolescents with haemophiliac may be of clinical, sociologic and economic interest. To our knowledge, only five studies investigated postural control performance in patients with haemophiliac; two in adults and two in children with haemophiliac . The fifth study by Hilberg et al .…”

“…To our knowledge, only five studies investigated postural control performance in patients with haemophiliac; two in adults 7,8 and two in children with haemophiliac. 9,10 The fifth study by Hilberg et al 11 included a haemophilic population with an age range between 16 and 44 years. Comparing the results of these studies is difficult, as there exists considerable methodological variation.…”

Joint bleeding in factor VIII deficient mice causes an acute loss of trabecular bone and calcification of joint soft tissues which is prevented with aggressive factor replacement

“…The potential significance is great because acute changes in the bone can impact whole joint function. There is evidence that chronic exposure of the joints to blood in haemophilia leads to destruction of both cartilage [9,10] and bone [11] resulting in osteoarthritis as well as consequent deficits in postural balance [12] and gait abnormalities [13]. In addition, alterations to the joint tissues may lead to joint instability [14][15][16], which is one of the primary factors for the onset and progression of osteoarthritis in patients with ligament injuries [17].…”