Content area
Full text
Abstract
Rehabilitation of persons with haemophilia includes all measures aimed at reducing the impact of disabling and handicapping conditions and enabling the disabled and handicapped persons with haemophilia to achieve social integration. The role of the physiotherapist in the management of patients with haemophilia has progressed rapidly in keeping with the improvements made with blood products in the developed world.
Keywords: haemophilia, arthopathy, rehabilitation
Haemophilia is an inherited X-linked chronic disease, which's clinical and functional consequences can be extremely serious in the absence of replacement therapy with clotting factors.
Repeated bleedings in joints and muscles lead to major functional impairments, with impact on daily activities and quality of life.
The most common bleeding occur in knees, elbows, ankles and rare in the hip joints, shoulders or wrists. Muscle bleeding is mostly found in the iliopsoas muscles, gastrocnemius and flexors of the forearm. (10-30% of total bleeding) (1.2)
According to clotting factor level, haemophilia is classified in three grades including bleeding risk and haemarthrosis (table 1) (3)
Physiotherapy and kinetotherapy, within an individualized rehabilitation program play an important and well established place in the treatment management of haemophilic patient.
The role of rehabilitation medicine is to diagnose, assess and treat functional disabilities. Also, rehabilitation treatment has the role of maintaining the highest degree of functional capacity and independence of haemophilic patients.
Physiotherapy, kinetotherapy together with clotting factors replacement therapy has revolutionized the management of these patients reducing morbidity and mortality.
The development of haemophilic arthropathy occurs in three stages:
1. Acute hemarthrosis
2. Chronic synovitis
3. Degenerative arthritis
Haemophilic arthropathy pathogenesis is multifactorial, including synovial, bone, cartilage and blood vessels changes. Recurrent bleeding leads to end-stage degeneration (haemophilic arthropathy) with high pain and movement limitation while the solution is surgery. (4) (Figure 1-2)
There is a general consensus that prophylaxis with clotting factor replacement at an early age is the best way to prevent and / or reduce the bleeding risk and thus haemophilic arthropathy (5-10).
The immobilization of painful joint and rest are used for short periods as necessary, but long term use can lead to movement limitation and muscle atrophy (11). Rehabilitation treatment is therefore essential for maintaining joint mobility and muscle tone.
Decreased pain and inflammation. Diathermy is unanimously accepted as...