Hemophilia children have problems with dynamic balance, falls: Study
Findings could help in planning rehabilitation programs for young patients
Children with hemophilia have problems with dynamic balance — the ability to maintain balance while moving — and an increased risk of falls compared with healthy peers, according to a new study by two researchers in Turkey.
The findings showed, however, that such impairments were not related to joint involvement and did not affect quality of life in this patient population.
The researchers did note that “muscle atrophy was detected in one-third of the children” assessed, and suggested that “the findings from our study may guide the planning of rehabilitation programs for [children with hemophilia].”
Their study, “Evaluation of balance in children with hemophilia and the effect of balance on quality of life,” was published in the journal Gait & Posture.
Investigating if repeated joint bleeds affect dynamic balance
A hallmark sign of hemophilia, a rare disorder marked by impaired blood clotting, is bleeding into the joints, also known as hemarthrosis. Joint bleeds most commonly affect the knees, ankles, hips, shoulders, elbows, and/or wrists, and can cause swelling and stiffness, leading to pain and limited mobility.
Studies have suggested that recurrent joint bleeds can lead to problems with static balance, or the ability to maintain a fixed posture while standing still, in hemophilia patients.
Here, scientists from two institutions in Turkey wondered whether repeated joint bleeds affect dynamic balance, or a person’s ability to keep one’s balance while moving, in children with hemophilia. The duo also questioned whether or not such impairments impact quality of life.
To find out, the team examined 30 boys with hemophilia, ages 7-18. A group of 30 age-matched healthy boys were also included as controls.
Upon examination, joint swelling was the most common finding, occurring in nearly half of the children (46.6%). About 1 in 3 (36.6%) had loss of range of motion or showed signs of muscle wasting (33.3%).
Joint health was assessed using the Gilbert score, also known as the World Federation of Hemophilia Orthopedic Joint Score. Scores ranged from 0 to 12, with higher scores indicating greater joint damage. The mean Gilbert scores were 2.5 in patients at age 7, and higher in the children as they got older. In those ages 8-12, the average score was 3.5, and in those 13-16, it was 4.1. For patients ages 17-18 and becoming adults, the mean score was 3.7.
The Hemophilia Specific Quality of Life Questionnaire, known as Haemo-QoL, was used to assess quality of life. Scores ranged from 0 to 100, with higher scores indicating worse quality of life. Test domains included physical health, feelings, family, friends, sports and school, and treatment.
The mean overall Haemo-QoL score was 25.2, with the family domain having worse scores in younger patients and the sport and school domain being the most impaired in older patients.
“Parents’ restrictive attitudes toward sports, aimed at protecting their children from trauma and falls, contribute to lower quality of life scores in the family and sports/school dimensions,” the researchers wrote.
Hemophilia children found to have higher risk of falls than peers
One test given to the participants, the Biodex Balance System, gauged dynamic balance, and involved limits of stability, dubbed LOS.
For that test, children stood on a platform and were instructed to keep the on-screen cursor in a central position, representing their center of gravity. They were then asked to move the cursor by swaying their bodies forward, backward, left, and right toward eight randomly blinking lights in different directions. After three tests, scores were calculated out of 100, with higher scores indicating better balance.
The test results showed that dynamic balance was impaired in hemophilia patients compared with the controls, as indicated by a statistically significant difference in total LOS scores (40.3 vs. 48.5 points). Scores for backward-moving dynamic balance, both left and right, were particularly affected in hemophilia patients.
In another assessment, the fall risk test, children were instructed to maintain the cursor at the center of the screen while the platform’s mobility progressively increased. Higher scores indicated an increased risk of falling.
This evaluation showed that hemophilia patients also had an increased risk of falls — again with significant differences in test scores compared with the controls (0.8 vs. 0.7 points).
Compared to their nonhemophilic peers, [children with hemophilia] exhibit reduced dynamic balance and an increased risk of falls. … There is no relationship between joint scores and balance test results. Furthermore, balance does not affect quality of life.
Despite these findings, the team found no statistically significant relationships between the total scores on the Gilbert test, the LOS test, the fall risk test, or the Haemo-QoL assessment.
“Compared to their nonhemophilic peers, [children with hemophilia] exhibit reduced dynamic balance and an increased risk of falls,” the researchers wrote. “There is no relationship between joint scores and balance test results. Furthermore, balance does not affect quality of life.”
The team did note that “quality of life was not evaluated in [the] healthy children,” leading the researchers to write that “further studies are needed to compare the quality of life between healthy children and [hemophilia children].”
About the Author
