Introduction

Hemophilia is the blood clotting disorder caused by deficiency of clotting factor in the blood. Some study concluded that Hemophilia is one of hereditary genetic disorders. It can occur to anyone. Hemophilia is more likely to occur in males than females.

Clotting factor is used to stop the bleeding when the blood vessel is broken. The clotting factor will stimulate the blood vessel to constrict when the bleeding happens. The cell will aggregate on each other until they stop the bleeding (PICTURE 1).

The coagulation activity will be impaired when abnormal clotting process occurs (PICTURE 1.).

How Hemophilia Occur?

The coagulation factors needed for a normal clotting process. People with Hemophilia have lower clotting factor level of blood plasma. PICTURE 1 shows the comparison of the blood clotting process among normal and the person with Hemophilia.

Normal person have normal clotting factor level of blood plasma that needed for a normal clotting process.

Example: Bleeding in normal person (PICTURE 1)

Source: genetic-disorder-wiki.wikispaces.com

Factors

There are two types of Hemophilia:

1. Hemophilia A

Hemophilia A (clotting factor VIII deficiency) is the most common forms of the disorder. From the statistic by International Hemophilia Congress of United State, 85% of Hemophilia are from this group.

2. Hemophilia B

Hemophilia B occurs with factor IX deficiency.

Aim of Physiotherapy Management

1. To control the pain and inflammation
2. To maintain available affected and unaffected joint range
3. To increase the affected joint range
4. To strengthen the affected muscle
5. To assist in maximum daily function
6. To prevent deformity
   

Signs & Symptoms

Hemophilia can cause spontaneous and prolong bleeding at any muscle, joint and internal organ. The complication is not only pain but can cause handicap and death.

Complications

• Limitation in daily activity due to pain

• Spontaneous bleeding over the joint
• Inflammation over the joint cartilage that can cause deformity if not treated
• Muscle atrophy (wasting) can cause weakness if not used
• Muscle shortening can cause contracture if not stretched
• Brain bleeding can cause permanently paralyze and mental retardation if not treated early
• Bleeding inside the important muscles of pelvic

Prevention

• Avoid participation in high loading activity eg jumping and contact sports eg soccer, rugby, boxing, jumping, basketball, skating, skiing etc
• Must always be cautious and carefull to prevent any injury in sport
• Low impact activity eg cycling and walking and non contact sports eg bowling, tennis, jogging, snooker, golf, ping pong, darts are advisable

Physiotherapy treatment

1. Acute Phase (bleeding)
   

Example: Support the limb (PICTURE 2)	Example: Splinting (PICTURE 3)
Source: piratstudenterna.se	Source: www2.aofoundation.org

2. Subacute Phase (reduction of pain & inflammation)

Example: Bandaging (PICTURE 4)

Source: painbehindkneetreatment.com

Chronic Phase

Example: Hydrotherapy (PICTURE 5)

Source: www.gosh.nhs.uk

Exercise Prescription:

No	Exercise	Demostration
1	Mobilising Exercise   i Position : Long sitting ii Instruction : Slide the heel downward & upward iii Frequency : 5 repetitions (3 sets)
2	Mobilising Exercise   i Position : Lying (on the stomach) ii Instruction : Bend the knee & slowly lowering it down iii Frequency : 5 repetitions (3 sets)
3	Strengthening Exercise (without resistance bag) i Position : Sitting ii Instruction : Cross the leg & resist the affected leg upward within 10 secs iii Frequency : 5 repetitions (3 sets)
4	Strengthening Exercise (with resistance bag) i Position : Lying (on the back) & affected knee support with a roll towel ii Instruction : Straighten the knee iii Frequency : Hold 5 secs (5 reps) (3 sets)
5	Isometric Exercise i Position : Lying (on the back) ii Instruction : Lift up the ankle & full straighten the knee iii Frequency : Hold 5 secs (5 reps) (3 sets)
6	Balancing Exercise i Position : Standing on the affected leg ii Instruction : Open the eyes & balance the body and can progress to: a)   Close the eyes b)   Soft surface iii Frequency : Hold 30 secs (3 sets)

Example: Exercise Prescription

Source: Jabatan Fisioterapi, Hospital Kuala Lumpur

Reference

1. Care protocol OA Knee oleh Jawatankuasa Teknikal Profesion Fisioterapi, KKM
2. Guidelines in the management of Hemophilia and von willebrand disease, Draft copy Pusat Darah Negara, 2004
   

Source Image

1. Retrieved Jun 3 2015. genetic-disorder-wiki.wikispaces.com
2. Retrieved Jun 3 2015. se
3. Retrieved Jun 3 2015. aofoundation.org
4. Retrieved Jun 3 2015. com
5. Retrieved Jun 3 2015. gosh.nhs.uk
6. (2012) Jabatan Fisioterapi Hospital Kuala Lumpur. Retrieved July 4 2013.