Postural control in children with hemophilia

Abstract

Introduction: Sensory information from visual, vestibular, and proprioceptive systems are necessary to control posture and balance. Impairment in proprioception due to repetitive joint bleedings may lead to a deficit in postural balance, which, in turn, leads to high joint stress and risk of bleeding recurrence. Despite the increase of attention in this field during the last years, there is still scarce data on how these bleeds can affect postural control of children with hemophilia (CWH) without arthropathy. Objectives: To evaluate postural balance under different sensory conditions in CWH. Methods: Twenty children with hemophilia (HG) and 20 age-paired children (CG) were recruited to this study. A force plate was used to record centre of pressure displacement (COP) under four different postural sensorial conditions during quiet standing: (cond1) eyes-open on firm surface, (cond2) eyes open on foam surface, (cond3) eyes-closed on firm surface, and (cond4) eyes-closed on foam surface. Variables of COP as sway area, velocity (VM), and the root mean square (RMS) and in anterior-posterior (x) medio-lateral (y) direction were processed, and for each variable quotients of vision (cond2/cond1), proprioception (cond3/cond1), and vestibular(cond4/cond1) were calculated and compared between groups. Results: No differences were found in visual and vestibular quotients variables between groups. Higher value was found in sway area variable on proprioception quotient in HG when compared with CG (P= 0,042). Conclusion: CHW without gross joint damage showed a difference in postural balance when compared with non-hemophiliac children. Contribution: The identification of early balance impairments in CWH can help us to understand better the effects of bleeds inside joints on postural control and plan a more effective rehabilitation treatment.