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Thesis

The neuromuscular effects of unilateral ankle hemarthroses in males with hemophilia

1 May 1995

Abstract

Background, Purpose, and Hypotheses. Recurrent hemarthroses, bleeding into joints, are a major complication of hemophilia. The purpose of this research was to study how ankle hemarthroses affect neuromuscular function. Specifically, it was hypothesized that, in persons with hemophilia and unilateral ankle hemarthroses, the involved ankle would have the following characteristics when compared to the uninolved ankle: an increase in single limb postural sway or a decrease in duration of single limb stance; a decrease in proprioceptive sensation; no change in superficial sensation as measured by two-point discrimination and by detection threshold. Subjects. Four subjects, aged 7-30, were obtained from the Oregon Hemophilia Center. Each subject had an involved ankle which had experienced at least twice as many ankle hemarthroses as the uninvolved ankle. Methods. Each subject was tested once to obtain the following data bilaterally: number of ankle joint bleeds, radiologically determined severity of arthropathy, total active ankle range of motion, proprioceptive and superficial sensation at the ankle, unilateral stance duration and postural sway, and strength (endurance) of the ankle muscles. Data from the involved and uninvolved sides were compared using a paired one-tailed t-test. Results. A decrease in total active range of motion (plantarflexion and dorsiflexion) and a decrease in total dorsiflexion work over 25 seconds were found. The talocrural joint of th einvolved ankle was found to have more severe arthropathy than the uninvolved ankle. No such distinction was seen at the subtalar joint. No differences were found in proprioception, superficial sensation, total plantarflexion work, or single limb stance duration or posutral sway. Conclusion and Discussion. The four subjects showed decreased active range of motion (AROM) and decreased dorsiflexor work on the more involved ankle. Even though no differences were found between ankles during single limb postural sway and duration, interesting trends were noted when the influence of vision was removed. Subjects had great difficulty standing on their more involved ankle with their eyes closed. We feel physical therapy to address the areas of ankle ROM, strength, and balance training is an important part of medical intervention for males with hemophilia.


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