Hemophilia is a disease that requires appropriate therapy. An important element is rehabilitation. What are the general principles of rehabilitation in a person with hemophilia? What exercises should he do? These and other questions are answered by MSc. Janusz Zawilski, physiotherapist from the Interlab Diagnostic and Treatment Center in Poznań.
Hemophiliais a disease that requires appropriate therapy. A very important element of it isrehabilitation . Haemophilia develops repeated haemorrhages. The result is synovial hypertrophy, damage to the cartilage that covers the surfaces of the bones of the joint, and further degenerative changes in the bones that make up the joints. These changes lead to progressive dysfunction of the joint, making it difficult for the patient to perform daily activities. The aim of rehabilitation of patients with hemophilia is to restore their physical fitness and restore the ability to work - argues MSc. Janusz Zawilski, physiotherapist from the Interlab Diagnostic and Treatment Center in Poznań.
Thanks to advances in medicine, people with severe hemophilia - a rare blood disorder - can now lead an active life. They can, however, provided that their systematic treatment is accompanied by appropriate rehabilitation. What is it?
On adjusting appropriate exercises to the patient's he alth. Exercise should accompany rehabilitation in hemophilia. Their type and degree of motor advancement, i.e. activity, depends on the therapeutic goal that we want to achieve. The physiotherapist and the treatment team must clearly define this goal. The point is for our patient to be physically fit, maintaining the proper body weight. It depends on many factors. The most important of these are: properly conducted treatment and a properly implemented exercise program. Today's medicine is able to "control" hemophilia, improving the quality of life of patients. When preparing an exercise program, we must first of all determine the nature of rehabilitation: whether it is prophylactic or preparation for surgery, or it is to be recovery after surgery. Together with the doctors: hematologist and orthopedist, we determine the type and scope of exercises.
Hemophilia mainly destroys the bone and joint system. Blood strokes tojoints cause damage to them. In such cases, exercise can be an extra chore?
Yes, it may or may not. The inefficiency of a large group of patients is the result of improper treatment. Years ago, there was no wider access to blood coagulation factors. Therefore, the vast majority of elderly haemophiliac patients have developed damage to the musculoskeletal system. Currently, children with the most severe form of hemophilia are covered by the so-called prophylactic treatment, i.e. regularly two or three times a week, administer the missing coagulation factor intravenously so that joint bleeding does not occur at all or very rarely. If the lack of blood clotting is not controlled, then each subsequent bleeding into the joints and muscles causes them to be damaged. Most often, damage and degradation occur in the knee, ankle and elbow joints as well as in the muscles of the forearm, calf and thigh. Their effect is a progressive limitation of joint mobility, joint pain and scarring of the muscles reducing their strength, flexibility and circumference. Such a patient stops walking and thus functions normally in society. Proper rehabilitation in such cases is a must. Exercise supports the muscles, which makes them more flexible, stronger, and improves their coordination. As a result, there is faster recovery after bleeding, the number of haemorrhages is reduced, and there are fewer complications.
Coming back to hemophilia. This rare blood disease, if properly managed, allows for a long, relatively active life. Does this activity need to be controlled taking into account the need for exercise?
Yes. Movement exercises are selected individually, adapting them to the patient's he alth and needs. The opinions of the therapeutic team are also taken into account. The gradation and intensity of exercises must take into account the patient's condition and well-being. We start the exercises smoothly, without sudden movements and without load. It is good to remember that the best measure of load is the weight of your own limb. Pain should not be allowed to occur. Exercise can only be started after administration of the deficient coagulation factor concentrate. Movement therapy must take place regularly and under constant control. That is why we provide our patients with sets of exercises addressed to each individual. We try to practice them with them under our control, and then monitor their performance, checking how they also exercise at home.
The clinic where you work is located in Poznań. How do you rate the availability of such specialized forms of rehabilitation in Poland?
Undoubtedlycould be better. Although there are not many patients with hemophilia in Poland, their rehabilitation is not satisfactory everywhere, taking into account the technical possibilities of treatment with movement. A project was created to solve these problems by establishing reference centers, grouping a well-prepared, interdisciplinary medical team, modern laboratories and properly equipped physiotherapy offices. The project envisaged that such centers would start operating from 2013 onwards. Unfortunately, it ended with the project. We do not fully use the possibilities offered by modern medicine.
Source: Medicinaria, 3rd edition, "Hemophilia - a rare blood disease", June 2015. Organizer: "Journalists for He alth" Association