Team Approach Toward Hemophilia Management

ANTHONY D. DENSON, GETHA PANDIAN, M.D., MELANIE LUCIDO, R.P.T., AND RICHARD NEIDER, C.O.


Since the advent of factor replacement therapy, the management of children with hemophilia has been relegated to parents and home treatment. Their chief complaint has been the number of joint bleeds that occur from the child's daily activity. The hemophilia team at Children's Medical Center of Dallas developed the hypothesis that the use of articulated ankle foot orthoses and knee ankle foot orthoses, in tandem with factor replacement therapy, would significantly reduce the number of joint bleeds that occur in the primary target joints of the ankle and the knee. Twelve cases were chosen from CMC's hemophilia clinic records which offered a 24 month history; twelve months without orthotic intervention and twelve months in which orthotic intervention was added to the factor replacement therapy. Prior to orthotic intervention, the group exhibited an average of 4 joint bleeds per month. After use of orthoses there were no joint bleeds for the last twelve months. The ability to decrease the number of joint bleeds interrupts the debilitating destruction of articular surfaces and can significantly extend the amount of independence that a person with hemophilia sincerely wishes to enjoy. By following a team approach to hemophilia management, the goal of extended independence can be reached.

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