Infrared Thermography as a Non-Invasive Tool to Explore Differences in the Musculoskeletal System of Children with Hemophilia Compared to an Age-Matched Healthy Group

Recurrent joint bleeds and silent bleeds are the most common clinical feature in patients with hemophilia. Every bleed causes an immediate inflammatory response and is the leading cause of chronic crippling arthropathy. With the help of infrared thermography we wanted to detect early differences between a group of clinical non-symptomatic children with hemophilia (CWH) with no history of clinically detected joint bleeds and a healthy age-matched group of children. This could help to discover early inflammation and help implement early treatment and preventative strategies. It could be demonstrated that infrared thermography is sensitive enough to detect more signs of early inflammatory response in the CWH than in healthy children. It seems to detect more side differences in temperature than clinical examination of silent symptoms detects tender points. Silent symptoms/tender points seem to be combined with early local inflammation. Using such a non-invasive and sensor-based early detection, prevention of overloading and bleeding might be achieved

Standardized Ultrasonography (HEAD-US) of Joints and First Correlation with Function in Haemophilic Arthropathy: Results of a Clinical Trial and Potential Importance of Joint-Ultrasound for an Individualized Prophylaxis in Haemophiliacs

Abstract Background: Sonography is applied in patients with bleeding disorders. By ultrasonography the extent of synovitis is detected as a sign of the activity of an existing hemophilic arthropathy, as a sign of progression are defects of articular cartilage and bony structures quantifiable. In 2013 an easy-to-use standardized ultrasound protocol (HEAD-US) for examination of early joint changes in Hemophilic Arthropathy was published. Correlation between functional and structural changes in Haemophilic Arthropathy was not published before. Aims: The sonographic quantification of the arthropathy by haemophilia-treaters could be the basis for better individualized haemophilia therapy in young patients. Methods: For this purpose, highly reproducible sonographic standard section planes and an examiner-independent ultrasound score (HEAD -US) were published by C. Martinoli in 2013. After a preliminary study of 27 patients now we have included 177 young german patients (children and young adults) with haemophilia A, haemophilia B or von-Willebrand- disease from different German hemophilia treatment centers in the HaemarthroSonoPilot study (DRKS00004483). After informed consent sonography of the elbow, knee and ankle joints with a Zonare " z.one ultra " ultrasound device (Linear probe L14 -5w ) was performed. Simultaneously an orthopedic clinical examination with clinical scoring and 3D motion analysis of the lower limbs for detecting early function defects were performed with an ultrasonic topometer (developed by the University of Bonn, Germany). Results: Already in the previous investigation of the pilot study on a small cohort yielded promising results depending on age. The investigations in the presented pilot study showed correlation of the sonographic diagnostics with the measurement of a clinical orthopedic examination in haemophilic arthropathy. Through the joint sonography changes were even partially already seen before that stood out in the clinical investigation. Conclusion: It may be useful if haemophilia treaters in future apply this method to individualize the therapy under close control and evaluation of joint changes. Disclosures Sigl-Kraetzig: Pfizer Deutschland GmbH: Research Funding. Bauerfeindt:Pfizer Deutschland GmbH: Honoraria, Research Funding. Seuser:BAXALTA Deutschland GmbH: Honoraria, Research Funding. </jats:sec

Handwriting Analysis in Children and Adolescents with Hemophilia: A Pilot Study

Background: Handwriting is a complex task that requires the integrity of different sensorimotor components to be performed successfully. Patients with hemophilia suffer from recurrent joint bleeds that may occur in the elbow, causing elbow dysfunction with handwriting performance impairment. In our study, we described instrumental dysgraphia that is related to functional disturbances. This pilot study aims to evaluate the handwriting performance in a group of patients with hemophilia. Methods: The study was performed at the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center in Milan. Boys with severe and moderate hemophilia A and B regularly followed-up at that Center, with age between 6&ndash;19 years, were eligible. Patients were invited to the Center for one multidisciplinary evaluation of the upper limbs that included: Clinical examination, surface electromyography, and handwriting assessment. Results: All patients, but one, completed handwriting assessment. Overall, 14/19 (74%) had abnormal handwriting, which was overt instrumental dysgraphia in six (32%). There was no difference in Hemophilia Joint Health Score (HJHS) between dysgraphic and non-dysgraphic boys, while surface electromyography (sEMG) revealed a prevalence of flexor muscles of the upper limb in dysgraphic as compared with non-dysgraphic boys. Conclusions: The rather high prevalence of instrumental dysgraphia found in this pilot study deserves a further development of this preliminary experience by increasing the number of examined patients and comparing them with a control group, including quality of life and psychological assessment

Handwriting Analysis in Children and Adolescents with Hemophilia: A Pilot Study

Background: Handwriting is a complex task that requires the integrity of different sensorimotor components to be performed successfully. Patients with hemophilia suffer from recurrent joint bleeds that may occur in the elbow, causing elbow dysfunction with handwriting performance impairment. In our study, we described instrumental dysgraphia that is related to functional disturbances. This pilot study aims to evaluate the handwriting performance in a group of patients with hemophilia. Methods: The study was performed at the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center in Milan. Boys with severe and moderate hemophilia A and B regularly followed-up at that Center, with age between 6–19 years, were eligible. Patients were invited to the Center for one multidisciplinary evaluation of the upper limbs that included: Clinical examination, surface electromyography, and handwriting assessment. Results: All patients, but one, completed handwriting assessment. Overall, 14/19 (74%) had abnormal handwriting, which was overt instrumental dysgraphia in six (32%). There was no difference in Hemophilia Joint Health Score (HJHS) between dysgraphic and non-dysgraphic boys, while surface electromyography (sEMG) revealed a prevalence of flexor muscles of the upper limb in dysgraphic as compared with non-dysgraphic boys. Conclusions: The rather high prevalence of instrumental dysgraphia found in this pilot study deserves a further development of this preliminary experience by increasing the number of examined patients and comparing them with a control group, including quality of life and psychological assessment.</jats:p

Establishing an online physical exercise program for people with hemophilia

Summary Background Hemophilia is a congenital bleeding disorder with an estimated frequency of 1:10,000 births. Repeated joint bleeding is a hallmark of the disorder and leads to painful hemophilic arthropathy. Regular exercise can help improve joint stability and function, reduce the risk of injury and bleeding and improve physical fitness and quality of life. This method paper describes an online training concept aiming to offer access to appropriate exercise instructions for people with hemophilia who are not able to attend regular training at a hemophilia center. Methods The online exercise program is accessible through the homepage of the Department of Physical Medicine, Rehabilitation and Occupational Medicine of the Medical University Vienna as well as through scanning a QR code printed on information material using a smart phone or tablet. Results The program contains exercises to improve mobility, coordination, muscular strength and flexibility. A brief introduction is given by a hematologist, a pediatrician and a physiatrist. An introductory video informs about contraindications and essential precautions, such as medical attendance and sufficient factor therapy to consider before starting the training. Another video gives advice on the exercise composition. The demonstrated exercises are explained by a physician and are available for adults and children. To individualize training recommendations and offer further diagnostic tools and physical treatment options as necessary, the Department of Physical Medicine, Rehabilitation and Occupational Medicine of the Medical University of Vienna will establish consultation hours for people with hemophilia. Conclusion As hemophilia is an orphan disease, patients are mainly treated in specialized centers. For patients who live far from these centers or have limited access to a training there for other reasons, the physical medicine consultation hour and the implementation of online exercise instructions offer individually adapted exercise information for a regular home-based training to benefit from increased physical fitness and joint stability. </jats:sec

A Systematic Review on the Value of Infrared Thermography in the Early Detection of Periprosthetic Joint Infections

Abstract Background Variations in the temperature of body and skin are symptoms of many pathological changes. Although joint replacement surgery of hip and knee has been very successful in recent decades, periprosthetic infection is a growing problem and the number one reason for revision. While many studies have investigated changes in blood levels, investigation of temperature has not been performed on a regular basis. The objective of this work is to determine whether reference literature exists for the infrared thermographic examination in knee and hip arthroplasty and if reference values can be derived for the methodology or if there is a peri- and postoperative benefit. Material und Methods By means of a systematic online database search and based on the Cochrane, PICOT and PRISMA guidelines, this systematic review retrieved 254 studies. All publications with thermographic examination in arthroplasty of the hip and knee were imbedded. 249 studies were excluded due to the defined inclusion and exclusion criteria and five studies with 251 patients have finally been included in the evaluation process. This was followed by an analysis and discussion of the methodology. Results and Conclusion Infrared thermography is a useful tool in the perioperative care of patients after arthroplasty of the knee and hip joint. The technology is portable, easy to use and non-invasive. Based only on these few publications, values can be derived, which provide a guidance for the thermographic aftercare in arthroplasty surgery.</jats:p