Hemofilia: ejercicio y deporte

El ejercicio físico y el deporte constituyen uno de los pilares básicos en el tratamiento de la hemofilia. Este trabajo describe un resumen de las características de la hemofilia y, a través de una exhaustiva revisión bibliográfica, se analiza la importancia de la condición física, en relación con la prevención y el tratamiento de las lesiones musculoesqueléticas en el paciente hemofílico. La hemofilia es una enfermedad hematológica hereditaria, con lesiones ortopédicas características. Afecta a individuos varones y presenta un déficit de factores de la coagulación que provoca hemorragias incluso espontáneas (en pacientes graves sin tratamiento). Las lesiones más frecuentes son: hemartrosis, sinovitis, hematomas musculares y artropatía hemofílica. La condición física del paciente hemofílico, instrumentada mediante terapia sustitutiva de factores de la coagulación, es fundamental y requiere fisioterapia, ejercicio físico y deporte. Basándonos en las recomendaciones de los comités de expertos de la Federación Mundial de Hemofilia (WFH) y utilizando las principales bases de datos, mediante estrategias de búsqueda con palabras clave, se obtuvieron 756 referencias, de las que tan sólo 74 superaron los criterios de inclusión. Las publicaciones se agruparon por áreas temáticas, diferenciando artículos de revisión, trabajos observacionales y experiencias clínicas, estudios experimentales y actuaciones intervencionistas sobre parámetros concretos de la condición física. Se concluye con la evidencia de la importancia de la recomendación del ejercicio físico y deporte en la hemofilia, el consenso en su idoneidad para el bienestar físico, psíquico y social de los pacientes, y la necesidad de incrementar los trabajos científicos al respecto

Differences in Inter-Rectus Distance and Abdominopelvic Function between Nulliparous, Primiparous and Multiparous Women

Widening of the inter-rectus distance (IRD) is highly prevalent among postpartum women and can lead to dysfunction of abdominopelvic muscles. The aim of this study was to evaluate the differences in IRD and abdominopelvic function between nulliparous, primiparous and multiparous women. A cross-sectional study was conducted on 75 women (25 nulliparous, 25 primiparous and 25 multiparous at 6 months postpartum). The participants underwent ultrasound assessment under three conditions (at rest, abdominal draw-in maneuver (ADIM) and curl-up) at two locations (2 cm above and 2 cm below the umbilicus). Furthermore, abdominopelvic muscle function was determined by prone, supine and side bridge tests. In all conditions and locations, the IRD were significantly higher (p 0.05) IRD at rest and during ADIM compared to the primiparous women. Regarding abdominopelvic muscle function, differences were only significant (p < 0.05) between the nulliparous with primiparous women in prone and supine conditions. These findings suggest that parity influences IRD: women at 6 months postpartum present greater IRD compared to nulliparous women; multiparous women present greater IRD at rest and during the activation of deep abdominal muscles than primiparous women; and primiparous women exhibit worse abdominopelvic muscle function than nulliparous women

Physical Activity Monitoring and Acceptance of a Commercial Activity Tracker in Adult Patients with Haemophilia

Physical activity (PA) is highly beneficial for people with haemophilia (PWH), however, studies that objectively monitor the PA in this population are scarce. This study aimed to monitor the daily PA and analyse its evolution over time in a cohort of PWH using a commercial activity tracker. In addition, this work analyses the relationship between PA levels, demographics, and joint health status, as well as the acceptance and adherence to the activity tracker. Twenty-six PWH were asked to wear a Fitbit Charge HR for 13 weeks. According to the steps/day in the first week, data were divided into two groups: Active Group (AG; ≥10,000 steps/day) and Non-Active Group (NAG; 0.05) in PA levels or adherence to wristband were produced. Only the correlation between very active minutes and arthropathy was significant (r = −0.40, p = 0.045). Results of the questionnaire showed a high level of satisfaction. In summary, PWH are able to comply with the PA recommendations, and the Fitbit wristband is a valid tool for a continuous and long-term monitoring of PA. However, by itself, the use of a wristband is not enough motivation to increase PA levels

HemoKinect: A Microsoft Kinect V2 Based Exergaming Software to Supervise Physical Exercise of Patients with Hemophilia

Patients with hemophilia need to strictly follow exercise routines to minimize their risk of suffering bleeding in joints, known as hemarthrosis. This paper introduces and validates a new exergaming software tool called HemoKinect that intends to keep track of exercises using Microsoft Kinect V2's body tracking capabilities. The software has been developed in C++ and MATLAB. The Kinect SDK V2.0 libraries have been used to obtain 3D joint positions from the Kinect color and depth sensors. Performing angle calculations and center-of-mass (COM) estimations using these joint positions, HemoKinect can evaluate the following exercises: elbow flexion/extension, knee flexion/extension (squat), step climb (ankle exercise) and multi-directional balance based on COM. The software generates reports and progress graphs and is able to directly send the results to the physician via email. Exercises have been validated with 10 controls and eight patients. HemoKinect successfully registered elbow and knee exercises, while displaying real-time joint angle measurements. Additionally, steps were successfully counted in up to 78% of the cases. Regarding balance, differences were found in the scores according to the difficulty level and direction. HemoKinect supposes a significant leap forward in terms of exergaming applicability to rehabilitation of patients with hemophilia, allowing remote supervision

EMG, Rate of Perceived Exertion, Pain, Tolerability and Possible Adverse Effects of a Knee Extensor Exercise with Progressive Elastic Resistance in Patients with Severe Haemophilia

In people with haemophilia (PWH), elastic band training is considered an optimal option, even though the literature is scarce. The aim was to evaluate normalized electromyographic amplitude (nEMG), rate of perceived exertion (RPE), pain, tolerability, and possible adverse effects during the knee extension exercise using multiple elastic resistance intensities in PWH. During a single session, 14 severe PWH undergoing prophylactic treatment performed knee extensions without resistance and with different intensity levels of elastic resistance. nEMG was measured for the knee extensors and participants rated their RPE, tolerability and pain intensity after each condition. Patients had to report the possible adverse effects after the session. In most of the cases, an nEMG increase is only evidenced after increasing the resistance by two to three levels. Significant associations were found between RPE and the nEMG (&rho; = 0.61), as well as between the elastic resistance level and nEMG (&rho; = 0.69) and RPE (&rho; = 0.71). All conditions were generally tolerated, without increased pain, and no adverse effects were reported. A wide variety of elastic resistance intensities during the knee extension are safe, tolerated, and do not increase knee pain in the majority of severe PWH undergoing prophylactic treatment

Safety, Fear and Neuromuscular Responses after a Resisted Knee Extension Performed to Failure in Patients with Severe Haemophilia

Background: low–moderate intensity strength training to failure increases strength and muscle hypertrophy in healthy people. However, no study assessed the safety and neuromuscular response of training to failure in people with severe haemophilia (PWH). The purpose of the study was to analyse neuromuscular responses, fear of movement, and possible adverse effects in PWH, after knee extensions to failure. Methods: twelve severe PWH in prophylactic treatment performed knee extensions until failure at an intensity of five on the Borg CR10 scale. Normalised values of amplitude (nRMS) and neuromuscular fatigue were determined using surface electromyography for the rectus femoris, vastus medialis, and vastus lateralis. After the exercise, participants were asked about their perceived change in fear of movement, and to report any possible adverse effects. Results: Patients reported no adverse effects or increased fear. The nRMS was maximal for all the muscles before failure, the median frequency decreased, and wavelet index increased during the repetitions. The vastus lateralis demonstrated a higher maximum nRMS threshold and earlier fatigue, albeit with a lower and more progressive overall fatigue. Conclusions: severe PWH with adequate prophylactic treatment can perform knee extensions to task failure using a moderate intensity, without increasing fear of movement, or adverse effects

Identifying performance-based outcome measures of physical function in people with haemophilia (IPOP)

Introduction: Recent recommendations of core outcome sets for haemophilia highlight the need for including measures of performance-based physical health and physical function sustainability. To date, there is no consensus on what outcomes might be of value to clinicians and patients. Aim: To identify instruments of performance-based physical function to monitor musculoskeletal health in people with haemophilia that are practical in the clinical setting. Methods: Utilising components from the Activities and Participation Category of the WHO International Classification of Functioning (WHO-ICF), a consensus-based, decision analysis approach was used to: identify activities people with haemophilia have most difficulty performing; identify quantitative performance-based measures of identified activities via a scoping review; and obtain views on acceptability of the tests utilising a DELPHI approach. Results: Eleven activities were identified: maintaining a standing position, walking long distances, walking up and down stairs, walking on different surfaces, running, hopping, jumping, squatting, kneeling, undertaking a complex lower limb task, undertaking a complex upper limb task. Following a 2-round DELPHI survey of international physiotherapists, the 6-min walk test, timed up and down stairs, 30-s sit to stand, single leg stance, tandem stance, single hop for distance (children only) and timed up and go (adults only) reached consensus. Conclusion: This study is the first step in defining a core set of performance-based instruments to monitor physical health and sustainability of physical function outcomes in people with haemophilia. Establishing the psychometric properties of the instruments and whether they are meaningful to people with haemophilia is essential

El portafolios como herramienta facilitadora del aprendizaje en la asignatura "Procedimientos generales de intervención en fisioterapia II"

[SPA]INTRODUCCIÓN: El portafolios es un método de enseñanza, aprendizaje y evaluación de gran utilidad educativa desde el enfoque constructivista. Su objetivo principal es que los estudiantes aprendan a buscar, relacionar y analizar información que consolide y complemente las sesiones de clase. MÉTODOS: Con el objetivo de valorar su utilidad, ventajas e inconvenientes en la asignatura “Procedimientos Generales de Intervención en Fisioterapia II” (PGIF II) pasamos una encuesta de valoración a los estudiantes. La elaboración del portafolios supone un volumen de 0,5 créditos ECTS y su calificación supone el 20% de la nota final. RESULTADOS: La encuesta fue contestada por 74 de los 100 alumnos matriculados. Las actividades realizadas que obtuvieron una mayor puntuación fueron la complementación de apuntes (8,92 ± 1,55) y la elaboración de casos clínicos (7,81 ± 1,60). El 83,8% opinó que el portafolios le había ayudado a complementar los contenidos teóricos; el 67,5% que había potenciado su pensamiento crítico y reflexivo; el 93,2% lo consideró una herramienta facilitadora del 2122 aprendizaje; el 33,1% confesó sentirse inseguro durante su realización. Sólo el 29,8% lo consideró un excesivo gasto de tiempo. CONCLUSIÓN: El portafolios es considerado por los alumnos como un método de enseñanza-aprendizaje de gran utilidad para propiciar el trabajo autónomo, completar la información de las clases teóricas y facilitar el aprendizaje de la asignatura “PGIF II”. [ENG]INTRODUCTION: The portfolio is a method of teaching, learning and evaluation. It is useful in an educational program from the constructivist approach. Its main objective is that students learn to find, correlate and analyze information to strengthen and complement the classroom sessions. METHODS: In order to assess its usefulness, advantages and disadvantages in the course "General Procedures in Physiotherapy II” (PGIF II) we carried out a closed survey with students. The development of the portfolio represents a volume of 0.5 ECTS credits and the mark is 20% of the total course marks. RESULTS: The survey was answered by 74 of the 100 students enrolled. The activities that scored highest marking (10 points, mean ± standard deviation) were notes supplementation (8.92 ± 1.55) and the development of case studies (7.81 ± 1.60). 83.8% of the students felt that the portfolio had helped to supplement the theoretical concepts, 67.5% replied that it had enhanced their critical and reflective thinking, 93.2% saw it´s a learning facilitator tool, 33,1% stated they felt unsacure during the performance. Only 29.8% of students considered it an excessive waste of time. CONCLUSION: The portfolio is considered by students as a teaching-learning method useful for promoting self-study, completing the information obtained in the classroom and facilitating learning of the course "PGIF II”.Campus Mare Nostrum, Universidad Politécnica de Cartagena, Universidad de Murcia, Región de Murci