Safe Sports in Haemophilia? Axel Seuser Centre for Prevention, - PowerPoint PPT Presentation

Safe Sports in Haemophilia? Axel Seuser Centre for Prevention, Rehabilitation and Orthopaedics, Bonn Institute for Motion Analysis (IBQ), Bonn Institute for Prevention and Aftercare (IPN), Cologne

Literature: REVIEW ARTICLE Haemophilia (2013), 1–12 The benefits of exercise for patients with haemophilia and recommendations for safe and effective physical activity C. NEGRIER,* A. SEUSER,† A. FORSYTH,‡ S. LOBET,§ A. LLINAS,¶ M. ROSAS** and L. HEIJNEN†† *Unite d’Hemostase Clinique, Centre Regional de Traitement de l’Hemophilie, Lyon, France; †Kaiser-Karl-Klinik, Bonn, Germany; ‡Christiana Care Health System Hemophilia Program, Newark, DE, USA; §Haemostasis and Thrombosis Unit,Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Brussels, Belgium; ¶Department of Orthopedics andTraumatology, Fundacion Santa Fe de Bogota, University Hospital and Universidad de los Andes, School of Medicine, Bogota, Colombia; **National Hemophilia Center, Banco Metropolitano de Sangre DC, Caracas, Venezuela; and ††Van CreveldKliniek, UMC, Utrecht and Rehabilitation Centre De Trappenberg, Huizen, The Netherlands

Literature: ORIGINAL ARTICLE Haemophilia (2015), S. 1 - 7 How fit are children and adolescents with haemophilia in Germany? Results of a prospective study assessing the sport-specific motor performance by means of modern test procedures of sports science. SEUSER A 1 , BOEHM P 2 , TRUNZ E 2 , OCHS S 2 , HALIMEH S 3 , KLAMROTH R 4 1 Practise for Prevention, Rehabilitation and Orthopedics, Bonn, Germany, 2 Institute for Prevention and Aftercare, Cologne, Germany, 3 Coagulation Center Rhein-Rhur, Germany 4 Vivantes Klinikum Berlin, Center for Haemophilia and Haemostaseology, Berlin, Germany

Own Investigations: • September 2002 – Mai 2012 • 23 CCC in Germany • 306 Patients from 8 – 25 y. (1/3 of the hemophilic age group in Germany) + 300 siblings and parents • Age 13,2 ± 4,2 y • Hight 159,2 ± 18,7 cm • Weight 52,8 ± 20,3 kg • 266 Hämophilia A, 40 Hämophilia B • 177 < 1%, 58 1-5%, 71 > 5%, • 29 inhibitors

Fit for life – Activities Hamburg 04 / 06 / 08  Rostock 04 / 05 / 07 / 09  Bremen 04 Berlin 03 / 04 / 08  Visselhövede 05 / 07 / 09  Potsdam 04  Hannover 03   Frankfurt/Oder 06 / 08    Münster 05  Magdeburg 04 / 07 Duisburg 07/ 09   Magdeburg 06  Düsseldorf 05 / 07    Leipzig 03 / 05  Köln 06 / 06   Blankenheim 02 / 03 Dresden 09  Bonn 08 Jena 08 Frankfurt 03 / 05 Rotenburg 04   Homburg / Saar 07 / 09 Ulm 04 Heidelberg 03 / 05 / 07/ 09     München 03 Freiburg 06 / 08 München 06

Haematologic Basis?

Clinical Examination? Loss of muscle Loss of muscle contraction contraction pattern in pattern in EMG? EMG? Ultraound: Ultraound: Treat pain and Treat pain and search for search for inflammation inflammation synovitis synovitis Early Early detection of detection of inflammation inflammation Find silent Find silent 3D Motion 3D Motion symptoms and symptoms and Analysis Analysis treat them treat them

Thermographiereport M- rechts- OSG ventral Min Max Bereich St.Abw. Wert links Thermographiereport R Peronealsehne Außenknöchel OSG 30,62 30,39 30,88 0,49 0,11 M- rechts- OSG dorsal Min Max Bereich St.Abw. -1,04 Wert links Peronealsehne Außenknöchel OSG L 31,66 31,26 31,98 0,73 0,16 R Ventrolaterale Kapsel OSG R Ventrolaterale Kapsel OSG 30,16 28,97 30,61 1,65 0,38 30,6 30,18 30,88 0,7 0,17 0,13 -1,23 L Ventrolaterale Kapsel OSG L Ventrolaterale Kapsel OSG 30,03 28,2 30,83 2,63 0,62 31,83 31,59 32,09 0,5 0,13 R Tibialis posterior Innenknöchel R Ventromediale Kapsel OSG 30,31 29,72 31,18 1,46 0,41 OSG 30,01 29,88 30,17 0,29 0,06 -1,96 Tibialis posterior Innenknöchel -1,07 L Ventromediale Kapsel OSG L 32,27 31,31 33 1,69 0,41 OSG 31,08 30,84 31,38 0,54 0,14 R Tibialis posterior Innenknöchel R Achillessehne 29,76 28,22 30,25 2,03 0,36 OSG 30,25 29,98 30,67 0,7 0,14 0,05 Tibialis posterior Innenknöchel Silent Symptoms ankle L Achillessehne 29,71 28,52 30,17 1,65 0,36 L OSG 31,4 30,62 31,92 1,3 0,42 -1,15 anteriomedial 4 2 9 (n = 102) 5 anteriolateral 3,9% 2,0% 8,8% 4,9% Painful tender point at ligament: Aussenband 3 47 2,9% Innenband 46,1% Malleolen 1 1,0% Achillessehne negative secondary changes in M. tibiales posterior Peroneussehne 31 30,4% 32,27 ° C arthro-neuro-muscular system 30,31 ° C leads to malfunction. (Nigg and Herzog 2007) 31,83 ° C 30,6 ° C Δ 1,96 ° C Δ 1,23 ° C right left right left Bemerkungen Bemerkungen Milan Schleiermacher; Chiemsee_110604 Kamera: VarioScan high resolution 3201 ST (Jenoptic Laser, Jena) 8-12 µm, ±0,03 K, 360x240 Pixel Milan Schleiermacher; Chiemsee_110604 Kamera: VarioScan high resolution 3201 ST (Jenoptic Laser, Jena) 8-12 µm, ±0,03 K, 360x240 Pixel

Percentage of joints with signs of hemarthropathy (HEAD-US Score)

The natural course of muscle function of the lower extremity in children and young adults with hemophilia. A two year superficial kinetic EMG study in San José, Costa Rica Axel Seuser, Martha Navarrete-Duran, Maria del Pilar Chaverri Saenz, Günther Auerswald Muscle coordination patterns and strength are intimately associated with cartilage disease! (Nigg & Herzog 2007) Diminished strength (Herzog et al., 1998) , weakening of muscles (Slemenda, et al., 1997 & 1998; Hurley, 1999) Reflex inhibition of maximum muscle contraction (Hurley & Newman, 1993) , change of contraction patterns from normal. ((Herzog & Federico 2003)

Personal Preperations? Warm up! Start slow! Stop early! Train regularly! Streching! Diminish own fitness deficits Professionell Sports and meet demands of Sport! Advice! Work with a coach!

Safest Sport.....? Low acceleration Low joint loading Match own fitness Low risk of injury with demands of sport No contact sports

Rugby/ American Football (1;3) 0% 20% 40% 60% 80% 100% Boehm P. Dissertation International injury statistics Squash (3;3,7) Rodeln (1;3) Wasserski (1;3) Bodybuilding (1;2) Ringen (2;3) Basketball (12;3,2) Gewichtheben (3;3,7) Handball (9;3,6) Inline-Skaten (3;3) Kampfsport (2;4) Volleyball (9;3,6) Fechten (1;3) Snowboarding (2;2,5) Ski-Alpin (10;3,3) Hockey (5;3,2) Fußball (14;3,3) Judo (7;3,4) Radsport (9;3,4) Eishockey (2;2) Tanzen (2;2,5) Leichtathletik (9;3,3) Badminton (6;3,7) Klettern (3;3) Joggen (5;2,6) Krafttraining-Gerät (1;2) Reiten (6;3,5) Kegeln (1;3) Aerobic (2;3,5) Eislaufen (4;3,5) Segeln (3;2,7) Tennis (10;3,4) Bergwandern/Alp. (2;3,5) Rudern (1;3) Tischtennis (2;3,5) Hanteltraining (2;2) Gerätturnen (10;3,4) Schwimmen (6;3,2) Ergometer (1;2) Golf (1;3) Skilanglauf (1;2) Walken (1;2) Wasserball (1;2)

Results of Fitness-Tests (n= 306) 5 4 3 2 3,37 2,45 3,02 3,51 1,98 2,68 3,47 1,73 2,36 2,59 2,64 1 F Co SF SE SB S MUE MLE OM A OR

Safe School Sport? Curriculum: No involved joint 1 ankle involved 9. Grade Basketball

100% Safety? 100% Safe No safety Thank you!