Typical hemophilia-related bleeding episodes, as well as the hereditary characteristics of the disease, were described in a part of the Jewish Talmud, the Tosefta, in second century BCE.
John Conrad Otto in 1803 and Leggs in 1872 described chronic muscle and joint problems in hemophilic patients. However, it was König who in 1892 characterized the clinical stages of the development of hemophilic arthropathy, considered to be different from other types of arthritis. The use of therapeutic measures then was essentially unimaginable, considering the average life expectancy of a hemophiliac was approximately 11 years and there was no effective way to stop bleeding.
Towards the end of the 19th century and beginning of the 20th century, the occurrence of hemophilia in several royal families sparked an interest in studying the disease. However, there are very few articles about specific rehabilitation efforts.
In 1962, Biggs and McFarlane proposed changing the direction of hemophilia therapy, suggesting it include both hematologic and orthopedic aspects. This thinking, along with advances in replacement therapy, has given rise to the development of a present-day multidisciplinary approach to treating hemophilia.
According to the World Health Organization, rehabilitation is a coordinated effort of medical, educational and professional measures designed to give a patient back as much of their independence and functional capacity as possible. A hemophilic patient can develop musculoskeletal problems that give rise to a disability that requires therapy to a greater or lesser extent.
Objectives for the treatment and rehabilitation of hemophilia should include not only functional recovery from lesions, but also the prevention of bleeding and health through exercise. Physical therapy is generally geared towards recovery from acute episodes. However, lesions become chronic with recurrent bleeding and the loss of function requires more complex objectives. For this reason, the rehabilitation team is a multidisciplinary unit that includes a rehabilitation physician, physiotherapist, orthopedist and sometimes an occupational therapist.
There are no specific rehabilitation techniques for a hemophilic patient, but there is a series of determinants used in evaluating risk/benefit. These include various forms of
- kinesitherapy (movement therapy),
- hydrotherapy (therapy using water),
- cyrotherapy (cold treatment therapy),
- electrotherapy (therapy using different types of currents),
- ultrasound and other orthopedic mechanisms.
With more than twenty years of experience in treating hemophilia, Hospital Donostia’s Rehabilitation facilities offers patients excellent medical equipment and heath services. In the 1990s, the department’s team of professionals pushed for and achieved a major improvement in the therapeutic assistance it provided its hemophilic patients. The result has been immediate clinical evaluation, better treatment techniques and much less paperwork.
The Rehabilitation department always works closely with Hematology and the Orthopedic Surgery Unit whenever a patient requires surgery. The team responsible for treating hemophilia and von Willebrand patients includes the following persons: 1 rehabilitation physician (Dr. Margarita Lecuona Navea) 1-2 physiotherapists as needed (Ms. Carmen Grijalba Legaz and Ms. Maria Josefa Martínez Artola) 1 orthopedist 1 occupational therapist (if necessary)