Objective:
The aim of this study was to determine if the young boys with hemophilia at our clinic have gross motor delays that may have been missed during the annual physical therapy evaluation. By identifying delays, our clinic can improve the standard of care and promote gross motor development in our patients to enhance their ability to be physically active and protect their joints and muscles from injury.
Method:
Over a one year period, boys with hemophilia A or B between the ages of 4 to 14 were tested by the physical therapist at our clinic using the Bruinink’s-Oseretsky Test of Motor Proficiency, Second Addition, BOT2. The BOT2 is a valid and reliable gross motor test for 4 to 21 year olds and is widely used to detect mild to moderate motor delays. The five gross motor subtests used in this study included upper extremity (UE) coordination, bilateral coordination, balance, strength, running speed and agility (run/agility). A total of 42 boys completed the study with scores distributed between three age groups: Group 1=4-7 year olds; Group 2=8- 11 year olds; and Group 3=12-14 year olds. Exclusion criteria included a bleed within the last week that was unresolved or other physical limitation preventing participation. All severities of hemophilia were included in the study, but were not separately analysed in the results.
Results:
Each age group mean scores for the subtests were within the normal mean range of 15±4 except for strength in Group 2. Group 1 had some participants score above average for four of the subtests, while Group 2 and 3 only scored above average on one subtest. Group 1 had 6-18% score below average on four of the subtests while Group 2 had 27-47% and Group 3 had 30-50% score below average on all 5 subtests. No adverse events or bleeds occurred during or as a result of the gross motor testing.
Conclusion:
At our Hemophilia Treatment Center, more than 50% of the boys tested had gross motor dels. The percentage of boys showing deficits increased and persisted after age 7. This reinforces the need to include some standardized gross motor testing during the annual physical therapy evaluation of our patients with hemophilia to identify boys with scores below average and make referrals at an early age to prevent persisting gross motor delays.