Still today, young PWH in Romania are not yet evaluated for musculoskeletal complications and for functional limitations ever in their lives and they never were included in a rehabilitation programme. From this perspective, there is a big learn more discrepancy between the patients from rural areas and those living in larger cities, giving access to university hospitals with rehabilitation departments. The main goal of rehabilitation in developing countries is to restore joint and muscle function, which is different from developed countries where the goal is to prevent musculoskeletal complications. Following the detailed musculoskeletal

and functional assessment, physical therapists, together with patient (and family) decide the goals of rehabilitation and develop a customized treatment. The first objective is often to decrease pain. Physiotherapists use ice cube massage, hydrotherapy, or electrotherapy suitable for children with haemophilia (pulsed ultrasound, phonophoresis with a hydrocortisone or Lidocaine) [31,32,33]. The use of kinesiotaping (elastic and adhesive tapes developed for re-educating the neuromuscular system, reduce pain, prevent injuries and to promote circulation

and healing) shows good results in controlling pain and inflammation. To prevent check details or to correct joint deformities, physiotherapists use custom-made splints or orthotics. This is cheaper than the high-tech imported ones. As soon as acute bleeding has stopped and the pain subsides, the click here goal is to restore the muscle strength and joint range of motion (ROM). Patients start with isometric exercises at different joint angles, followed by isotonic and resistive exercises. In the Rehabilitation unit of the Elias Hospital, Bucharest, good results are seen in muscle training supervised by use of EMG-biofeedback. If ROM

does not improve accordingly with strength, self-stretching exercise, then pool therapy or continuous passive motion (CPM) could be efficient [34]. As gait is the major determinant of functional independence, gait training becomes a key goal of rehabilitation. Physical therapists of the above mentioned unit start the gait training with body-weight support [35], in order to decrease the risk of re-bleeding and to re-learn a better gait pattern in young PWH. Last but not least, an important role of the physiotherapist is to teach patients a safe home exercise programme, how to manage an acute bleed and to help patients understand that without regular physical activity, adolescents with haemophilia are often overweight and at greater risk of recurrent haemarthroses. The articular problems of PWH begin early in infancy; the immature skeleton is very sensitive and severe structural deficiencies may develop quickly [36]. Untreated, this will result in handicaps in early life, while proper treatment is expensive, inadequate treatment is even more so, both to the individual and to the community [37].