Browsing by Author "Can, Filiz"

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Muscle Strength and Joint Health in Children With Hemophilia: a Cross-Sectional Study
(Turkish J Pediatrics, 2020) Tat, Necati Muhammed; Tat, Ayse Merve; Can, Filiz; Antmen, Bulent; Oner, Ahmet Fayik
Background and objectives. We aimed to evaluate joint health in children with hemophilia (CwH) and to investigate the effects of hemarthrosis on the musculoskeletal system. Method. Forty-one CwH aged between 6-18 years participated in the study. Joint health status was evaluated according to Hemophilia Joint Health Score (HJHS). Pain intensity level was assessed in resting and in activity using Visual Analog Scale. Range of motion was measured with goniometer and musde strength was assessed with digital dynamometer. Arthropathic joints were examined in three groups named knee, elbow and ankle. Results. Physical examination revealed arthropathy findings to be found in 29 knee, 19 elbow and 18 ankle joints. The median of flexion angle of the affected side were 120 degrees, 122 degrees and 12 degrees for the knee, elbow and ankle and extension losses of these joints were 5 degrees, 7 degrees and 0, respectively. In CwH having knee and elbow arthropathy, index joint HJHS was found to be significantly higher than those with ankle arthropathy (p <0.01). The flexor and extensor muscle strength significantly decreased in 11 CwH with unilateral elbow arthropathy compared to the non-arthropatic side (p <0.05). In 15 CwH with unilateral ankle arthropathy decreased in the extensor muscle strength (plantarflexors) (p <0.05). Extension loss showed a good correlation with index HJHS of elbow, knee and ankle joints, respectively. (r(s) = 0.599, 0.576, 0.606, p <0.01). We observed that the muscle strength of elbow flexors/extensors and ankle extensors were significantly decreased compared to the non-arthropathic side. However this situation was not detected in knee joint despite having highest index HJHS. Conclusion. Our findings indicate that hemarthrosis may cause more muscle strength loss in the upper extremity than the lower extremity. Furthermore, extension loss was found to be an important parameter in physical examination of hemophilic arthropathy. Musculoskeletal system should be evaluated comprehensively at regular intervals and when necessary rehabilitative treatment should be planned.
Static Postural Balance Evaluation and an Investigation of the Relationship With Joint Health in Children With Severe Haemophilia: a Controlled Cross-Sectional Study
(Wiley, 2021) Tat, Necati M.; Tat, Ayse M.; Oner, Ahmet F.; Karaman, Kamuran; Kaplan, Seyhmus; Can, Filiz
Introduction Recurrent hemarthroses disturbing force/movement control are likely to impair postural balance. Aim To investigate the possible changes in static postural balance parameters in children with haemophilia (CwH) and to reveal its relationship with Haemophilia Joint Health Score (HJHS). Methods Twenty-one CwH aged 6-18 who had haemophilic arthropathy in at least one lower limb joint and 21 healthy peers were evaluated by using a force platform. Centre of pressure (CoP) signals were displayed as a map in both anteroposterior direction (APD) and mediolateral direction (MLD) by statokinesigram. Accordingly, the amplitude, velocity and standard deviation of CoP displacements along with the perimeter and ellipse area were measured. Assessments were made under eyes opened and eyes closed in bipedal stance for 60 s. Joint health and muscle strength were evaluated with HJHS and digital dynamometer, respectively. Results Velocity and amplitude of CoP displacements in MLD were increased in CwH (p<0.05). It was also found that these parameters were moderate correlated with the clinical score of the lower limb joints (p<0.05). In CwH, standard deviation of CoP displacements in the APD was significantly higher in eyes closed, while standard deviation in MLD was significantly higher in eyes opened (p<0.05). Conclusion Disturbances during bipedal stance reveal the need for balance evaluation in CwH. Increased mediolateral oscillations may be an early sign of disorders of the musculoskeletal system in CwH. In addition to improving joint health, postural balance exercises that increase MLD stability have to be included in the rehabilitation programme of CwH.