The goal of this clinical trial is to learn if there are effect of close kinetic chain exercises on muscle strength, joint position sense and Quality of life in children with haemophilia? Null hypothesis It will be hypothesized that: There is no effect of close kinetic chain exercises on muscle strength, joint position sense and Quality of life in children with haemophilia.
Sample size estimation will be carried out to determine the recruited number of children selected randomly from Out Patient clinic of Atfal Misr hospital, Cairo governorate to participate in this study. The study targets male children with hemophilia A. They will be selected based on the following: Inclusion criteria: 1. Their chronological age will be 5-7yeasr. 2. All children will receive prophylaxis therapy. 3. They will able to stand and walk independently. 4. They will be able to follow instructions during evaluation and treatment. Exclusive criteria: The children will be excluded if they have one of the following: 1. Visual or auditory problem. 2. Radiographic changes as bone erosions, destruction, or joint subluxation, or congenital or acquired skeletal deformities in both lower limbs. 3. Surgical procedures performed six weeks prior to or during study. 4. Bleeding in joint 2 week prior to assessment.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
40
Close kinetic chain (CKC) exercises : 1. Supine wall push exercise: Start position: supine with the both leg against wall, other limb straight. Exercise action: push against wall for thirty seconds. 2. Wall push against Swiss ball exercise: Start position: Supine with a Swiss ball between patient's legs and the wall. Exercise action: push against the wall for thirty seconds. 3. Supine half bridging exercise: Start position: Lying on back, knees bent Exercise action: keeping spine neutral and hinging up from the hips, move into a bridge.
Control Group (A): will receive the traditional physical therapy (PT) , the traditional physical therapy program will include the following: * Stretching exercise for shortening muscle of lower limbs (LL) mainly (hip flexors, adductors, knee flexors and ankle planter flexors). * Balance training from standing while giving perturbations. * Balance board training. * Step ups: repeated stepping anteriorly and laterally onto a step with both legs alternatively, progressing to higher step and decreasing upper extremity support. * Forward and backward walking (with or without handheld mobility devices). * Side walking (with or without handheld mobility devices). * Walking in astride line (with or without handheld mobility devices).
Out Patient clinic of Atfal Misr hospital
Cairo, Egypt
a) Assessment of muscle strength:
The isometric muscle strength of bilateral knee extensors muscles will be measured with a handheld dynamometer.
Time frame: baseline only
b) Assessment of knee joint position sense.
Knee joint position sense will be measures with a Saunders digital inclinometer.
Time frame: baseline only
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