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Treating the Patient with Hemophilia

Katie O'Shea, PT, DPT, MBA, GCS, CDP

February 26, 2021

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Question

What is joint disease and hemophilia as well as the precautions and contraindication for treating an individual with hemophilia?  

Answer

Joint disease is the most common complication of hemophilia in which the synovium and cartilage become damaged. The joint bleed triggers a repetitive cycle of swelling which becomes chronic and results in a deformity. These joints are known as the target joints.  The target joints include the knee, ankle, elbow, shoulder, wrist, and hip. The impacted muscles include biceps brachii, forearm flexors, iliopsoas, quadriceps, hamstrings, and gastrocnemius.  

The synovium’s role is to remove fluid from the joint. In a patient with hemophilia, this means it absorbs the blood; which is high in iron. Iron triggers the synovium to get thicker. Thicker synovium contains more blood vessels and additional blood vessels contribute to more profuse bleeding. Synovium releases collagenase when it is swollen, which destroys the cartilage that covers the bone.  The result is painful bone-on-bone contact.

Precautions for PT include:

  • Pain which may not always be felt early in a bleed
    • Patient awareness of their body and limitations is very important
  • Patient reported fatigue
  • Hematomas
  • Timing of session with factor replacement
  • Severe hemophilia associated with reduced lumbar bone mineral density

Contraindication for PT include:

  • Uncontrolled or unmanaged bleed
  • Life threatening bleed
  • Unstable spine
  • Bleed caused by trauma, awaiting imaging to rule out a fracture
  • Working muscles that cross two joints, one of which is an active bleed
  • 1 Repetition Max
  • Ballistic stretching

For more information on physical therapy management and treatment considerations, please see our course: Hemophilia by Dr. Katie O'Shea, PT, DPT, MBA, GCS, CDP


katie o shea

Katie O'Shea, PT, DPT, MBA, GCS, CDP

Dr. Katie O’Shea graduated from Thomas Jefferson University in 2006 with her Masters and 2008 with her Doctorate. From there Katie pursued her Master of Business Administration graduating in 2010 from Holy Family University.

Katie has clinical experience in acute care, inpatient rehabilitation, homecare, and outpatient settings. She found her clinical passion in working with the geriatric population and is a Board Certified Geriatric Clinical Specialist (GCS) by the American Board of Physical Therapy Specialists and also a Certified Dementia Practitioner as appointed by the National Council of Certified Dementia Practitioners. She has co-authored chapters on rehabilitation status post total knee and hip arthroplasty.

Katie has spent the last several years of her career in management and leadership development. She has been involved from ground-up facility operations to over-seeing established rehabilitation programs. Katie has extensive experience in program development, marketing, staff training, and performance improvement. Katie has also obtained her Lean Six Sigma yellow belt certification.

Katie is an active member of the American Physical Therapy Association (APTA) and is a certified eSpeaker. She currently operates her company, Therapy Edge Consulting, and works as adjunct faculty with Rutgers University.


Related Courses

Hemophilia 101
Presented by Katie O'Shea, PT, DPT, MBA, GCS, CDP
Recorded Webinar

Presenter

Katie O'Shea, PT, DPT, MBA, GCS, CDP
Course: #3822Level: Introductory2 Hours
  'Well organized'   Read Reviews
Hemophilia is a medical diagnosis seen few and far between on caseload, however one that has nuances that the clinician needs to be aware of prior to initiating services. This introductory course will cover what hemophilia is, its impact on the adult patient across the different continuum of care, and the critical education you need to pass onto your clients. This course is directly related to the practice of physical therapy and athletic training and is therefore appropriate for the PT/PTA and AT.

Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 1 hour of general and 1 hour of Direct Access CE credit.

Acute Care: Selecting the Right Dispo Setting, Knowing Your Options of Post-Acute Services
Presented by Katie O'Shea, PT, DPT, MBA, GCS, CDP
Recorded Webinar

Presenter

Katie O'Shea, PT, DPT, MBA, GCS, CDP
Course: #3881Level: Advanced2 Hours
  'Excellent course! Clarified some things in my practice!'   Read Reviews
The acute care hospital is the beginning point for so many patients who require rehabilitation services’ therapists in this setting are challenged with quickly assessing and making a recommendation based off function from a small window of time. This course aims to educate therapists on the different levels of post-acute rehabilitation as well as to expand their knowledge on additional support services in the community and home level. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Physical Therapy and Behavioral Health Patients – Setting Boundaries, Getting Outcomes
Presented by Katie O'Shea, PT, DPT, MBA, GCS, CDP
Recorded Webinar

Presenter

Katie O'Shea, PT, DPT, MBA, GCS, CDP
Course: #3959Level: Intermediate2 Hours
  'Presenter made topic interesting'   Read Reviews
We have all been there, the packed gym space and the one patient who is the life of the party and causing lots of distractions. How do you establish boundaries and create an awareness to accomplish what you need with that patient as well as what your rehab space needs for others? This 2-hour course looks at the evidence-based medicine of treatment involving mental health diagnosis. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Physical Therapists as Case Managers in Home Healthcare
Presented by Katie O'Shea, PT, DPT, MBA, GCS, CDP
Recorded Webinar

Presenter

Katie O'Shea, PT, DPT, MBA, GCS, CDP
Course: #3982Level: Intermediate2 Hours
  'Great information about Medicare requirements and responsibilities of the PT case manager'   Read Reviews
PDGM has changed the home health care world as we know it, from diagnosis to visit allotments to therapist overall involvement in care. PT’s are finding themselves more frequently as the case manager for an episode of care and learning what exactly that entails. This course will dive into the steps you need to take to maximize delivery of care, recognize opportunities to refer other disciplines into care, oversee other disciplines, and successfully communicate with the referral source while ensuring optimal patient care. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Ethics in Action - A Legal and Therapy Perspective
Presented by Charles C. Bratton, JD, L.L.M. II, Katie O'Shea, PT, DPT, MBA, GCS, CDP
Recorded Webinar

Presenters

Charles C. Bratton, JD, L.L.M. IIKatie O'Shea, PT, DPT, MBA, GCS, CDP
Course: #4005Level: Introductory2 Hours
  'real life examples, case scenarios'   Read Reviews
This 2-hour course will use a case-based approach of the RIPS model to identify ethical considerations as directly related to clinical practice. Therapists will learn to apply a framework to assist in the decision-making process in ethically challenging scenarios while maintaining the Code of Ethics and HIPAA regulations. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.