Effects of biofeedback treatment on gait in children with cerebral palsy

PURPOSE: We evaluated the effectiveness of biofeedback treatment on gait function in children with cerebral palsy. METHOD: Thirty-six children with spastic cerebral palsy and dynamic equinus deformity were included in the study. The biofeedback group consisted of 21 children who each received EMG biofeedback training plus conventional exercise programme. The control group consisted of 15 children who each received conventional exercise programme only. Active range of motion of the ankle joints, muscle tone of plantar flexors, and gait function of the children were evaluated and compared. RESULTS: The biofeedback group displayed statistically significant improvements regarding tonus of plantar flexor muscles and active ROM of ankle joints (p < 0.000 for all parameters). Gait function showed statistically significant progress in both of the groups, but the biofeedback group was superior to controls. CONCLUSIONS: Children with cerebral palsy and dynamic equinus deformities may benefit from biofeedback treatment for ambulation.     

Dynamic Versus Fixed Equinus Deformity in Children With Cerebral Palsy: How Does the Triceps Surae Muscle Work?

?vehlík M, Zwick EB, Steinwender G, Kraus T, Linhart WE. Dynamic versus fixed equinus deformity in children with cerebral palsy: how does the triceps surae muscle work?Objectives:To detect outcome measures that could help differentiate between dynamic and fixed equinus (FEQ) deformities in children with cerebral palsy, and secondary, to describe the function of the gastrocnemius and soleus (SOL) muscles when either dynamic triceps surae tightness or FEQ contracture is present.Design:A group-comparison study.Setting:Gait analysis laboratory.Participants:Children (N=23; 31 limbs) with cerebral palsy; 12 limbs showed a fixed contracture (FEQ group) and 19 limbs showed dynamic tightness of the triceps muscle (dynamic equinus group). Healthy children (N=12) without a neurologic or orthopedic disorder served as the control group.Interventions:Not applicable.Main Outcome Measures:Time-distance, kinematic and kinetic gait variables, muscle-tendon length, and velocity parameters.Results:Maximal ankle dorsiflexion angles were decreased in both equinus groups compared with the control group. Ankle range of motion, maximal power generation of the plantar flexors, and its timing during the gait cycle were different among groups. The ankle slope parameter showed substantial differences among groups. Muscle-tendon length parameters for the SOL and the medial (MGAC) and lateral gastrocnemius muscles were abnormal in both equinus groups compared with the control group. Maximal muscle lengths of the MGAC and SOL were longer in the dynamic equinus than FEQ group. Peak lengthening velocity of the triceps surae muscle was significantly slower for all triceps surae muscles in the FEQ group than in the dynamic equinus group and occurred in the early swing phase.Conclusions:The presented results indicate that peak lengthening velocity of the triceps surae muscle might be one of the discriminating factors between FEQ and dynamic equinus deformity in children with cerebral palsy. This could help clinical decision making for treatment of an equinus gait pattern.     

Treadmill training with an incline reduces ankle joint stiffness and improves active range of movement during gait in adults with cerebral palsy

Purpose: We investigated if 30?min of daily treadmill training with an incline for 6 weeks would reduce ankle joint stiffness and improve active range of movement in adults with cerebral palsy (CP).

Methods: The study was designed as a randomized controlled clinical trial including 32 adults with CP (GMFCS 1–3) aged 38.1 SD 12 years. The training group (n?=?16) performed uphill treadmill training at home daily for 30?min for 6 weeks in addition to their usual activities. Passive and reflex mediated stiffness and range of motion (ROM) of the ankle joint, kinematic and functional measures of gait were obtained before and after the intervention/control period. Intervention subjects trained 31.4 SD 10.1 days for 29.0 SD 2.3?min (total) 15.2?h.

Results: Passive ankle joint stiffness was reduced (F?=?5.1; p?=?0.031), maximal gait speed increased (F?=?42.8, p?F?=?5.3, p?F?=?12.5; p?Conclusion: Daily treadmill training with an incline for 6 weeks reduces ankle joint stiffness and increases active ROM during gait in adults with CP. Intensive gait training may thus be beneficial in preventing and reducing contractures and help to maintain functional gait ability in adults with CP.

• Implications for rehabilitation

• Uphill gait training is an effective way to reduce ankle joint stiffness in adult with contractures.

• 6 weeks of daily uphill gait training improves functional gait parameters such as gait speed and dorsal flexion during gait in adults with cerebral palsy.

     

Computerized gait analysis of Botulinum Toxin treatment in children with cerebral palsy

Purpose. Intramuscular botulinum toxin A (BTA) injection is a local reversible treatment with a wide range of therapeutic applications, including temporary reduction of spasticity. The aim of this work was a quantitative, computerized objective evaluation of BTA-induced improvement of the walking functional ability in a group of children with cerebral palsy (CP).

Methods. Fifteen children with CP and 20 healthy children were evaluated. All patients were equinus walkers without fixed contractures of triceps surae muscles and they were evaluated before and after about 1.5 months from BTA injections into the calf muscles. The effectiveness of treatment was evaluated by 3D computerized gait analysis.

Results. Data analysis revealed a significant improvement of equinus foot and ankle range of motion during gait after BTA injection. Positive effects were evident also at the knee joint as documented by the improvement of kinetics characteristics (moment and power).

Conclusions. Computerized gait analysis is a valid method for quantification of BTA effect on walking in children with CP, allowing a detailed evaluation of improvement at each joint and a quantitative evaluation of treatment outcome.     

Does microcurrent stimulation increase the range of movement of ankle dorsiflexion in children with cerebral palsy?

Aim:?To determine whether microcurrent stimulation (MENS) increases the range of motion (ROM) of the ankle joint in children with cerebral palsy.

Design:?Twelve children with spastic hemiplegia (age range 4.5 to 16 years) with moderate myocontracture of the triceps surae, received MENS for 1?h five times a week for 4 weeks. An equally long baseline period was preceded. The assessments were: active and passive ROM of ankle dorsiflexion, popliteal flexion and ankle dorsiflexion in maximal flexion of knees in standing position while maintaining the heels in contact with the floor, one foot standing and hopping on one foot.

Results:?After the treatment with MENS, the passive ROM of ankle dorsiflexion with both knees flexed and extended (p?<?0.001) increased significantly. Increases were also observed in popliteal flexion (p?<?0.001) and ankle dorsiflexion (p?=?0.0012) during maximal flexion of the knees in a standing position. The ROM of active dorsiflexion with the knee flexed (p?<?0.05) and one foot standing (p?<?0.05) also improved. Children and parents found this treatment easy to carry out.

Conclusions:?MENS relieves myocontracture and can enhance conventional rehabilitation programmes for children with cerebral palsy.     

痉挛型脑瘫儿童步行时的动态足底压力特征

目的：了解痉挛型脑瘫儿童步行时的动态足底压力特征。方法：试验组痉挛型脑瘫儿童20例，对照组为52例具有正常步行能力的健康儿童．运用Uhraflex连续性足底压力步态分析系统．对两组儿童进行了步行时动态足底压力运动力学数据采样，经过电脑数据录入分析，取得动态足底压力曲线及特征量参数（包括双测的z1、z2、z3、t1、t2、t3、ts）。对实验组和对照组的步态分析曲线及各参数进行分析和统计分析。结果：得到典型足底压力双峰图及相应特征量数据的实验组儿童10例，其步态的足底压力特征量参数与对照组相比，双侧的单足支撑时间、右侧的tz1、tz2、tz3表现出显著性差异，脑瘫儿童双侧的单足支撑时间均较正常儿童短，右侧的tz1、tz3增加，而tz2缩短。结论：部分痉挛型脑瘫患儿动态足底压力曲线不能表现出典型的双峰曲线。能得到典型足底压力双峰图及相应特征量数据的实验组儿童中，双侧的单足支撑时间均较正常儿童短，右侧的tz1、tz3增加，而tz2缩短。     

Group aquatic training improves gait efficiency in adolescents with cerebral palsy

Purpose.?To evaluate the effect and feasibility of a 10-week group aquatic training programme on gait efficiency in adolescents with cerebral palsy (CP). The secondary purpose was to determine the exercise intensity during aquatic training in a heterogeneous group of adolescents with CP and to investigate the impact of the training programme on the musculoskeletal system.

Method.?Twelve ambulatory adolescents with spastic CP were recruited. They participated in 20 aquatic training sessions (45?min twice a week). Three physical therapists and a sports teacher supervised the training sessions. Participants wore a heart rate monitor to assess sessions' intensity and a floatation device as appropriate. The primary outcome measure was gait efficiency as measured by the gait energy expenditure index (EEI). The secondary measures were (1) gait spatiotemporal parameters, (2) maximal isometric knee strength and (3) gross motor function.

Results.?Ten adolescents completed the training programme. No adverse effect was reported. Average exercise intensity was mild to moderate for more than half of the training session. A significant reduction of the EEI and the heart rate during walking was observed following the training programme. No significant change was observed on secondary outcome measures.

Conclusions.?Group aquatic training increases gait efficiency in adolescents with CP. This improvement is related to systemic cardiorespiratory adaptations. Group aquatic training programme is feasible in adolescents presenting CP at different levels of severity.     

Strength training can be enjoyable and beneficial for adults with cerebral palsy

Purpose:?To explore the positive and negative perceptions of participating in a strength- training programme for adults with cerebral palsy.

Method:?Ten adults aged over 40 years with cerebral palsy participated in a group-based 10-week progressive resistance strength-training programme in a community gymnasium. After the programme, each participant was interviewed using an in-depth semi-structured format and the results coded thematically.

Results:?Participants perceived that their strength, and ability to perform everyday activities had improved. However, the main benefit for participants was enjoyment and social interaction. The only negative perceptions related to fatigue, short-term muscle soreness and a feeling that they had not improved as much as they had expected.

Conclusions:?Enjoyment, a factor that can promote adherence and sustainability, was a key benefit of this strength-training programme for adults with cerebral palsy that led to perceptions of increased strength and physical functioning. These findings suggest that exercise programmes for adults with cerebral palsy should be conducted in a group in the community, thereby promoting community inclusion. In addition, it is important to provide education to participants about the normal responses and expectations of an exercise programme.     

Adults with cerebral palsy benefit from participating in a strength training programme at a community gymnasium

Purpose:?This study examined whether a community-based progressive resistance strength training programme could improve muscle strength and functional activity in a group of adults with cerebral palsy with high support needs.

Method:?Using a single group pre-post clinical design, 10 adults (7 males, 3 females; mean age 47.8 SD 5.7 years) with cerebral palsy and high support needs completed 4 weeks of introduction and familiarization, followed by a 10-week progressive resistance strength training programme in a community gymnasium. Participants were measured for muscle strength, locomotion speed and timed sit-to-stand.

Results:?After establishment of a stable baseline from weeks 2 to 5 with no systematic change and a high degree of association (r?>?0.86), participants increased leg strength by 22.0% (p?=?0.02), arm strength by 17.2% (p?=?0.01) and improved performance of sit-to-stand (p?=?0.02) during the 10-week strength training intervention.

Conclusions:?This study adds to the accumulating evidence that strength training can be beneficial for people with cerebral palsy by demonstrating benefits for adults with cerebral palsy and high support needs who are subject to decline in physical function associated with the ageing process.     

Effects of botulinum toxin A therapy with electrical stimulation on spastic calf muscles in children with cerebral palsy

OBJECTIVE: To assess the additive effect of adjuvant electrical stimulation on botulinum toxin A injection in children with spastic diplegic cerebral palsy. DESIGN: Eighteen children with dynamic foot equinus deformity were treated with botulinum toxin A injection into the calf muscles. Seven children were assigned to a treatment group who received botulinum toxin A and adjuvant electrical stimulation, and 11 children were assigned to a control group with botulinum toxin injection only. Before botulinum injection, and at 2 wks and 3 mos after injection, the Physician Rating Scale, passive ranges of ankle and knee motion, and the modified Ashworth scale were measured. RESULTS: A significant increase in passive range of ankle motion was observed at 2 wks after injection in the treatment group and at 3 mos after injection in both groups. Both groups showed significant improvements by the modified Ashworth scale at 2 wks after injection. Subscales of the Physician Rating Scale (equinus foot, crouched gait) and total Physician Rating Scale scores were significantly improved in the treatment group at 3 mos after injection, but this was not observed in the control group. CONCLUSIONS: Adjuvant electrical stimulation for a short period after botulinum toxin A injection was found to benefit early improvement of range of motion and maintenance of gait improvement in children with spastic diplegia cerebral palsy showing dynamic equinus.     

足底压力式步态分析中痉挛型脑瘫儿童的平衡能力特征

目的:临床上坐位、站立位的平衡测试常利用平衡仪来进行,但由于平衡仪足踏板的限制,无法对脑性瘫痪(脑瘫)患儿步行时动态连续步行周期的平衡能力进行测试.文章利用足底压力式步态分析技术,观察痉挛型脑瘫儿童步行时在平衡能力方面的特征.方法:选择具有正常步行能力的健康儿毫78例作为正常儿童组,另外选择2004 05/2007-05在深圳市儿童医院康复科日间病房住院治疗的脑瘫患儿25例作为脑瘫儿童组.利用足底压力式步态分析系统,对2组对象分别进行足底压力式步态分析,记录2组儿童步行时的足底压力数据.观测指标分为量化指标和直观压力图.量化指标包括步频、步态周期时间、步态周期各时相的绝对对称性指标等参数.直观压力图包括动态足底压力图以及足底压力重心偏移轨迹图.结果:与正常儿童组相比,脑瘫儿童组步频较小,步态周期时间较长(P<0.01).脑瘫儿童组单足支撑期、摆动期、双足支撑期、步态周期时间的绝对对称性指标均大于正常儿童组(P<0.05).脑瘫儿童步行时双足的足底压力图的对称性、重复性较正常儿童差;重心偏移轨迹图不能形成左右对称的蝴蝶状图形.结论:痉挛型脑瘫儿童步行时,步态周期各时相均存在对称性下降的情况.足底压力式步态分析技术能有效地应用于痉挛型脑瘫儿童步态的平衡能力评估.     

Effectiveness of a community-based low intensity exercise programme for ambulatory stroke survivors

Purpose.?To establish the feasibility and effectiveness of a community-based exercise programme for ambulatory patients with stroke discharged from rehabilitation

Method.?Eighteen participants were recruited 3–12 months after onset of first stroke. Using a time series experimental design, the group completed a baseline period of 4 weeks (A1), a group exercise programme of low-intensity progressive resistive exercise and functional tasks for lower limb muscles (B) and repeat assessment after cessation of exercise (A2). Fitness instructors delivered sessions at Leisure Centres twice weekly for 14 weeks with physiotherapy support and the minimum attendance requirement was 16 sessions. Measures included muscle strength, gait velocity, Berg Balance Scale and Nottingham Extended Activities of Daily Living.

Results.?Lower limb muscle strength improved after training (ANOVA, p?<?0.02). Paretic knee extension strength increased from 43.4?±?5.9 to 60.4?±?6.8 Nm after 16 exercise sessions. Walking velocity increased significantly (ANOVA, p?<?0.001), from 0.54?±?0.07 to 0.75?±?0.08 m/s (t?=??3.31, p?<?0.01). Balance and everyday function were also significantly improved (p?<?0.003). There were marked individual variation in the response to training, and those who completed additional training did not show benefit.

Conclusions.?This community-based exercise programme was feasible and delivered positive improvements in physical function for participants. Further issues raised for investigation include the individual response to training and the benefits of extended training.     

痉挛型脑瘫患儿个体化康复治疗前后步态特征分析

目的:采用三维步态分析定量评价痉挛型脑瘫患儿下肢步态特征,为其下肢功能的康复疗效提供量化评定依据。方法:选取我院10例脑瘫患儿为观察组,再将12例健康儿童为对照组,应用三维运动捕捉系统采集2组的步态时空参数及运动学参数,根据评定结果为观察组制定个体化康复训练,在训练1个月前后分别对观察组采用粗大运动功能评定(GMFM)、Berg平衡量表(BBS)、改良Ashworth肌张力评定量表(MAS)及三维步态分析系统进行评定。结果:治疗1个月后,观察组GMFM和BBS评分较治疗前均明显提高(均P<0.01),MAS评分较治疗前明显下降(P<0.01)。观察组步态周期和跨步时间较治疗前均明显降低(均P<0.05),步频、跨步长、步长及髋、膝关节的关节活动度和屈曲最大角度以及踝关节的关节活动度较治疗前均明显增加(P<0.05,0.01);观察组治疗前后较对照组比较,步频、步速、跨步长及步长均明显降低(均P<0.01),除了膝关节屈曲最大角度差异无统计学意义,其余髋、膝及踝关节各运动学参数均明显增加(均P<0.01)。结论:三维步态分析可以量化评定脑瘫患儿的下肢运动功能,能为患儿康复治疗方案的精确制订及疗效评估提供客观科学依据。     

The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy

Purpose.?To assess the effectiveness of a hinged ankle-foot orthoses on gait impairments and energy expenditure in children with hemiplegic cerebral palsy (CP) whom orthoses were indicated to control equines.

Method.?Eleven children (seven males, four females) who had a diagnosis of hemiplegic cerebral palsy were included in the study. Each child underwent gait analysis and energy consumption studies with and without ankle-foot orthosis (AFO). The AFOs were all custom-made for the individual child and had plantarflexion stop at 0° with no dorsoflexion stop. The Vicon 512 Motion analysis system was used for gait analysis. Walking energy expenditure measurements were done with breath by breath method using an open-circuit indirect calorimeter (Vmax 29c, Sensormedics, USA). All tests were carried out on the same day with enough resting period.

Results.?AFO application, as compared with the barefoot condition improved walking speed, stride length and single support time. Double support time was decreased significantly with AFOs and no change in cadance. Ankle dorsiflexion at initial contact, midstance and midswing showed significiant increase. Knee flexion at initial contact was decreased and no significant change in maximum knee extension at stance and maximum knee flexion at swing was obtained. The oxygen consumption was significantly reduced during AFO walking.

Conclusion.?The hinged AFO is useful in controlling dynamic equinus deformity and reducing the energy expenditure of gait in children with hemiplegic spastic cerebral palsy.     

Effect of balance training on postural balance control and risk of fall in children with diplegic cerebral palsy

Abstract

Purpose: The purpose of this study was to evaluate the effects of balance training on postural control and fall risk in children with diplegic cerebral palsy. Methods: Thirty spastic diplegic cerebral palsied children (10–12 years) were included in this study. Children were randomly assigned into two equal-sized groups: control and study groups. Participants in both groups received a traditional physical therapy exercise program. The study group additionally received balance training on the Biodex balance system. Treatment was provided 30?min/d, 3?d/week for 3 successive months. To evaluate the limit of stability and fall risk, participated children received baseline and post-treatment assessments using the Biodex balance system. Overall directional control, total time to complete the test, overall stability index of the fall risk test and total score of the pediatric balance scale were measured. Results: Children in both groups showed significant improvements in the mean values of all measured variables post-treatment (p?<?0.05). The results also showed significantly better improvement in the measured parameters for the study group, as compared to the control group (p?<?0.05). Conclusion: Balance training on Biodex system is a useful tool that can be used in improving postural balance control in children with diplegic cerebral palsy.

• Implications for Rehabilitation

• Postural problems play a central role in the motor dysfunction of children with diplegic cerebral palsy.

• Balance control is important in the competence in the performance of most functional skills.

• The Biodex Balance System is an important balance assessment and training tool.

• Balance training in children with cerebral palsy can improve performance in postural control.

     

佩戴踝足矫形器对痉挛型脑性瘫痪儿童足底压力步态的作用

背景:由于设计及方法的差异,佩戴蹀足矫形器对脑性瘫痪(脑瘫)儿童步行时运动学、运动力学、能耗等各方面的影响尚未取得统一的结果.目的:观察佩戴踝足矫形器对痉挛型脑瘫患儿足底压力步态特征的影响.方法:采用足底压力式步态分析系统对21例具有独立步行能力的痉挛型脑瘫儿童进行步态分析.分别记录同一天内、同一时间段、同一种身体状态下不佩戴踝足矫形器及佩戴踝足矫形器步行时每例脑瘫患儿足底压力式步态分析数据,包括时间参数、运动学参数以及各参数的绝对对称性指标,并进行对比.记录双足的足底压力重心偏移轨迹作为步行能力的定性直观观察指标,对比佩戴支具前后的足底压力重心偏移轨迹图并做对照描述.结果与结论:与未佩戴踝足矫形器相比,佩戴踝足矫形器使痉挛型脑瘫患儿步态周期时间缩短,步频增加(P<0.01).佩戴踝足矫形器步行时脑瘫儿童单足支撑期、单侧支撑期、单足摆动期、步态周期时间的绝对对称性指标值均较未佩戴矫形器时显著减少(P<0.05).痉挛型脑瘫儿童步行时双足的足底压力重心偏移轨迹表现出无序的特性,不能形成左右对称的蝴蝶状轨迹图.佩戴踝足矫形器后,足底压力中心偏移轨迹比未佩戴时有序,尖足步态患儿佩戴踝足矫形器后患足的足底压力偏移轨迹起始点后移.结果提示痉挛型脑瘫儿童佩戴踝足矫形器后步态周期时间缩短,步频增加,步态对称性改善,总体步行能力得到提高.足底压力式步态分析系统能以客观精确的数据和直观的图表表达,是评定脑瘫儿童步行能力的一种新型测试手段.     

“Strong and steady”: a community-based strength and balance exercise group for children with cerebral palsy

Abstract

Purpose: This study investigated the effect of an eight-week community-based strength and balance exercise group for children with cerebral palsy (CP). Method: Ten children with CP participated in the study (8–15 years; six male; GMFCS I?=?6, II?=?4; five diplegia; five hemiplegia). Muscle strength was assessed using dynamometry and functional strength tests (seated throw, distance jump, vertical jump). Balance was assessed using the Bruninks–Oseretsky Test of Motor Proficiency, the Movement Assessment Battery for Children (MABC), lateral and forward reach tests and the Timed-up and Go. Results: Muscle strength improved in dominant side elbow flexors, hip abductors, ankle dorsiflexors and ankle plantarflexors (p?=?0.018–0.042). Functional strength improved in seated throw (t?=?2.7; p?=?0.024), distance jump (t?= ?2.8; p?=?0.025) and lateral step-up (p?<?0.05). Balance improved on the MABC (t?=?2.4; p?=?0.040), lateral (p?<?0.05) and forward reach (p?<?0.05). Conclusion: This feasibility study translated research into sustainable practice, showing that a community-based, low dose, group exercise program can improve the balance and strength of children with CP within current funding capacity.

• Implications for Rehabilitation

• It has been known that strength and balance training in the clinical research setting with specialized equipment is effective for children with CP, but this study demonstrates the translation of research into clinical practice in a low-cost, low-dose group program.

• Significant gains in both muscle strength and balance can be achieved in an eight-week community-based gym group using simple equipment.

     

Comparative biomechanical analysis of gait in patients with central cord and Brown-Séquard syndrome

Abstract

Purpose: This is a pilot study with the aim to highlight the use of kinematic and kinetic analyses as an adjunct to the assessment of individual patients with central cord syndrome (CCS) and hemisection or Brown-Séquard syndrome (BSS) and to discuss their possible consequences for clinical management. Methods: The sample studied consisted of 17 patients with CCS, 13 with BSS and 20 control subjects (control group (CG)). Data were obtained using a three-dimensional motion analysis system and two force plates. Gait differences were compared between CCS, BSS walking at a self-selected speed and CG at both a self-selected and a similar speed to that of the patient groups. Results: The most relevant findings involved the knee and ankle, especially in the sagittal plane. In patients with CCS, knee flexion at initial contact was increased with respect to those in the BSS group (p?<?0.01). The ankle in the BSS group made initial contact with a small degree of plantar flexion. Conclusion: The use of gait biomechanical analysis to detect underlying impairments can help the physician to set a specific rehabilitation program in each CCS and BSS walking patient. In this group of patients, rehabilitation treatment should aim to improve gait control and optimise ankle positioning at initial contact.

• Implications for Rehabilitation

• In this study, gait differences between patients with CSS and BSS were evaluated with biomechanical equipment.

• The most remarkable differences were found in the knee and ankle sagittal plane due to ankle position at initial contact.

• In this group of patients, rehabilitation treatment should aim to improve gait control and to get a better ankle positioning at initial contact.

     

Efficacy of pulsed high-intensity laser therapy on pain,functional capacity,and gait in children with haemophilic arthropathy

Aim: The aim of this study was to evaluate the effects of pulsed high-intensity laser therapy (HILT) on pain, functional capacity, and gait in children with haemophilia.

Methods: Thirty children with haemophilia type A with ages ranging from 9 to 13 years were selected for this study. They were assigned randomly, into two equal treatment groups. The laser group received the traditional physical therapy programme plus active laser (total energy of 1500 J through three phases/3 sessions/week), whereas the placebo group received the same physical therapy programme plus placebo laser over three consecutive months. Baseline and post-treatment assessments used the visual analogue scale (VAS) to evaluate pain, a 6-min walk test (6MWT) to evaluate functional capacity, and the GAITRite^® system to evaluate gait parameters.

Results: Children in the laser group showed significant improvement in pain, functional capacity, and gait parameters compared to those in the placebo group (p?Conclusions: HILT is an effective modality in reducing pain, increasing functional capacity, and improving gait performance in children with haemophilic arthropathy.

• Implications for Rehabilitation

• Haemophilic arthropathy due to recurrent joint bleeding leads to physical, psychological, and socioeconomic problems in children with haemophilia and reduces their quality of life.

• Early physiotherapeutic interventions help to prevent and treat the sequelae of recurrent haemarthrosis.

• High-intensity laser therapy has been introduced as non-invasive and an effective physiotherapy modality for rapid pain control, with consequent improvement in children’s quality of life.

• High-intensity laser therapy should be used as an adjunct to exercise programme in the rehabilitation of children with haemophilic arthropathy.