title: Gait analysis in children with haemophilia: first Italian experience at the Turin Haemophilia Centre.
abstract: OBJECTIVE
  To investigate the functional status in haemophilia patients referred to an Italian paediatric haemophilia centre using gait analysis, verifying any differences between mild, moderate or severe haemophilia at a functional level.
  
  
  METHODS
  Forty-two patients (age 4-18) presenting to the Turin Paediatric Haemophilia Centre who could walk independently were included. Therapy included prophylaxis (n = 21), on-demand (n = 17) or immune tolerance induction + inhibitor (n = 4). Patients performed a test of gait analysis. Temporal, spatial and kinematic parameters were calculated for patient subgroups by disease severity and background treatment, and compared with normal values.
  
  
  RESULTS
  Moderate (35.7%) or severe (64.3%) haemophilia patients showed obvious variations from normal across a variety of temporal and spatial gait analysis parameters, including step speed and length, double support, swing phase, load asymmetry, stance phase, swing phase and speed. Kinematic parameters were characterized by frequent foot external rotation with deficient plantar flexion during the stance phase, retropelvic tilt, impaired power generation distally and reduced ground reaction forces. Both Gait Deviation Index and Gait Profile Score values for severe haemophilia patients indicated abnormal gait parameters, which were worst in patients with a history of past or current use of inhibitors and those receiving on-demand therapy.
  
  
  CONCLUSIONS
  Functional evaluation identified changes in gait pattern in patients with severe and moderate haemophilia, compared with normal values. Gait analysis may be a useful tool to facilitate early diagnosis of joint damage, prevent haemophilic arthropathy, design a personalized rehabilitative treatment and monitor functional status over time.
authors.affiliation: Transfusion Unit, Regional Reference Centre for Inherited Bleeding and Thrombotic Disorders, Turin, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Forneris
authors.affiliation: Department of Traumatology and Pediatric Orthopedics, Children's Hospital 'Regina Margherita', Turin, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Andreacchio
authors.affiliation: Transfusion Unit, Regional Reference Centre for Inherited Bleeding and Thrombotic Disorders, Turin, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Pollio
authors.affiliation: Bayer Healthcare SpA, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Mannucci
authors.affiliation: Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Franchini
authors.affiliation: University of Padua, Padua, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Mengoli
authors.affiliation: Transfusion Unit, Regional Reference Centre for Inherited Bleeding and Thrombotic Disorders, Turin, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Pagliarino
authors.affiliation: Transfusion Unit, Regional Reference Centre for Inherited Bleeding and Thrombotic Disorders, Turin, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Messina
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D042241:Early Diagnosis; D005260:Female; D005684:Gait; D006467:Hemophilia A / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007558:Italy; D007592:Joint Diseases / Q000175:diagnosis / Q000453:epidemiology*; D007719:Knee Joint / Q000473:pathology*; D008297:Male; D016138:Walking
keywords: arthropathy; children; gait analysis; haemophilia