1. Physical Therapy and Wellness Promotion
Heidi Lane, DPT, PT, PCS
Hemophilia Alliance Members’ Fall Meeting
9/18/2017

2. Session Topics Comprehensive/integrative care
Describe physical therapy
Discuss how PTs promote wellness
Integrating physical therapy into your HTC

3. What does physical therapy look like at your HTC?
Gut reaction…

4. pediatric hematologist nurse coordinator psychosocial professional
MASAC Document #132: Standards and Criteria for the Care of Persons with Congenital Bleeding Disorders (Revised April Retrieved NHF.org, 09/17/2017).
The Core Team:
hematologist
pediatric hematologist
nurse coordinator
psychosocial professional
coagulation laboratory director
ideally, include genetics counselor and physical therapist
What is available to us for guidance on how to do this???

5. MASAC Document #132: Standards and Criteria for the Care of Persons with Congenital Bleeding Disorders (Revised April Retrieved NHF.org, 09/17/2017).
The Core Team:
hematologist
pediatric hematologist
nurse coordinator
psychosocial professional
coagulation laboratory director
ideally, include genetics counselor and physical therapist

6. MASAC Document #132: Standards and Criteria for the Care of Persons with Congenital Bleeding Disorders (Revised April Retrieved NHF.org, 09/17/2017).
”Each core team member should participate in each comprehensive clinic as a full member of the assessment team, including the post-clinic discussion, identifying and talking with the patient and family regarding their special needs and providing follow-up with patients as appropriate.”
Among other things….

7. “The Panel suggests that a hematologist, a specialized hemophilia nurse, a physical therapist, a social worker, and round-the-clock access to a specialized coagulation laboratory be part of the integrated care team, over an integrated care team that does not include all of these components.”
Guidance for comp/integrative hemophilia care

8. “The Panel suggests that a hematologist, a specialized hemophilia nurse, a physical therapist, a social worker, and round-the-clock access to a specialized coagulation laboratory be part of the integrated care team, over an integrated care team that does not include all of these components.”

9. Who is a physical therapist?
If the ideal model is to include PT – who is a PT

12. Little to no exposure to bleeding disorders in PT curriculum
Physical Therapists “Transforming society by optimizing movement to improve the human experience” APTA Vision (2013)
Licensed professionals
Masters or clinical doctorate - from an accredited education program
Specialists in activity, exercise and rehabilitation
Little to no exposure to
bleeding disorders in PT curriculum

13. Physical Therapy Practice Guidelines for evaluation of person’s with bleeding disorders (MASAC #238)
“The physical therapy evaluation… is aimed at identifying musculoskeletal limitations and vulnerabilities which impact function and quality of life.”
musculoskeletal and functional status
develop educational and exercise programs
perform pre- and post-operative rehabilitation and conservative treatment protocols
maximize independent functional status of all persons seen at the comprehensive clinic.
Some guidance – for PTs in HTCs
MASAC Document #238. Approved 8/15/15 and adopted 11/13/15.

14. Physical Therapy Practice Guidelines for evaluation of person’s with bleeding disorders (MASAC #238)
range of motion
evaluation for assistive/adaptive devices
strength
orthopedic joint examination
growth and development
pain assessment
change in status between visits
sensation
posture
treatment interventions
gait (ambulation)
imaging studies may be indicated
functional status
MASAC Document #238. Approved 8/15/15 and adopted 11/13/15.

15. Promoting health and wellness – Young child with hemophilia at annual comprehensive clinic visit
What does this look like?

16. Young child with hemophilia at annual comprehensive clinic visit
Examination/Evaluation
Patient priorities and concerns
Musculoskeletal evaluation
Functional evaluation
Gait, Balance, sport-related
Communicating findings to Patients/Families
Education
Home exercise program
Wellness promotion
Physical activity, diet, stress/anxiety etc
What does this look like?
Developmentally appropriate and culturally sensitive manner.

17. Balance/Proprioception - assessment

18. Working on balance at home

19. Ankle rehabilitation
Strengthening
Balance
Courtesy S. Funk

20. Promoting health and wellness in the athlete with hemophilia
Bleed clinic visit
15 with <1% FIX and history of repeated quadriceps muscle bleeds
Pt goal: continue with competitive basketball
PT intervention:
Education, Education, Education
Return to sport criteria
Prevention of re-bleed
Remaining active…and ultimately….

21. Promoting health and wellness in the athlete with hemophilia
ultimately

22. Promoting health and wellness in the patient with hemophilia who is medically complicated

23. Promoting health and wellness in the patient with hemophilia who is medically complicated
Comprehensive clinic visit:
36 y.o. with severe Hemophilia A, history of B total knee replacements, liver failure, comorbidities
limited elbow extension and LE weakness
Pt goal: attend daughter’s soccer game (walk across the field) and concerned about getting on/off the toilette
PT interventions
hiking poles
elevated commode
mini squats
36 y.o. with severe Hemophilia A, history of B total knee replacements – where he is today.
Main impairments: limited elbow extension (B hiking poles), LE weakness
Wants to be able to go to daughter’s soccer game and has difficulty getting on/off the toiler
Through our assessment:
B hiking poles, elevated commode, Mini squats

24. Promoting health and wellness in the girls and women with bleeding disorders
PT intervention:
Education
Bleed recognition and management
Physical activity
Problem solve…
EducationEmpowering women to get moving, despite chronic pain, e

25. What does physical therapy look like in your HTC?
Given what we discussed today, is your HTC optimizing physical therapy?
Do you have PT, has your experience been good??

26. PTs Need support Partners modules (Basic)
Partners “Advanced for Physical Therapists”
NHF Annual Meeting
Colleagues in Hemophilia

28. Thank you!!

29. References
MASAC Document #132: Standards and Criteria for the Care of Persons with Congenital Bleeding Disorders. NHF;s Medical and Scientific Advisory Committee. Revised April NHF-McMaster Guideline on Care Models for Haemophilia Management. PAI, et al. Haemophilia (2016), 22 (Suppl. 3), 6–16