Abstract
A 49-year-old man, treated with coagulation factor VIII since being diagnosed with hemophilia A at age four, was admitted to our hospital with a massive intraabdominal hemorrhage. Although he had hemophilic arthropathy, and arthrodesis of the right knee from the age of thirteen, he had been able to live independently and engage in limited social activity. However, a month of immobilization due to intensive medical treatment for the intra-abdominal hemorrhage resulted in severe impairment from multiple joint contractures and generalized muscle atrophy. Following consultation with our department, we prescribed physical and occupational therapy including physical modalities for joint contracture, ROM exercise, isometric muscle strengthening, underwater exercise and activity training in combination with a daily prophylactic infusion of coagulation factor VIII. After 5 months of intensive rehabilitation, the patient's physical functioning was restored and he was able to walk outdoors and perform daily activities independently. During the course of inpatient rehabilitation, not a single hemorrhage episode occurred. Adult hemophilic arthropathy patients may tend to become severely disabled due to acute medical problems. Although recovery of physical function may take much time, intensive rehabilitation combined with prophylactic use of coagulation factor may be an effective treatment in cases such as this.
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