e. decreasing pain, swelling and warmth, but secondarily to achieve the functional level the PWH had prior to the last bleed [95]. This will be reached step-by-step, using

functional milestones, a method introduced recently in haemophilia care. MK-1775 This method originates from regaining functional independence after hip fractures and is totally focused on the perspective of the patient [96]. This means, for example, that a PWH will make small steps from being restricted to bed-rest to reaching full daily functioning, and each step in the process will be marked by exercises needed to perform the activities required to advance to the next stage. Physiotherapy following chronic conditions such as synovitis and haemophilic arthropathy also starts from setting functional goals. This time achievements Lumacaftor are limited by the loss of flexibility, strength, proprioception, balance and aerobic capacity. This process evolves slowly [97], so optimizing all of these items is not a goal in itself, but a means

to reach an optimal functional level for that particular PWH. Functional goals reached should be stabilized, so that the PWH is aware of, and capable of maintaining this level over an extended period of time. If not, the conditions need to be readdressed. Practically put, the best way to view this method is similar to the manner in which one learns a new sport: you practise those skills you want to become proficient in performing. An example would be using the sport-specific activity of throwing darts as a functional exercise in the rehabilitation of an elbow joint. Alternatively, one may use occupational tasks to achieve the same results. medchemexpress With a patient who has developed adaptive muscle shortening in the upper extremity, using reaching tasks at work allows a significant degree of functional success to be maintained,

while therapeutically addressing the established pathology. It should be noted, however, that precautions need to be taken when utilizing this approach because of the difficulty of monitoring whether or not susceptible tissues such as synovium or cartilage are being negatively impacted by end-range repetitive micro-trauma. One method of addressing this potential problem is to apply a hinged, lockable brace that prevents potentially damaging close-packed positions of the joints from being reached. As the level of tissue irritation subsides, greater amounts of movement may be allowed by adjusting the position of the ROM lock. These braces though useful, are not always available, can be costly and never eliminate the responsibility of the therapist to closely monitor the effects of the exercise programme. To measure progression in an objective way is of the utmost importance. In acute situations measurements are mostly performed as ROM and circumference of a joint, and strength of an extremity. Regarding function, one often asks the PWH about their physical activity level prior to the last bleed.