A new study has found an association between the dynamic motor control index during walking (Walk-DMC) and joint damage in people with hemophilic arthropathy, particularly in terms of pain with knee flexion and Hemophilia Joint Health Score (HJHS).

The study, published in Haemophilia, suggests that the Walk-DMC could be a potentially useful tool for clinicians who are monitoring disease progression in people with hemophilic arthropathy.

Clinicians currently use the HJHS, ultrasound, and magnetic resonance imaging to assess pain and joint impairment in people with hemophilic arthropathy. In addition, the Walk-DMC uses surface electromyography (sEMG) to provide a summary metric of neural control of gait.

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“(People with hemophilic arthropathy) with an altered Walk-DMC showed more years with arthropathy, experienced more pain, and had a higher knee flexion contracture and greater joint and gait impairment,” the authors noted. “However, the assessment of the Walk-DMC index is sensitive to the number of muscles used for sEMG measurements.” The authors proposed that a minimum of 8 leg muscles should be measured by sEMG when assessing the Walk-DMC.

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Twenty-two men with moderate or severe hemophilia and 15 age-matched healthy controls were included in the study, and the limb with the highest HJHS score was assessed with sEMG to determine muscle activity patterns and gait cycle events. Using these data, the Walk-DMC was calculated for each individual. Neural control was determined to be altered in 13 of the 22 men.

In addition to having more years with arthropathy and higher HJHS scores, the participants with altered Walk-DMC scores started prophylactic treatment later than those without an altered index and showed greater coactivation of hip, knee, and ankle joint muscles.

The authors emphasized the fact that additional factors, such as kinesiophobia, pain processing, and catastrophism, can also impact neural control, and their contribution to the status of people with hemophilic arthropathy should be explored in future investigations.


Cruz-Montecinos C, Maas H, Cerda M, Pérez-Alenda S. Altered neural control of gait and its association with pain and joint impairment in adults with haemophilic arthropathy: clinical and methodological implications. Haemophilia. Published online February 24, 2022. doi:10.1111/hae.14517