Motor Proficiency of People With Bleeding Disorders Using the BOT-2 (TM)

The primary purpose of this study is to determine whether gross motor proficiency of children
and young adults with hemophilia falls below average, sex-specific normative data, using the
standardized motor assessment the Bruininks-Oseretsky Test of Motor Proficiency, Second
Edition (BOT-2™). The primary hypothesis is that children and young adults with hemophilia
perform at a lower level of gross motor proficiency compared to same-aged peers, despite
advances in care.

The secondary purpose is to establish whether there is a relationship between joint health
and level of gross motor proficiency. The secondary hypothesis is that history of
hemophilia-caused ankle, knee, or elbow arthropathy will result in significant differences in
gross motor proficiency within and between the populations of children and young adults with
hemophilia.

Background/justification/rationale With the advent of widely-used prophylactic treatment for
people with bleeding disorders, activity-limiting joint disease may be significantly reduced.
Research investigating joint health and aerobic capacity of boys with hemophilia, an X-linked
bleeding disorder, have shown no significantly different levels of functional ability when
compared to peers, though other parameters may continue to be lower. However, a recent
unpublished report of preliminary data using the Bruinicks-Oseretsky Test of Motor
Proficiency (BOT-2 tm), a standardized gross motor assessment tool, suggests that male
children and young adults with bleeding disorders function at a significantly lower level of
gross motor skills compared to normative, sex-specific data, established when standardizing
the BOT-2. This question is important in the determination of prognosis and intervention in
this population.

Study Design Research will be conducted utilizing a prospective, cross-sectional study design
to analyze the relationship between a diagnosis of bleeding disorder and gross motor
development in male children and young adults as well as the association between joint health
and gross motor development. As diagnosis of hemophilia is extremely rare in women and
statistical analysis requires use of sex-specific normative data, this research study will
focus strictly on the population of boys and young men with a diagnosis of hemophilia.

Once informed consent and assent (if applicable) is obtained, data will be collected by OHSU
research personnel during a regular clinic visit at the Hemophilia Treatment Center (HTC). If
a subject is unable to visit the clinic, informed consent/assent and study visit may be
performed at the subject's home.

Recruitment Methods Potential subjects will be recruited during any clinic visit to the
Hemophilia Treatment Center at OHSU. An IRB-approved recruitment letter may also be mailed to
the Hemophilia Treatment Center's mailing list to recruit potential subjects.

Consent Process Informed, face-to-face consent will be sought prior to the collection of any
data. Following a detailed explanation of the components of the study, the parent or legal
guardian of the subject, if the subject is under 17, or the subject themselves may sign the
informed consent. Assent will be obtained from patients aged 7-17. All children eligible for
participation in the study and under the age of 17 will be assessed for their understanding
prior to signing the assent form. Should the subject or their parents be non-English
speaking, an in-person interpreter will be present for the entire consenting process to
ensure understanding.

Study Procedures Data collection will take place in one clinic visit or one home visit by
OHSU personnel. An interpreter will be scheduled should the family require an interpreter
during a home visit or clinic visit. If data collection is not completed in one visit, a
return visit, either to the clinic or to the home, will be conducted.

Clinical Data Current clinical data will be collected from the subject's medical record.
Clinical data includes body composition recorded as Body Mass Index (BMI), type of bleeding
disorder, severity, presence of inhibitor, method of management, and age. If a current height
and weight is not available in the chart and the data collection occurs in the subject's
home, appropriate devices for measurement of height and weight will be supplied to the
investigators for this visit. This data will be transcribed onto the data collection sheet
for each subject. Collected data will then be deposited into the data collection spreadsheet.

In addition, existing hemophilia repositories IRB # e5102 & IRB # e7074 will be accessed for
each subject in the study to collect the following data: clinical joint health, as documented
using the Hemophilia Joint Health Score (HJHS), and presence of chronic synovitis. Collected
data will be deposited into the data collection spreadsheet.

Range of Motion During the subject's clinic or home visit, assessments of range of motion of
hip flexion and extension, knee flexion and extension, ankle dorsiflexion and plantarflexion,
elbow flexion and extension, forearm pronation and supination, and shoulder flexion will be
taken using a goniometer and musculoskeletal landmarks according to standard clinical
practice at the Hemophilia Treatment Center at OHSU.

Strength Subjects grip strength will be measured with hand held dynamometry. The Jamar
Hydraulic Hand Dynamometer will be used to assess the bilateral grip strength in each
subject, using the protocol set forth in the Jamar Owner's Manual.

Gross Motor Proficiency Gross motor proficiency will be assessed utilizing the following
subtests of the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2™):
Upper-Limb Coordination, Bilateral Coordination, Balance, Running Speed, and Agility and
Strength. Prior to administration of the subtests, the researcher will determine the
subject's hand and foot preferences for writing, throwing, and kicking, to be used within
each subtest that requires use of a preferred extremity. Testing environment and test
administration will conform to the protocol set out in the BOT-2™ Administration Manual.

Inclusion Criteria:

- Patient of the Hemophilia Treatment Center at OHSU

- Male

- Aged 4 years, 0 months to 21 years, 11 months

- Diagnosis of bleeding disorder

Exclusion Criteria:

- Acute bleed or injury in the last two weeks that prevents activity

- Diagnosed developmental delay