# Assessment of Static Balance with and Without Cognitive Dual Task in Children with Haemophilia: A Cross-Sectional Study

## TL;DR

Children with haemophilia show worse balance, especially when performing tasks that require both physical and mental effort, compared to healthy children.

## Contribution

This study is the first to compare static balance and dual-task performance in children with haemophilia and healthy controls using the Wii Balance Board®.

## Key findings

- Children with haemophilia had significantly worse balance performance under unipedal and dual-task conditions.
- They engaged in less frequent and less intense physical activity compared to healthy controls.
- Balance deficits were more pronounced under cognitive dual-task conditions, suggesting integrated motor-cognitive impairments.

## Abstract

Background: Balance is an essential motor skill that enables individuals to maintain a stable posture and perform daily activities safely. Dual-task assessments are widely used to evaluate the integration of motor and cognitive functions in paediatric populations, but their effects on postural control in children with haemophilia (CwH) remain poorly understood. The objective was to analyse and compare static balance performance under single-task and cognitive dual-task conditions between CwH and age-matched healthy controls (HC). Methods: This comparative cross-sectional study included 34 CwH and 32 HC aged 8–12 years. Balance was assessed using the Wii Balance Board® under six conditions: bipedal, bipedal with cognitive task, and dominant and non-dominant unipedal (with and without cognitive task). Primary outcome variables included overall stability index, total velocity, and sway area. Physical activity habits were also recorded in both groups with an ad hoc questionnaire. Among CwH, joint health was measured with the Haemophilia Joint Health Score (v2.0), and joint effusion/synovial hypertrophy was evaluated by ultrasound. Results: CwH showed significantly poorer performance in all variables, primarily under unipedal dominant/non-dominant dual-task conditions (p < 0.05) with percentage differences ranging from approximately 15% to over 60%. CwH reported lower-intensity and shorter-duration physical activity than HC. Conclusions: CwH demonstrates impaired balance, especially under unipedal and cognitive demands. Assessment of balance alongside dual-task performance may help detect subtle deficits not captured by only static balance assessment. These findings may suggest the incorporation of dual-task training into balance training programmes for this population.