Prevent Crippling Effects of Bleeding. As a result of repeated episodes of hemarthrosis, incompletely adsorbed blood in the joints, and limitation of motion, bone and muscle changes occur that result in flexion contractures and joint fixation. During bleeding episode the joint is elevated and immobilized. Active range-of-motion exercises are usually instituted after the acute episode. This allows the child to control the degree of exercise and discomfort. If an exercise program is instituted in the home, aphysical therapist or public health nurse may need to supervise compliance with the regimen. Rarely, orthopedic intervention, such as casting, application of travtion, or aspiration of blood, may be necessary to preserve joint function. Diet is also an important consideration, since excessive body weight can increase the strain on affected joints, especially the knees, and predispose the child to hemarthrosis. Consequently, calories need to be supplied in accordance with energy requirements.