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THE EFFICACY OF KINESIOTAPING ON LOCOMOTOR ABILITIES IN CEREBRAL PALSY: A CASE STUDY

Deepika P. Metange*, Madhavi V. Lokhande

ABSTRACT Abstract- Objective of the study was to investigate the effect of kinesiotaping along with conventional treatment protocol on locomotor abilities in a patient with spastic diplegic cerebral palsy. Design: A single case study. Patient: A 5 year 3 months old female patient diagnosed as cerebral palsy shortly after birth. Intervention:Motor ability of the patient was assessed using clinical measures ankle and knee tardieu scale, and Gross Motor Function Measure-88, [GMFM]. The goal area score was 71.66% which included standing and locomotion dimension. Intervention included a session of conventional physical therapy consisting of 1 hour session repeated 3 days a week for a period of 4 weeks based on neurodevelopmental treatment. It included stretching, weak muscle strengthening exercises, postural, balance and gait training exercises and kinesiotaping Taping was applied to lateral hamstring muscle bilaterally using facilitatory approach. Changes in locomotor abilities were observed by means of video recording and observing changes in the gait parameters. There was an increase of 18.85% in the GMFM goal score. Also the gait pattern demonstrated more stable and symmetrical locomotor pattern.. Conclusion: The findings show that kinesiotaping when combined with conventional physical therapy can improve locomotor abilities and thereby can be a useful adjunct to therapy. Keywords: Kinesiotaping; cerebral palsy; locomotor abilities; gait

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INTRODUCTION

Limitations in the motor activity of children with cerebral palsy (CP) are the consequence of a failure to acquire appropriate motor schemas,

caused by arrested normal brain maturation. Nevertheless, some of these children, exploiting their few available resources1, manage to walk, thanks to the emergence of

atypical but still functional locomotor patterns2, 3. However, these patterns can lead to long-

term instability, contractures, and deformities4. Common treatments for children with CP include botulinum toxin, serial casting, orthopaedic surgery, and orthoses5. These interventions are designed to act at the peripheral level, without particularly aiming at

promoting more normal motor development at the central level. Kinesiotaping may be a solution in trying to reach this objective. . Although it has been used in the orthopaedic and sports settings, it is gaining acceptance as an adjunct in the treatment of other impairments. The use of Kinesiotaping in

conjunction with the childs regular therapy program may favourably influence the cutaneous receptors of the sensorimotor system

resulting in subsequent improvement of voluntary control and coordination6, 7. This intervention could favour the integration of therapy and daily activities and increase participation in social life. Nevertheless, it has

been only applied infrequently in these children8, 9. Important intervention objectives are to strengthen weakened muscles, to improve the quality and active range of motion,

and to improve the childs level of independence with activities of daily living. Kinesiotaping, when applied properly, can theoretically improve the following: strengthen

weakened muscles, control joint instability, assist with postural alignment, and relax an over-used muscle. When the application procedure is followed correctly, the taped area can be used to facilitate a weakened muscle or to relax an overused muscle. The method for applying the tape varies depending on the specific goals: improve active range of motion,

relieve pain, adjust malalignment, or improve lymphatic circulation (Kase, Wallis, &Kase, 2003)10. The variables in tape application include the amount of prestretch applied to the tape, position of the area to be taped, treatment goals (pain reduction, subcutaneous blood flow, improved muscle function)11. Therefore the purpose of the case study was to investigate the efficacy of kinesiotaping along with

conventional physical therapy on gait in a

patient diagnosed as spastic diplegic cerebral palsy.

METHODOLOGY

Patient was a 5 year 3 months old female diagnosed as spastic diplegic cerebral palsy shortly after birth. She was going to normal school and parents came with chief complaints of walking on toes and difficulty in independent walking. She was on regular physiotherapy treatment 2 years back which

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was later stopped and was not using any orthosis. Informed consent was taken from the parents and the patient prior to the study. Motor ability of the subject was assessed using clinical measures ankle and knee tardieu scale, and Gross Motor Function Measure-88, [GMFM] 12. On observational gait analysis the patient walked on toes, had bilateral in toeing, mild hip and knee flexion and scissoring gait. The total score on GMFM was 46.8%. The grand total score or goal area score was 71.66% which included standing and locomotion dimension. Intervention included a session of conventional physical therapy consisting of 1

hour session repeated 3 days a week for a period of 4 weeks based on neurodevelopmental treatment (derived from the Bobath concept)13. It included stretching, weak muscle strengthening exercises, postural,

balance and gait training exercises and kinesiotaping. After thorough assessment it was

found that lateral hamstrings on either side were weak while medial hamstrings on both the sides were overactive. Specifically right side hamstring showed more hypertonia and over activity while walking which was manifested as in-toeing gait. Also bilateral plantar flexors showed hypertonia, which manifested as toe walking. Ankle plantar flexors showed more of static component of spasticity, due to which plantar flexors were not assessed for kinesiotaping.

Prior to kinesiotaping, basic assessment was

done to decide on the technique of application. Active knee flexion in prone position was used as outcome measure. Active knee flexion in

prone showed excessive internal rotation of tibia right more than left because of hyperactive medial hamstrings which could be the cause of bilateral scissoring during gait. Change in lateral hamstring strength was assessed by using muscle technique of kinesiotaping.

Assessment revealed that the muscle gliding towards origin i.e. ischial tuberosity gave better recruitment of lateral hamstrings and thus better quality of active knee flexion.

2 Inches wide, pink coloured kinesio tape was applied by using I technique. Pink coloured tape was preferred as it has facilitatory effect on a muscle performance. The length of the

tape was measured with the muscle in maximally stretched position .Because of balance issues in standing this measurement was done in supine with hip knee flexion. Base of the tape was applied in prone position near ischeal tuberosity with the muscle in resting position (without any stretch).The base of tape was activated by rubbing a tape. The rest of the tape was applied carefully over the lateral hamstrings without giving any stretch to the

tape. Again tape was activated by rubbing it. Lateral hamstring function was reassessed by active knee flexion, which showed significant improvement in prone as well as in standing & walking. Changes in gait pattern were observed by means of video recording.

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Fig 1. Findings seen on observational gait analysis.

RESULTS AND DISCUSSION Results showed the acquisition of more incremented GMFM. The improvement in the goal GMFM score was 90.4% which was with the difference of 18.85% post treatment. Also the gait pattern demonstrated more stable (reduced step width) and symmetric (more similar step length and reduced scissoring) locomotor patterns. However, the equines foot

was not corrected by the taping. Muscles which are usually tackled are antagonist to spastic muscles. But as spastic muscles are also weak,

and there is need to work upon these weak muscles too. Also, kinesiotaping increases

proprioceptive and tactile information and therefore restores optimal muscle length,

thereby providing a foundation for normal firing and recruitment patterns. Observed functional improvements were not accompanied by evident changes in the ankle and knee tardieu scale values. This result could

represent a specific difference between kinesiotaping and serial casting. Serial casting, in fact, typically leads to short-term improvements on passive range of motion, but does not always improve active functioning14, 15 since it may lead to muscle wasting, and weakening spastic and non-spastic muscles5. Kinesiotaping, conversely, provides support to the weak muscles, facilitating their normal

activity. Further randomized controlled investigations on wider samples are certainly needed to assess effectively the effects of the taping treatment. Nevertheless, the fact that

observed gait improvements occurred during the treatment period, demonstrate the efficacy of kinesiotaping along with conventional

physical therapy. Also, parents reported positive feedback about the effects of the kinesiotaping on childs participation in social activities, locomotor ability, and tolerability to the treatment which could also be an advantage

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over use of orthosis. In conclusion,

kinesiotaping seems to be a promising intervention for improving locomotor function

in children with CP and a very useful adjunct to the conventional therapy.

Fig. 2. Graph demonstrating effect on GMFM scores pre and post intervention.

Fig 3. Changes seen in the gait pattern pre and post intervention.

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CORRESPONDENCE

* Assistant professor, Terna Physiotherapy College, Nerul, Navi Mumbai, INDIA. Email: deepikapuri12@gmail.com