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Level 4 Pilot Study Investigating the Effects of Kinesio Taping in an Acute Pediatric Rehabilitation Setting. 0

Level 4 Pilot Study Investigating the Effects of Kinesio Taping in an Acute Pediatric Rehabilitation Setting. 0

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104
 January/February 2006, Volume 60, Number 1
Pilot Study: Investigating the Effects of Kinesio Taping
®
in anAcute Pediatric Rehabilitation Setting
Audrey Yasukawa,Payal Patel,Charles Sisung
OBJECTIVES.
The purpose of this pilot study is to describe the use of the Kinesio Taping
®
method for theupper extremity in enhancing functional motor skills in children admitted into an acute rehabilitation program.
METHOD.
Fifteen children (10 females and 5 males; 4 to 16 years of age), who were receiving rehabilitationservices at the Rehabilitation Institute of Chicago participated in this study. For 13 of the inpatients, this wasthe initial rehabilitation following an acquired disability, which included encephalitis, brain tumor, cerebral vas-cular accident, traumatic brain injury, and spinal cord injury. The Melbourne Assessment of Unilateral UpperLimb Function (Melbourne Assessment) was used to measure upper-limb functional change prior to use ofKinesio Tape
®
,immediately after application of the tape, and 3 days after wearing tape. Children’s upper-limbfunction was compared over the three assessments using analysis of variance.
RESULTS.
The improvement from pre- to posttaping was statistically significant,
(1, 14) = 18.9;
<.02.
CONCLUSION.
These results suggest that Kinesio Tape may be associated with improvement in upper-extremity control and function in the acute pediatric rehabilitation setting. The use of Kinesio Tape as an adjunctto treatment may assist with the goal-focused occupational therapy treatment during the child’s inpatient stay.Further study is recommended to test the effectiveness of this method and to determine the lasting effects onmotor skills and functional performance once the tape is removed.
Yasukawa, A., Patel, P., & Sisung, C. (2006). Pilot study: Investigating the effects of Kinesio Taping
®
in an acute pediatricrehabilitation setting.
American Journal of Occupational Therapy, 60,
104–110.
Introduction
Kinesio Tape
®
is a relatively new technique used in rehabilitation programs to treatupper-arm or hand pain. Although it has been used in the orthopedic and sportssettings, it is gaining acceptance as an adjunct in the treatment of other impair-ments. The use of Kinesio Taping
®
in conjunction with the child’s regular therapy program may favorably influence the cutaneous receptors of the sensorimotor sys-tem resulting in subsequent improvement of voluntary control and coordinationof the upper limb.Children admitted into an acute rehabilitation program receiveintensive daily therapies during their inpatient stay. Important intervention objec-tives are to strengthen weakened muscles, to improve the quality and active rangeof motion, and to improvethe child’s level of independence with activities of daily living.Kinesio Taping
®
,when applied properly, can theoretically improve the follow-ing: strengthen weakened muscles, control joint instability, assist with posturalalignment, and relax an over-used muscle. Kinesio Tex
is the brand name of thetape. The Kinesio Tex tape is more elastic compared to conventional rigid tape.The nonstretch rigid tape is used to limit unwanted joint movement or to protectand support a joint structure (Grelsamer & McConnell, 1998; Macdonald, 1994).However, data suggest that regular athletic tape does not restrict joint movement.Bragg et al. (2002) found that athletic tape loses its ability to restrict joint motionafter 15–20 minutes of exercise. Therefore, the effects of taping may be due to thecutaneous stimulation of the sensorimotor and proprioceptive systems (Simoneau,Degner, Kramper, & Kittleson, 1997). Taping provides immediate sensorimotorfeedback regarding functional abilities. With the Kinesio Tape applied, patients
Audrey Yasukawa, MOT,OTR, is Chief of OccupationalTherapy, LaRabida Children’s Hospital, East 65th Street atLake Michigan, Chicago, Illinois 60649;ayasukawa@larabida.orgPayal Patel, OTR, is Staff Occupational Therapist,Rehabilitation Institute of Chicago, Chicago, Illinois.Charles Sisung, MD, is Medical Director, Pediatric andAdolescent Rehabilitation, Rehabilitation Institute ofChicago, Chicago, Illinois.
 
The American Journal of Occupational Therapy 
105
often report symptom relief, improved comfort level, or sta-bility of the involved joint. The elasticity of Kinesio Tapeconforms to the body, allowing for movement. The tape islatex-free, very thin, and stretches in the longitudinal plane.Kinesio Tape has been suggested to provide proprioceptiveinput in the acute phase of the injury process for lateralankle sprain (Murray & Husk, 2001). Healthy subjects with good proprioception did not benefit from patellar tap-ing on the knee joint. However, patellar taping for thosehealthy subjects with poor proprioception appeared toenhance proprioception (Callaghan, Selfe, Bagley, &Oldham, 2002). The elastic quality and proprioceptiveinput as well as subtle biomechanical factors may accountfor the functional changes observed. When the application procedure is followed correctly,the taped area can be used to facilitate a weakened muscleor to relax an overused muscle. The method for applyingthe tape varies depending on the specific goals: improveactive range of motion, relieve pain, adjust misalignment,or improvelymphatic circulation (Kase, Wallis, & Kase,2003). Theoretically Kinesio Tex is applied based on treat-ment goals. The variables in tape application include theamount of prestretch applied to the tape, position of thearea to be taped, treatment goals (pain reduction, subcuta-neous blood flow, improved muscle function). Unpublisheddata (Kase & Hashimoto, 1997) suggest that applyingKinesio Tex to areas most likely to affect blood circulation,superficial blood flowwas increased in all cases whereunderlying neuromusculoskeletal pathology (pain, tingling,swelling in upper extremity, patella tendonitis, osteoarthri-tis, hypertension) was present but demonstrated no effecton blood flow in subjects who did not display any patholo-gy.This limited case report suggests that Kinesio Tapingmay affect superficial blood flow in cases where pathology is present and haveno effect on superficial blood flowmea-sures on normal, healthy subjects.Various taping approaches havebeen adapted to beused clinically in rehabilitation centers for patients who pre-sent with shoulder subluxation or shoulder pain. Tapingcan be used as an adjunct during the rehabilitation programto enhance functional recovery. For the treatment of anteri-or shoulder impingement, taping was applied to provideproximal scapular stability. The application of the scapulartaping used in conjunction with a home exercise programprovided relief of shoulder pain and improved overheadreach (Host, 1995; Schmitt & Snyder-Mackler, 1999). Westarted using Kinesio Taping at the RehabilitationInstitute of Chicago as an adjunct to therapy in 1998.Typically children who are admitted into an acute pediatricrehabilitation program at the Rehabilitation Institute of Chicago receive 3 hours or more of therapy throughouttheir inpatient stays. Prior to the intensive rehabilitationprogram, the Functional Independent Measure (FIM
)isused initially to measure functional outcomes during thelength of the inpatient stay (Hamilton et al., 1987). The agerange is from 8 years of age to adult and six domains areassessed: self-care, mobility, locomotion, sphincter control,communication, and social cognition. The WeeFIM
®
mea-sures independent rating and the developmental level of theage of the child from 6 months to 7 years of age (
Guide totheUniform Data Set for Medical Rehabilitation for Children
). The WeeFIM and the FIM present uniform datadescribing the severity of disability and the need for assis-tance. Both instruments are used as an initial evaluation tomeasure the basic functional abilities in the six domainsprior to the initiation of the therapy program. By consider-ing the child’s developmental level and physical ability,intervention can be targeted at the essential skills compo-nent necessary for improved independence in self-care func-tion (Shepherd, Procter, & Coley, 2001). The therapy pro-gram may consist of a daily morning self careprogram,strengthening exercises through functional activities for theinvolved upper extremity, improvement of fine motor con-trol, and coordination.The secondary musculoskeletal effects of a neurologicalassault include muscle weakness or imbalance, pain, limit-ed active and passive range of motion, and poor functionaluse (Hertling & Kessler, 1996). The treatment approach of taping is difficult to objectively measureas a viable tool touse to assist with promoting function of the upper extrem-ity. Limited data exist to support the effectiveness of Kinesio Taping as an adjunct to treatment to facilitateattainment of functional motor skills. Therapists often usequalitativeassessment tools to measure their results, includ-ing subjective clinical observation, anecdotal reporting, ordescriptiveterminology to assess upper-extremity move-ment quality. If evidence supports the use of taping thiscould ultimately justify the rationale for taping children with upper-extremity weakness.The primaryobjective of this pilot study was todescribe functional hand and arm skills in children admit-ted into a rehabilitation program subsequent to use of Kinesio Taping.
Method
Subjects 
Fifteen children (5 males, 10 females, 4–16 years of age)admitted to the pediatric inpatient program at theRehabilitation Institute of Chicago participated in thisstudy.Informed consent was obtained from the guardiansin accordance with the Institutional Review Board, which
 
106
 January/February 2006, Volume 60, Number 1
approved the study. Study criteria included: decreased mus-cle strength of the upper extremity as measured by manualmuscle testing (poor to fair range) and/or abnormal muscletone interfering with functional movement as measured by the Modified Ashworth Scale (MAS) (Bohannon & Smith,1986). This study enrolled children admitted into thepediatric rehabilitation program with varied diagnoses(Table 1). However, all children demonstrated the inclu-sion criteria of muscle weakness and/or abnormal tone thatinterfered with upper-extremity functional use. Criteria forselection included children with enough motivation andcognition to follow direction to the Melbourne Assessmentof Unilateral Upper Limb Function (Melbourne Assess-ment) (Randall, Johnson, & Reddihough, 1999), and hadno significant behavioral problems. The primary treatingtherapists recommended those children who were able tofollowdirections to task, appeared alert and oriented totheir surroundings.Children with dense sensory and motor loss (musclegrade at zeroto trace) in the area to be taped were not eli-gible for the study.Children with significant spasticity onthe MAS of 3 or 4 (3 representing considerable increase intone, passive movement difficult and 4 representing affect-ed parts rigid in flexion or extension) were also not eligiblefor inclusion as study participants. Assessing clinical change in the upper extremity in chil-dren admitted into a rehabilitation program is a complexmeasurement task. The results of this study demonstratethat, despite the heterogeneity of the diagnoses in this study,the subjects presented with similar presenting causes forfunctional losses (muscle weakness and imbalance). Theinclusion criteria were established to target children withdecreased muscle strength; except for those who presented amuscle grade at zero to trace. The subjects were all evaluat-ed bythe same therapist to eliminate the variability foundinmanual muscle testing. Although this assessment wasdesigned for children with neurological conditions, it wasalso used in this study for children with muscle weaknessfrom orthopedic condition and/or spinal cord injury (SCI).The subjects in this study were listed by neurological im-pairments 1–9, and orthopedic and SCI 10–15 (Table 1).The test items of the Melbourne Assessment were task-specific, which represented the most important compo-nents of arm and hand function (Table 2).
Measures 
The Melbourne Assessment scores quality of upper-limbfunction based on 16 criterion-referenced items with 37subscores, and consisting of 3-, 4-, and 5-point scales torecord results. The Melbourne Assessment is an objectivestandardized measure evaluating the quality of upper-extremity function of reach, grasp, release, and manipula-tion. Each subject’s performance is recorded on a videotapefor scoring. Each movement test item is subdivided intospecificdescriptivecriteria and assigned a point scale. Theraw scores arerecorded on the score sheet and later con-verted to a percentage score (range 0% to 100%). A higherpercentage score indicates better quality of arm and handmovements based on the specific test items.The Melbourne Assessment was developed to measurefunction in children with cerebral palsy (Bach,Reddihough, Burgess, Johnson, & Byrt, 1994,Reddihough, Bach, Burgess, Oke, & Hudson, 1990). Thetest–retest reliability of the Melbourne Assessment consist-edof a study population of 20 children with cerebral palsy of varying types and severity and indicated that theMelbourne Assessment was highly reliable with the samplepopulation. An initial reliability study resulted in the final16 items. The development of the clinical test battery quan-tifies the quality of upper-limb function and demonstrates
Table 1. Physical Characteristic and Taped Areas of the Subjects
Subject ImpairmentsSexAgeArea Taped1.R hemiplegia/encephalitisF4 yrsforearm supination, triceps, nger extension, thumb extension, palmar stability2.L hemiplegia/CVA F7 yrssupination, wrist extension, thumb extension3.Lhemiplegia/ seizureF7 yrsscapula stability, supination, encephalomyelitis, palmar stability4.R hemiplegia/CVA, brain tumor F10 yrs wrist extensor, palmar stability, thumb extension, scapular stability5.R hemiplegia/brain tumorF12 yrsscapular stability, supination, palmar stability6.Traumatic brain injuryM12 yrsscapular stability, wrist extension, deltoid7.Rhemiplegia/Traumatic brain injuryM16 yrsscapula stability, deltoid, supination, palmar stability8.R hemiplegia/brain stem CVAM12 yrsback extensor, palmar stability thumb extension, postural correction9.Generalized muscle weakness, cerebral palsyM14 yrswrist extension, palmar stability, deltoid, thumb extension10.C2-C6 SCI lesion/brain tumorF8 yrswrist extension, thumb extension, palmar stability, scapular stability11.Left shoulder arthritis/sickle cell disease, F11 yrsscapula stability, deltoidmultifocal osteomyelitis,12.SCI C5-6 incomplete/tetraplegiaF14 yrsnger extensor, wrist stability13.SCI C5-6 incomplete/tetraplegiaF15 yrsnger exors, wrist extensors, scapula, deltoid14.SCI C5-6 incomplete/tetraplegiaF15 yrswrist extension, palmar stability, deltoid15.SCI C6-7 incomplete/tetraplegiaM16 yrsnger exor, thumb opposition, palmar stability
Note.
C2–7 cervical spinal levels 2–7; CVA = cerebral vascular accident; L = left; R = right; SCI = spinal cord injury.

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