491010

research-article2013
NNRXXX10.1177/1545968313491010Neurorehabilitation and Neural Repair XX(X)Pelosin et al

Clinical Research Article

Neurorehabilitation and

KinesioTaping Reduces Pain and Modulates

Neural Repair
27(8) 722­–731
© The Author(s) 2013
Sensory Function in Patients With Focal Reprints and permissions:
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Dystonia: A Randomized Crossover Pilot DOI: 10.1177/1545968313491010

nnr.sagepub.com

Study

Elisa Pelosin, PhD1, Laura Avanzino, PhD1, Roberta Marchese, MD1, Paola Stramesi2,
Martina Bilanci, MD1, Carlo Trompetto, PhD1, and Giovanni Abbruzzese, MD1

Abstract
Background. Pain is one of the most common and disabling “nonmotor” symptoms in patients with dystonia. No recent
study evaluated the pharmacological or physical therapy approaches to specifically treat dystonic pain symptoms. Objective.
To evaluate the effectiveness of KinesioTaping in patients with cervical dystonia (CD) and focal hand dystonia (FHD) on
self-reported pain (primary objective) and on sensory functions (secondary objective). Methods. Twenty-five dystonic
patients (14 with CD and 11 FHD) entered a randomized crossover pilot study. The patients were randomized to 14-
day treatment with KinesioTaping or ShamTaping over neck (in CD) or forearm muscles (in FHD), and after a 30-day
washout period, they received the other treatment. The main outcome measures were 3 visual analog scales (VASs)
for usual pain, worst pain, and pain relief. Disease severity changes were evaluated by means of the Toronto Western
Spasmodic Torticollis Rating Scale (CD) and the Writer’s Cramp Rating Scale (FHD). Furthermore, to investigate possible
KinesioTaping-induced effects on sensory functions, we evaluated the somatosensory temporal discrimination threshold.
Results. Treatment with KinesioTape induced a decrease in the subjective sensation of pain and a modification in the ability
of sensory discrimination, whereas ShamTaping had no effect. A significant, positive correlation was found in both groups
of patients between the improvement in the subjective sensation of pain and the reduction of somatosensory temporal
discrimination threshold values induced by KinesioTaping. Conclusions. These preliminary results suggest that KinesioTaping
may be useful in treating pain in patients with dystonia.

Keywords
focal dystonia, KinesioTaping, sensory function, pain

Introduction Moreover, there is a paucity of literature examining the

Idiopathic focal dystonia is a disorder characterized by pro-
longed involuntary muscle contractions causing abnormal
postures of a single body part (blepharospasm, spasmodic
torticollis, writer’s cramp). Although dystonia is commonly
defined as a “motor” condition,1 “nonmotor” symptoms are
increasingly recognized as an important determinant of
quality of life in dystonic patients.2-4 Pain is one of the most
common and disabling “nonmotor” symptoms occurring in
up to 70% of patients with cervical dystonia and up to 30%
of patients with focal hand dystonia.2-5 Current treatment
for focal dystonia is symptomatic and can range from phar-
macological (drugs, botulinum toxin) to surgical (selective
peripheral denervation, deep brain stimulation) interven-
tions.6 These treatments may also be effective in relieving
pain in a number of patients; however, no recent study eval-
uated specific approaches to treat dystonic pain symptoms.
effect of physical therapy approaches in dystonia,7-9 and to
our knowledge, no study was specifically focused on
improving pain symptoms.
KinesioTaping is an alternative taping technique, cur-
rently used in rehabilitation in the treatment of various mus-
culoskeletal and neuromuscular deficits.10-12 Recently
KinesioTaping has been used in patients suffering from
orthopedic and neurological diseases with promising results
in relieving pain.13-15
1
University of Genoa, Genoa, Italy
2
IRCCS AOU San Martino-IST, Genoa, Italy
Corresponding Author:
Giovanni Abbruzzese, Department of Neurosciences, University of
Genoa, Largo Daneo 3 (ex Via De Toni 5), 16132, Genoa, Italy.
Email: giabbr@unige.it
Pelosin et al 723
We designed a randomized crossover clinical study to
evaluate the effectiveness of KinesioTaping in patients with
cervical dystonia (CD) or with focal hand dystonia (FHD)
on self-reported pain. The experimental intervention was
KinesioTaping over the neck muscles (in CD) or over the
forearm muscles (in FHD) for 2 weeks; the control inter-
vention was a sham tape (ShamTaping) application.
The primary outcome measure was the identification of
changes in pain severity assessed by means of visual analog
scales. Furthermore, since patients with dystonia present
specific sensory abnormalities, that is, the temporal dis-
crimination between tactile stimuli (defined as the ability to
perceive 2 tactile stimuli applied to the skin as clearly dis-
tinct),16,17 we investigated possible KinesioTaping effects
on objective sensory functions. Evaluation of the somato-
sensory temporal discrimination threshold (STDt) and
changes in disease severity were assessed as secondary out-
come measures.
Methods
Study Design
The study was a single-center randomized crossover pilot
study. Patients were randomly assigned to the experimental
(KinesioTaping) or control (ShamTaping) treatment, and
after a 30-day washout period, they received the alternative
treatment. The randomization sequence was created using
computer generated random number tables, with 1:1 alloca-
tion of individuals to either the intervention group or the
control group. Subjects were assessed 4 times: at the inclu-
sion visit (T0), after 14 days with the tape in situ (T1), after
a 30-day washout period (T2), and after 14 days with the
tape in situ (T3). Outcome assessors and patients were
unaware of group assignments. All authors vouch for the
completeness and accuracy of the data and attest to the
fidelity of the trial to the protocol. The randomization and
the study design are summarized in Figure 1A and B.
Participants
A total of 25 consecutive outpatients affected by focal dysto-
nia (according to standard diagnostic criteria)18 entered the
study. All participants were recruited from the outpatients of
the Movement Disorders clinic of the Department of
Neuroscience, University of Genoa. For each subject,
informed consent was obtained prior to the experiments
according to our institutions’ policy and according to the
Declaration of Helsinki. The study was approved by the local
ethics committee of the University of Genoa. The randomiza-
tion and the study design are summarized in Figure 1.
The following exclusion criteria were applied: (a) past
history of neurological disorders other than dystonia, (b)
presence of psychiatric or sensory/somatic abnormalities,
(c) cognitive deficits (Mini-Mental State Examination
[MMSE] score < 24); and (d) treatment with botulinum
toxin in the past 6 months. Three subjects did not meet the
inclusion criteria and were excluded from the study.
Participants were naïve to the purpose of the study and
they did not have any previous experience of KinesioTaping
application.
Cervical Dystonia.  This group consisted of 12 patients (Female
= 8; mean age = 55.83 ± 9.0 years) affected by CD. Disease
duration ranged from 3 to 19 years (mean = 7.2 ± 5.9 years).
The severity of motor impairment was evaluated by means of
the Toronto Western Spasmodic Torticollis Rating Scale,19
and the mean severity score was 18.08 ± 6.6. All patients pre-
sented a prevalent rotational torticollis with involvement of
the sternocleidomastoid (SCM). Detailed demographic and
clinical information are provided in Table 1.
Focal Hand Dystonia. This group consisted of 10 patients
(Female = 7; mean age 48.7 ± 6.5 years) affected by writer’s
cramp in the dominant hand. All participants were right
handed (Edinburg Handless Inventory). Duration of the dis-
ease ranged from 2 to 20 years (mean = 9.2 ± 6.3 years).
Disease severity was evaluated by means of the Writer’s
Cramp Rating Scale,20 and the mean severity score was 18.2
± 5.8. In all patients the dystonic features were prevailing in
the wrist flexor muscles.
Detailed demographic and clinical information are pro-
vided in Table 1.
Taping Interventions
All participants were taped by the same investigator (a cer-
tified KinesioTaping physiotherapist) who did not partici-
pate in the outcome assessment. The treatment group
received, as first intervention, a standardized therapeutic
application of KinesioTape, while the control group started
with an ineffective taping application (ShamTape). A stan-
dard beige KinesioTape was used for all the applications,
and we choose “I”-shape strips as they have been indicated
as effective in treating pain symptoms.21 Taping was
replaced by the physiotherapist involved in the study every
4 days.
For the experimental treatment, the tape was applied
with paper-off tension, which means applying the tape
directly to the skin as it comes off the paper backing
(approximately with 15% to 25% of available tension).21 In
patients with CD, KinesioTape was applied over the SCM
dystonic muscle by means of 2 “I-strips”: the first strip was
placed on the medial (sternal) head and the second was
applied on the lateral (clavicular) head of the SCM muscle
(Figure 2A). KinesioTape was applied from the mastoid
bone to the clavicle (rostrocaudal direction) with the SCM
placed in a position of maximum stretching. In patients with
724 Neurorehabilitation and Neural Repair 27(8)

Figure 1.  (A) Flow chart of recruitment and randomization of study participants. (B) Time line of the experimental protocol.
Abbreviations: T0, visit 1; T1, visit 2; T2, visit 3; T3, visit 4; STDt, somatosensory temporal discrimination threshold.

FHD, KinesioTape was applied over the medial-upper part and on the flexor carpi ulnaris (FCU; Figure 2A).
of the forearm dystonic muscles by means of 2 “I-strips”: KinesioTape was applied in a rostro-caudal direction while
each of them was applied on the flexor carpi radialis (FCR) the forearm muscles were stretched.
Pelosin et al 725

Table 1.  Baseline Demographic and Clinical Characteristics of the Participants.

No. Group Age Side Gender Disease (Years) Pre KT

TWTRS  
 1 CD 40 L F 19 30
 2 CD 63 R F 2 16
 3 CD 59 L M 6 13
 4 CD 44 L F 2 19
 5 CD 66 R F 3 14
 6 CD 63 L F 10 8
 7 CD 43 L M 4 15
 8 CD 60 R F 5 22
 9 CD 61 R F 9 28
 10 CD 55 R M 3 18
 11 CD 64 L F 5 11
 12 CD 52 L F 18 23
WCS  
 1 FHD 51 R M 11 16
 2 FHD 57 R F 20 20
 3 FHD 43 R F 12 16
 4 FHD 44 R F 9 14
 5 FHD 54 R F 7 20
 6 FHD 52 R M 3 12
 7 FHD 51 R M 2 26
 8 FHD 41 R F 17 26
 9 FHD 38 R F 2 8
 10 FHD 56 R M 5 24

Abbreviations: CD, cervical dystonia; FHD, focal hand dystonia; R, right; L, left; F, female; M, male; SCM, sternocleidomastoid; TRA, trapezius; SC,
splenius capitis; FDP, flexor digitorium profundus; FCU, flexor carpi ulnaris; FDS, flexor digitorium superficialis; FLP, flexor pollicis longus; PT, pronator
teres; TWSTRS, Toronto Western Torticollis Rating Scale; WC, Writer’s Cramp Scale.

For the control treatment (ShamTaping), smaller
“I-strips” of KinesioTape were used and they were applied,
with no tension and without stretching the muscles, perpen-
dicularly to the muscle belly (starting from the middle and
progressing to each side) over the same dystonic muscles as
in the experimental group (Figure 2B). Although the spe-
cific therapeutic elements of KinesioTaping (ie, longitudi-
nal stretch, start and ending point tape application) were
removed, the procedure was very similar to that adopted in
the experimental KinesioTaping treatment. Patients were
informed that they will be submitted to 2 different types of
taping techniques, each one potentially effective, and the
patients were not able to distinguish between “real” and
“sham” taping. On the other hand, due to the nature of the
intervention it was not possible to blind the physiotherapist
to patient allocation.
Outcome Measures
Clinical Assessment.  Main outcome measures were 3 visual
analog scales for usual pain (VAS-U), worst pain (VAS-
W), and Pain Relief (VAS-PR). In addition, we evaluated
disease severity changes by means of the Toronto Western
Spasmodic Torticollis Rating Scale (for CD) and the Writ-
er’s Cramp Rating Scale (for FHD).
Evaluation of Somatosensory Temporal Discrimination Thresh-
old.  In all the patients, STDt was tested in 2 different body
regions: in the neck and in the forearm (one affected and
one unaffected depending on patients’ type of focal dysto-
nia). Testing was performed on the skin overlying the mus-
cles where the tape was applied. Fourteen normal subjects
(NS), age (49.1 ± 9.3) and gender (Females = 8) matched
with dystonic patients were recruited as a control group,
and STDt was tested on the same body areas.
STDt was determined by delivering square wave electri-
cal pulses with a constant current stimulator with a D360
amplifier (Digitimer Limited, D360, Welwyn Garden City,
UK). The stimulation intensity was defined for each subject
by delivering a series of stimuli at increasing intensity from 2
mA in steps of 1 mA; the intensity used for STDt was the
minimal intensity perceived by the subject in 10 of 10 con-
secutive stimuli. Paired stimuli were applied starting with an
inter-stimulus interval (ISI) of 0 ms (simultaneous pair) and
progressively increasing the ISIs (in 10 ms steps). Twenty-
four ISIs (from 0 to 230 ms) were included in our
726 Neurorehabilitation and Neural Repair 27(8)
Figure 2.  KinesioTape (A) and Sham (B) application.
Abbreviations: SCM, sternocleidomastoid; FCR, flexor carpi radialis;
FCU, flexor carpi ulnaris.
experimental protocol. During the test the ISIs were applied
in a random sequence and subjects had to report whether they
perceived a single stimulus or 2 temporally separated stimuli.
The first of 3 consecutive ISIs at which patients recognized
the stimuli as temporally separated was consider the STDt.22
In patients with focal dystonia, STDt was tested immedi-
ately before taping application, at T0 and at T2 and 12 hours
after the tape was removed at T1 and T3. Specifically,
patients were instructed to remove the taping on the last day
of treatment at 9 pm by themselves, and they were tested at
9 am of the following day.
Statistical Analysis
For continuous variables, since data were not normally dis-
tributed (according to the Kolmogorov–Smirnov statistical
test), nonparametric tests were used to assess at baseline
differences in clinical data between groups (VASs for pain)
and, separately for each group (CD and FHD), the effect of
“Treatment” (real or sham) on clinical outcomes (VASs for
pain and disease severity score). Mann–Whitney U test was
used for between-subjects analysis, and the Wilcoxon rank-
sum test was used for within-subjects analysis.
STDt values in patients and healthy subjects were com-
pared in a between-group repeated-measures (RM) ANOVA
with the factor “Group” (NS, CD and FHD) as the main
between-subjects factor and the factor “Body region” (neck
and forearm) as the main within-subjects factor.
RM ANOVA with the factors “Treatment” (real and
sham), “Time” (before and after treatment), and “Body
region” (neck and forearm) as within-subject factors and
“Group” (CD and FHD) as between-subjects factor was
used to compare STDt changes induced by KinesioTaping
treatment in dystonic patients.
To evaluate if there were any lasting effects on VASs for
pain and STDt during the washout, we compared values at
the 2 baselines (T0 vs T2) by means of paired t tests, sepa-
rately in the groups of patients who underwent first experi-
mental or control KinesioTaping treatment.
Spearman’s correlation coefficient was used for assess-
ing possible correlations between changes in STDt values
and changes in disease severity and pain scores.
When ANOVA gave a significant result (P < .05), post
hoc analysis was performed using t tests.
All statistical analyses were performed with SPSS 18.0.
Results
Evaluation of Pain
At baseline, the VAS scores for pain were significantly
higher in the CD group than in the FHD group (VAS-U: P <
.001; VAS-W: P = .014). KinesioTaping treatment induced
a decrease in the VAS scores for pain in both CD (VAS-U:
P = .003; VAS-W: P = .002) and FHD (VAS-U: P = .01;
VAS-W: P = .004), whereas the VAS scores for pain did not
change after ShamTaping treatment either in CD (VAS-U:
P = .65; VAS-W: P = .15) or FHD (VAS-U: P = .48; VAS-
W: P = .32). The percentage of pain relief was 45% in CD
and 19% in FHD after KinesioTaping treatment, whereas it
was 5% in CD and 6% in FHD after ShamTaping treatment.
No lasting effects of either KinesioTaping (VAS-U, P = .19;
VAS-W, P = .35) or ShamTaping treatment (VAS-U, P =
.10; VAS-W, P = .20) on VAS scores were found when com-
paring the 2 baseline values (T0 vs T2).
In CD, neither KinesioTaping (P = .74) nor ShamTaping
treatment (P = .56) influenced disease severity score, evalu-
ated by means of the Toronto Western Spasmodic Torticollis
Rating Scale. In FHD, neither KinesioTaping (P = .41) nor
ShamTaping treatment (P = .38) influenced disease severity
score, evaluated by means of the Writer’s Cramp Rating
Scale. All clinical data are reported in Table 2.
At the end of each period of taping application, no side
effects (such as skin irritation and/or hypersensitivity) were
observed and patients reported a positive feedback on
acceptability.
Pelosin et al 727

Table 2.  Mean (SD) Baseline and Postintervention of Primary Outcome Measures for Participants. Mean (SD) Baseline Disease
Severity Score.a

Pre Post Pre Post Post Pre Post

Intervention   VAS-W VAS-W VAS-U VAS-U VAS-PR (%) Rating Scale Dyst
KinesioTape  
 CD Mean 7.04 4.13** 5.50 3.33** 45% 18.08 (TWTRS) 18.08
  SD 1.76 1.79 1.45 1.23 0.29% 6.67 6.62
 FHD Mean 5.00 4.00* 3.10 2.30* 19% 18.20 (WSC) 18.40
  SD 1.56 1.41 0.87 0.68 0.11% 6.06 5.91
ShamTape  
 CD Mean 6.33 6.50 5.42 5.33 6% 18.25 (TWTRS) 18.17
  SD 1.83 1.88 1.24 1.23 0.8% 6.81 6.77
 FHD Mean 5.40 5.30 3.10 3.30 5% 18.40 (WSC) 18.10
  SD 2.01 1.95 0.88 1.25 0.7% 5.95 5.30

Abbreviations: CD, cervical dystonia; FHD, focal hand dystonia; VAS-W, worst pain; VAS-U, usual pain; VAS-PR, pain relief; TWSTRS, Toronto West-
ern Torticollis Rating Scale–Part I; WC, Writer’s Cramp Scale.
a
Asterisks indicate significant differences between Pre and Post values (*P < .05, **P < .01).

Evaluation of STDt after treatment P = .32; forearm: before vs after treatment P

The intensity of electrical stimuli for STDt testing was
unchanged across the different time points of STDt record-
ings (P always >.05).
As expected, STDt values in the affected and unaffected
body regions at baseline were higher in patients than in
healthy subjects. RM ANOVA showed a significant factor
“Group” (F(2, 33) = 9.04; P = .001), a significant factor
“Body region” (F(1, 33) = 3.73; P = .035), and a significant
interaction “Group* Body region” (F(2, 33) = 4.03; P =
.027). Post hoc analysis revealed that STDt values were
lower in NS than in CD and FHD patients for both the neck
(CD, P < .0001; FHD, P = .008) and the forearm regions
(CD, P = .008; FHD, P < .0001). No difference in the STDt
values of neck and forearm regions was found between CD
and FHD patients (neck, P = .39; forearm, P = .2).
KinesioTaping induced a reduction of STDt in dystonic
patients only in the affected (and treated) body region
whereas ShamTaping left the abnormal STDt unchanged in
the 2 body regions (Figure 3). RM ANOVA showed a signifi-
cant interaction “Treatment* Time* Body region* Group”
(F(1, 20) =36.98; P < .0001). Post hoc analysis revealed that,
in patients with CD, the KinesioTape applied over the neck
induced a decrease of STDt in the neck (before vs after treat-
ment P < .0001), but not in the forearm (before vs after treat-
ment P = .11). Furthermore, in CD patients, the ShamTape
applied over neck left the STDt unchanged in the 2 body
regions (neck: before vs after treatment P = .87; forearm:
before vs after treatment P = .77). In FHD patients, the
KinesioTape applied over the forearm induced a decrease of
STDt in the forearm (before vs after treatment P < .0001), but
not in the neck (before vs after treatment P = .71). Furthermore,
in FHD patients, the ShamTape applied over the forearm left
the STDt unchanged in the 2 body regions (neck: before vs
= .28).
After KinesioTaping treatment the reduction of STDt
was 20% in either neck (in CD) and forearm (in FHD);
however, STDt values were still higher in patients than in
healthy subjects and RM ANOVA showed a significant fac-
tor “Group” (F(2, 33) = 5.05; P = .012). Post hoc analysis
revealed that STDt values were still lower in NS than in CD
(P = .015) and FHD patients (P = .008) whereas there was
no difference between CD and FHD (P = .72).
Finally, it is worth noting that no lasting effects of either
KinesioTaping (P = .83) and ShamTaping treatment (P =
.31) was found when comparing the 2 STDt baseline values
(T0 vs T2).
Clinical Correlation
Changes in STDt values induced by KinesioTaping in the
affected body region were positively correlated with
changes in the VAS-U score for usual pain both in patients
with CD (Spearman rho = 0.64; P = .026) and FHD
(Spearman rho = 0.61; P = .045), thus suggesting that STDt
changes might, at least in part, be a consequence of the
reduction of the subjective sensation of pain induced by
KinesioTaping (see Figure 4).
Discussion
The aim of the present study was to assess the possible
effectiveness of KinesioTaping in relieving pain symptoms
in patients with focal dystonia. Furthermore, to elucidate
the possible effects of KinesioTaping on sensory functions,
we included in the study the evaluation of STDt, which is
consistently abnormal in dystonic patients.22-24
728 Neurorehabilitation and Neural Repair 27(8)

Figure 3.  Somatosensory temporal discrimination thresholds (STDt) tested in 2 body parts (neck and forearm) in patients with
cervical dystonia (CD) and focal hand dystonia (FHD) before and after KinesioTaping (KT) and ShamTaping (ST) treatment in the neck
muscles and forearm muscles, respectively.
Each column represents mean value; the bars represent standard error. Dotted lines indicate STDt mean value for normal subjects. Asterisks indicate
significant differences between Pre and Post values (**P < .01).

Treatment with KinesioTape induced a decrease in the
subjective sensation of pain (assessed with the VAS) and a
modification in the ability of sensory discrimination. Indeed,
after 14-day treatment with KinesioTape, the VAS scores for
usual and worst pain were significantly reduced in patients
with both cervical and focal hand dystonia, whereas no
change was observed after sham treatment. As expected, the
STDt was higher in dystonic patients than in healthy sub-
jects25 in both affected and unaffected body regions.22 After
KinesioTaping, STDt selectively decreased in the affected
body regions (neck for CD, forearm for FHD), where the
KinesioTape was applied. Furthermore, a significant positive
correlation was found in both groups of patients between the
improvement in the subjective sensation of pain (decrease of
VAS for usual pain) and the reduction of STDt values induced
by treatment. On the other hand, no modification of dystonia
severity was observed after KinesioTaping treatment. Such
discrepancy is not surprising, since a large body of evidence
suggests that dystonic pain cannot be entirely explained by
excessive muscle contraction and the severity of dystonia in
the neck muscles does not always correlate with the duration
or intensity of neck pain.26 Indeed, treatment with botulinum
Pelosin et al 729

Figure 4.  Linear correlation between changes in STDt values and changes in the VAS-U score for usual pain induced by
KinesioTaping treatment, in patients with cervical dystonia and focal hand dystonia.
Changes in STDt values and VAS-U scores are expressed as % with respect to baseline values. Solid lines represent the linear fitting.

toxin can improve dystonic contractions without relieving
pain or vice versa.27-30
The Effect of KinesioTaping on Pain
Pain is a common and disabling symptom that presents
across all the different types of focal dystonia. One potential
reason for such high prevalence is that the threshold for
experiencing pain may be reduced in dystonic subjects.
Pain-pressure thresholds were about 2 times lower in 9
patients with idiopathic cervical dystonia versus a group of
age- and gender-matched controls.31
Patients with dystonia may also have abnormalities in
pain processing, even in body parts without dystonic
involvement. For example, in the same study, the unaffected
masseter muscles of patients with idiopathic cervical dysto-
nia also showed reduced pain-pressure thresholds compared
with the control group.31 Another potential mechanism for
enhanced pain includes changes in the somatosensory sys-
tem that have been largely documented in patients with
focal or generalized dystonia. These include changes in
excitability on neurophysiological testing, abnormal corti-
cal representation of dystonic body parts, and changes in
somatosensory cortical activity during movement.32
The observed reduction of self-reported pain after 14
days of treatment with KinesioTape is in line with recent
studies showing the efficacy of this treatment in improving
pain not only after acute but also in chronic injuries.13 Three
possible mechanisms may be considered to explain the pain
relieving effect. First, KinesioTaping seems to in increase
the flow of blood and lymphatic fluids due to a lifting effect,
which creates a wider space between the skin and the mus-
cle and interstitial space. Second, when mechanical loads
create a deformation of the skin, the tape is supposed to
stimulate the cutaneous mechanoreceptors.33 This activa-
tion causes local depolarizations that trigger nerve impulses
along the afferent fibers traveling toward the central ner-
vous system. Pain modulation according to the “gate con-
trol theory” is a plausible explanation as it has been proposed
that KinesioTaping provides an increased afferent feed-
back.34 Finally, we cannot exclude that, by acting on cutane-
ous mechanoreceptors and proprioceptors KinesioTaping
might influence sensory integration at a central level in
patients with dystonia.
The Effect of KinesioTaping on Somatosensory
Temporal Discrimination
One intriguing result of the present study is that
KinesioTaping treatment was able to improve the ability to
discriminate 2 somatic stimuli temporarily separated.
Furthermore, the reduction of STDt values induced by treat-
ment was significantly and positively correlated with the
improvement in the subjective sensation of pain, suggesting
that the KinesioTaping-induced reduction of pain may con-
tribute to the modulation in sensory discrimination ability.
The somatosensory temporal discrimination is a purely
sensory process that allows the brain to select relevant sen-
sory inputs for processing information coming from exter-
nal sources. A recent study by Conte and coworkers35
showed that, by applying theta burst stimulation to the cor-
tical areas involved in processing sensory discrimination,
the STDt is probably encoded in the primary somatosensory
area (S1), possibly depending on intrinsic S1 neural circuit
properties. This finding agrees with previous observations
showing that single-pulse transcranial magnetic stimulation
730 Neurorehabilitation and Neural Repair 27(8)
over S1 interferes with STDt processing.36,37 Accordingly,
in dystonia, Tamura et al38 showed that in a group of patients
with focal hand dystonia the abnormal STDt correlates with
altered intracortical inhibition of somatosensory evoked
potentials (SEPs). The authors showed an inverse correla-
tion between STDt and the activity of inhibitory circuits
within the somatosensory cortex, suggesting that inhibitory
mechanisms within the sensory areas play a main role in
STDt process. In particular, surround inhibition is an inhibi-
tory mechanism within the somatosensory system that helps
sharpen acuity and aids in 2-point discrimination.39-41
Patients with dystonia present abnormalities in surround
inhibition processes within the somatosensory system.42
In experimental studies, it has been demonstrated that sur-
round inhibition under noxious electrical stimulus is stronger,
possibly to provide finer discrimination during the noxious
stimulus.43,44 A direct correlation between pain and defective
surround inhibition within the somatosensory cortex has not
yet been provided in dystonia. However, we can hypothesize
that the KinesioTaping-induced reduction of pain may cause
a modulation of surround inhibitory mechanisms within the
somatosensory cortical representation of the area treated with
KinesioTape. Such modulating effect of nociceptive inputs
on intracortical inhibitory processes in the sensory areas is
not likely to be the sole mechanism involved in STDt abnor-
malities in patients with dystonia. Indeed, STDt abnormali-
ties have been reported in affected and unaffected body
regions (without correlation with disease severity) and even
in patients’ unaffected relatives, suggesting that STDt may
represent a primary endophenotypic trait.22-25
We might postulate that 2 different mechanisms are
involved in discrimination abnormalities in dystonia: a
“peripheral” mechanism, dealing with the amount of sen-
sory information coming from periphery (including noci-
ceptive inputs), and a “central” mechanism, dealing with
multimodal sensory integration at the central level that
involves the interplay between cortical and subcortical
structures including basal ganglia.
Study Limitations and Future Research
It is important to stress the exploratory nature of this study
and its limitations. First, because of the study design (cross-
over), follow-up evaluations were not performed. Future
studies designed to assess what is the optimal duration of
the KinesioTaping treatment and possible long-term effects
in a large cohort of patients would be useful.
Second, the secondary aim of the present study was to
assess the possible effectiveness of KinesioTaping in modi-
fying motor symptoms in dystonia. However, motor disabil-
ity has been assessed by means of numeric rating scales,
which are congruent with clinical practice, but present poor
sensitivity in measuring small changes. Further works based
on kinematic quantitative evaluation of movements might
provide valuable information for early detection of improve-
ment of movements after KinesioTaping treatment. Finally,
we hypothesized that the reduction of pain may contribute
to the modulation in sensory discrimination ability, since
we found a correlation between the reduction of STDt val-
ues and the improvement in the subjective sensation of pain
in the affected (and treated with KinesioTape) body parts.
However, since we did not evaluate the effect of KinesioTape
on STDt in nonaffected body parts, we cannot exclude other
potential physiological mechanisms that are worthy to be
investigated in future research.
Conclusions
The present preliminary results suggest that KinesioTaping
may be useful in treating pain in patients with dystonia. In
addition, KinesioTaping treatment is likely to interfere with
the mechanism underlying abnormalities in temporal dis-
crimination between tactile stimuli in focal dystonia.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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