Topics in Stroke Rehabilitation

ISSN: 1074-9357 (Print) 1945-5119 (Online) Journal homepage: https://www.tandfonline.com/loi/ytsr20

Effects of trunk rehabilitation with kinesio and

placebo taping on static and dynamic sitting
postural control in individuals with chronic stroke:
A randomized controlled trial

Yong-Hun Cho, Kyun-Hee Cho & Shin-Jun Park

To cite this article: Yong-Hun Cho, Kyun-Hee Cho & Shin-Jun Park (2020): Effects of trunk rehabilitation
with kinesio and placebo taping on static and dynamic sitting postural control in individuals with chronic
stroke: A randomized controlled trial, Topics in Stroke Rehabilitation, DOI: 10.1080/10749357.2020.1747672

To link to this article: https://doi.org/10.1080/10749357.2020.1747672

Published online: 06 Apr 2020.

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TOPICS IN STROKE REHABILITATION
https://doi.org/10.1080/10749357.2020.1747672

ARTICLE

Effects of trunk rehabilitation with kinesio and placebo taping on static and dynamic
sitting postural control in individuals with chronic stroke: A randomized controlled trial
a a b
Yong-Hun Cho , Kyun-Hee Cho , and Shin-Jun Park
Department of physical therapy, AVENS Hospital, Anyang-si, Gyeonggi-do, Republic of Korea; bDepartment of Physical Therapy, Gangdong
a

University, Chungcheongbuk-do, Republic of Korea

ABSTRACT ARTICLE HISTORY

Background: Impaired trunk postural control is common after stroke. Combining kinesio taping with Received 30 December 2019
trunk rehabilitation has been shown to enhance the recovery of postural control ability in patients with Accepted 20 March 2020
stroke. KEYWORDS
Objective: We investigated whether the combination of kinesio taping with trunk rehabilitation would Trunk; rehabilitation;
improve dynamic and static sitting stability after stroke. kinesiotape; postural
Methods: Twenty-eight patients with stroke were recruited and randomly assigned to one of the two 8- control; stroke; sitting
week trunk rehabilitation programs with kinesio (experimental group) or placebo taping (control
group). Outcome measures were dynamic forward, dynamic backward, affected-side, and unaffected-side
sway areas, static sway area and length, and the total limit of stability (LOS) area. The variables were
measured using the BioRescue analysis system. All outcome measures were assessed at baseline and after
8 weeks of trunk rehabilitation.
Results: Significant increases were observed in the dynamic forward, dynamic backward, affected- side,
and unaffected-side sway areas, and the total LOS area, in the experimental and control groups,
whereas decreases were observed in the static sway area and length. The dynamic forward sway area
was significantly higher in the experimental group than in the control group, but there were no
significant differences between the groups in the other variables.
Conclusions: Trunk rehabilitation is effective for improving dynamic and static sitting stability after
stroke. The addition of kinesio taping to the back muscles further increases forward mobility.

Introduction
From a pathological perspective, disabilities that
prevent body organs from functioning properly
often develop in patients with stroke due to func-
tional limitations that lead to the impairment of
motor function, sensory function, postural control,
perception, range of motion, muscle tone, and
cardiovascular conditioning. These conditions are
caused by loss of brain functions due to the block-
age or rupture of blood vessels in the brain.1,2
Among these disabilities, impaired postural con-
trol may be caused by an inability to maintain the
center of gravity, delayed onset of postural
response, or loss of ability to modify the postural
strategy.3 Patients with hemiparesis with trunk
muscle weakness and altered trunk position sense
have poor trunk control, which leads to difficulties
in sitting postural control.4 Greater impairments
are also developed in the chronic stage. 5 Therefore,
trunk rehabilitation has been performed to
improve the trunk control, sitting and standing
balance, and mobility in patients with stroke.6
Impairments on one side of the cerebral cortex
usually result in the appearance of neurological
symptoms in the arm and leg of the opposite side, 7
and, thus, interventions are finally applied there.
However, recent studies have reported that exercise
using both legs is more effective than using the
affected-side leg for the improvement of postural
control ability in patients with stroke.8 Neurarchy
in the trunk does not involve control of only one
side of the body. Rather, control is shared by both
sides of the cerebral cortex. Consequently, patients
with stroke experience trunk muscle weakening on
the affected and unaffected side. 9 However, as the
trunk is a single structure, an exercise method that

CONTACT Shin-Jun Park 3178310@naver.com Department of Physical Therapy, Gangdong University, 278, Daehak-gil, Danpyeong-ri, Gamgok-Myeon,
Eumseong-gun, Chungcheongbuk-do, Republic of Korea
© 2020 Taylor & Francis Group, LLC
2 Y.-H. CHO ET

activates the trunk muscle can promote trunk func-

Anyang, Gyeonggi Province. Forty-five
tion on both sides, which can improve their
individuals were initially recruited for the study
physical function.10
and 28 of them met the inclusion criteria. The
Trunk rehabilitation increases trunk stability in
inclusion criteria were: (1) single stroke diagnosis;
patients with stroke and improves sitting postural
(2) onset time ≥ 6 months and < 2 years; (3) trunk
control11, standing posture, and gait ability.12 As
impair- ment scale (TIS) static balance score ≥ 5
alternatives to singular intervention methods,
points (score ranges from 0 to 7, interquartile
trunk rehabilitation methods that combine physi-
range from 5 to 7)30,31; (4) no damage to visual and
cal agent therapy, such as motor13 and sensory
vestibular senses; (5) Korean Mini-Mental State
nerve stimulation,10,14 have been introduced.
Examination (K-MMSE) score ≥ 24 points (score
Trunk rehabilitation exercise with physical therapy
ranges from 0 to 30, normal range: ≥ 24 points)32;
has an even greater effect on the trunk control and
(6) no ortho- pedic disorder in the spine; and (7)
gait ability of patients with stroke due to the sen-
normal find- ings in a pin prick test (assessment
sory input with respect to the trunk 10,14 and motor
for severe sensory deficits).33 Patients were asked
unit recruitment by the back muscles.13
to respond when the sensation of the paretic side
Kinesiotape stimulates proprioceptive receptor
was more or less sensitive, or comparable to that
when applied to the skin,15 by increasing motor
felt on the non-paretic side. The test was
nerve excitability16 and modulating muscle
conducted under eyes-open and eyes-closed
activity.17 Kinesiotape may be applied to patients
conditions. The exclu- sion criteria were: (1)
with stroke to relax and support shortened and
allergic reactions (irritant contact dermatitis) when
weakened muscles respectively and/or correct
taping was applied; (2) low back pain; (3)
body malalignment.18 In recent studies, taping of
previous spinal surgery history;
the shoulders or ankles of patients with stroke
(4) apraxia; (5) hemineglect; and (6) presence of
resulted in improvements in patients’ joint position
cerebellar and vestibular ataxia or orthopedic dis-
sense,19 hemiplegic shoulder pain,20 Berg Balance
order that may affect sitting postural control. The
scale (BBS) score, forward reach test, mediolateral
flowchart of recruitment is depicted in Figure 1.
sway area,21 step length, gait speed, and functional
ambulation classification.22
However, evidence supporting the effects of Sample size calculation
trunk taping on static and dynamic sitting stability
Analysis was performed based on the reported
is still lacking. Actually, on discharge from our
effects of additional core stability exercise on sitting
rehabilitation center, 40% of patients with stroke
postural control (Spanish version of TIS 2.0,
used a wheelchair and they were exposed to
dynamic sitting balance) in patients with stroke. 34
kyphosis due to looseness of the back support or
The sample size was calculated using the power
cushion of the wheelchair.23–25 For patients with
analysis software G*Power (version 3.1.9.2,
stroke with trunk malalignment, such as forward
Heinrich Heine University, Dusseldorf, Germany).
head posture and kyphosis, back muscle taping can
G*Power is an easy-to-use sample and power
be performed to correct their posture.24,26,27 This
calculation for a variety of statistical methods. It can
can improve body alignment28 and increase
calculate the number of samples and
postural control ability.29
power for F-, t-, χ2, Z, and exact tests. The effect
Therefore, our aim was to identify whether
size was derived using the mean and standard
trunk rehabilitation is more effective for static deviation of
and dynamic postural control improvement using dynamic sitting postural control among the
kinesio taping than placebo non-elastic tapes. primary outcomes. Based on the results, input of
an error probability of 0.05, power of 0.8, and
effect size of
Materials and methods 0.97 produced a total sample size of 28. Thus, 28
Participants patients were therefore selected for the study.

The study population consisted of patients with

stroke from the AVENS rehabilitation hospital in Study design
This study was conducted in accordance with the
 TOPICS IN STROKE 3
ethical principles of the Helsinki Declaration.
The
 4 Y.-H. CHO ET
Assessed for eligibility (n = 45)
Baseline assessment (n = 28)
Randomized (n = 28)
Allocated intervention (n = 14)
Received allocated correction taping with trunk rehabilitation (n = 14)
Did not receive allocated intervention (n = 0)
Lost to follow-up (n = 0)
Discontinued intervention (n = 0)
Analyzed (n = 14)
Figure 1. Flow flowchart of the participants selection.
K-MMSE, Korean-mini mental state examination; TIS, trunk impairment scale.
study was a randomized single-blind controlled
clin- ical trial (parallel treatment design). Initial
assess- ment was performed after obtaining a
signed informed consent form from the candidates.
Concealed randomization after the baseline assess-
ment was performed by an administrator not
directly involved in the study. Randomization was
performed using random numbers generated in
Microsoft Excel to separate the participants into
two groups: the experimental (n = 14) and the con-
trol group (n = 14), in which the participants per-
formed stabilization exercises with kinesio and
placebo taping, respectively. In this study, partici-
pants were blinded to eliminate performance bias.
Prior to the intervention, the physical therapist told
all subjects the following: “You may or may not
feel any support to back muscles after apply
taping.” Trunk rehabilitation was performed by
eight physi- cal therapists, including one of the
researchers. The
Excluded (n = 17)
Not meeting the inclusion criteria (n = 17) TIS static balance score < 4 points
K-MMSE < 24 points
Severe sensory deficits (less sensitive)
Other reasons (n = 0)
Allocated intervention (n = 14)
Received allocated placebo taping with trunk rehabilitation (n = 14)
Did not receive allocated intervention (n = 0)
Lost to follow-up (n = 0) Discontinued
intervention (n = 0)
Analyzed (n = 14)
therapists were randomly assigned to the patients.
All therapists possessed neurodevelopmental treat-
ment certifications and at least 5 years of clinical
experience. Taping was performed by three trained
physical therapists, including one of the
researchers. Assessments were performed by a
research assistant. The participants were blinded to
the study objectives and the group that they
belonged. Both groups com- pleted an 8-week
intervention, and post-hoc assess- ment was
performed after the intervention was completed.
The present study was approved by the Institutional
Review Board at Yong in University (2- 1040966-
AB-N-01-20-1811-HSR-116-9).
Intervention methods
The experimental and the control group performed
trunk rehabilitation exercises with kinesio and pla-
cebo taping, respectively. In the experimental
group,

when the participant complained of severe skin
pull- ing or discomfort, the tape was removed;
however, no one complained of discomfort. The
tapes were applied once per day to all participants
and remained in place for an average of 18 hours
per day. In patients with stroke, placebo taping has
no elasticity and, thus, no effect on position sense.
Conversely, kinesio taping has an effect on
position sense.19 Therefore, elastic-property tapes
were applied to the experimental group.
The research and control groups were subjected
to the Trunk Rehabilitation three times a week for
8 weeks; taping was applied every single day.
Kinesio taping
An elastic 5-cm width tape (3NS tape, TS Co., Ltd,
Seoul, Korea) was used in the study. Two I-shaped
tapes were applied to the paravertebral muscles. 29
First, the length from the 4th lumbar to the 1st
thoracic vertebrae was measured while the patients
sat upright and the tape was cut to the measured
length. After cutting off ¼, the tape was applied to
the paraspinal muscles on both sides. Taping was
performed in the back as straight as possible and
the tape was stretched for application from the 4th
lumbar vertebra to the 1st thoracic vertebra. In the
control group, placebo taping was performed
using the same method with non-elastic, weak
surgical tapes (3M™ Micropore Surgical Tape
White, 3M Health Care, Saint Paul, MN, USA).
Trunk rehabilitation
For trunk rehabilitation, we selected task-related
trunk training exercises that patients with stroke
could perform. The exercises were modified and
supplemented for the study and consisted of pelvic
bridging, sit-up, flexion and extension of the
trunk, lateral flexion of the trunk, rotation of the
upper and lower parts of the trunk, and reaching
within and out of arm’s reach for trunk control in
three planes and trunk muscle strength.10 These
six exercises were performed for 10 min each
(60 min in total). The therapists who participated
in the study (n = 8) encouraged movement to
improve speed, repetitions, and range of motion
during trunk rehabilitation. The patients were
allowed to rest when they became fatigued. The
TOPICS IN STROKE 5
patients were rested for safety, but the exact rest
time was not monitored.
Assessment methods
The main outcome variables were dynamic
affected- side sway, dynamic unaffected-side sway,
dynamic forward sway, dynamic backward sway,
and limit of stability (LOS) total areas. The
secondary outcome variables were static sway area
and length. All outcome measures were assessed at
baseline and after 8 weeks of trunk rehabilitation.
Center of pressure (COP) displacement
measurement
The AP1153 BioRescue (RM Ingenierie, Rodez,
France) analysis system was used to measure the
participant’s COP displacements. It is a pressure
sen- sitive platform with 1,600 sensors
embedded in a measurement field of 400 × 400
mm. The pressure sensitive platform was placed on
the chair for sitting COP displacement
measurements. The participants placed their legs
comfortably on the ground and maintained a sitting
posture with both hands down and the back straight
in a ready position for measurement.
Dynamic COP displacement
For dynamic COP displacement measurements in
the sitting posture, the participants shifted their
body weight in the direction given while sitting
without moving their legs. They were instructed to
keep both buttocks attached to the chair while
shifting their weight from one side of the buttocks
to the other. Then, they crossed their arms and
placed them on their chest, shifted their weight
from the starting to the furthest point they could
move in the given direction, and maintained the
posture for the measurement. Weight shifting was
performed in eight directions indicated by arrows
on a forward-facing monitor: forward (↑), back-
ward (↓), left (←), right (→), forward and outward
(↖,↗), and backward and outward (↙,↘). The
participants returned to their original position
once the arrow disappeared and the measurement
began again when the next arrow appeared. All
participants in this study completed each step.
Data were analyzed to determine the forward,
6 Y.-H. CHO ET

backward, affected-side and unaffected-side sway

areas, and the total LOS area. As a change for each
of the directions was considered the COP displa-
cement distance of the straight line from one spe-
cific direction. The distance of each of the
directions of the BioRescue corresponded to the
maximum weight shift.35
Static COP displacements
Static COP displacement measurements were per-
formed for 30 sec with a measurement frequency
of 100 Hz. These measurements were performed
after the participants lifted the affected-side arm
with the unaffected-side arm and assumed
a position with the shoulder flexed ≥ 90°. This
posture was maintained for a set amount of time
while the static sitting COP displacement was
measured. The data were analyzed to determine
the sway area and length.
Statistical analysis
Statistical analysis of the data was performed using
the SPSS version 20.0 software (IBM Corp., Armonk,
NY, USA). For confirmation of homogeneity
among the general characteristics of the
participants, indepen- dent samples t-test and chi-
square test were per- formed to express the results
as the mean plus standard deviation and frequency,
while K-S tests were performed to test for normal
distribution. The intervention effect was measured
using two-way repeated-measure analysis of
variance. The within- participants factors were the
pre- and post- intervention results (time). The
between-participants factors were the experimental
and control group results (group-by-time). When
significant differences
were observed in group-by-time (interactions or
main effects) analyzes, the t-test was performed. The
statis- tical significance level was set at alpha =
0.05.
Results
General characteristics
The general characteristics of the participants are
shown in Table 1. The results showed no
significant difference in sex, paretic side,
pathogenesis, disease duration, age, weight, height,
and K-MMSE scores between the control and
experimental groups, con- firming homogeneity
between the groups.
Changes in dynamic sitting stability
Both the control and experimental groups showed
significant increases in the dynamic affected-side,
unaffected-side, forward, and backward sway
areas, and in the total LOS area after the interven-
tion compared to the baseline values. Although the
experimental group showed a significant increase
in the dynamic forward sway area than the control
group, there were no significant differences in
other variables between the two groups (Table 2).
Discussion
Our findings confirmed that trunk rehabilitation
plays an important role in static and dynamic
sitting stability. However, when trunk rehabilita-
tion was combined with kinesio taping, there was
no difference in the variables tested, with the
exception of the forward area. Most studies invol-
ving healthy individuals have reported that kinesio

Table 1. Classification of characteristics.

Classification Control group (n = 14) Experimental group (n = 14) p-value
Sex (male/female) 11/3 12/2 .622
Paretic side (left/right) 7/7 8/6 .705
Pathogenesis (hemorrhages/infarction) 7/7 6/8 .705
Disease duration (months) 12.21 ± 2.16 12.00 ± 2.68 .820
Age (years) 61.00 ± 8.73 60.38 ± 6.23 .836
Weight (kg) 71.14 ± 10.18 68.00 ± 9.62 .418
Height (cm) 168.14 ± 8.80 162.69 ± 11.64 .180
BMI (kg/m2) 25.11 ± 2.43 25.77 ± 3.38 .315
Hypertension, participants (%) 7 (50) 8 (57.14) .705
K-MMSE score 26.71 ± 1.07 27.15 ±.80 .241
K-NIHSS score 9.90 ± 3.35 9.94 ± 4.02 .383
Values are presented as the mean ± SD. BMI, body mass index; K-MMSE, Korean-mini mental state examination; K-NIHSS, Korean-
National Institute of Health Stroke Scale; SD, standard deviation.
 TOPICS IN STROKE 7
Table 2. Changes in the dynamic and static sitting center of pressure displacements in the two intervention groups.
Measure/group Pre-interventiona Post-interventiona Within-group changeb Between-group changeb
Primary outcome
Dynamic affected-side sway area (mm2)
Experimental group 185.77 ± 86.67 274.54 ± 129.61 88.77 (43.02,134.52)* 28.05 (−19.41,75.52)
Control group 257.00 ± 152.96 317.71 ± 167.47 60.71 (37.67,83.76)*
Dynamic unaffected-side sway area (mm2)
Experimental group 249.77 ± 118.24 350.00 ± 169.42 100.23 (42.35,158.11)* 38.02 (−22.20,98.23)
Control group 317.43 ± 187.66 379.64 ± 194.78 62.21 (32.70,91.73)*
Dynamic forward sway area (mm2)
Experimental group 264.31 ± 129.80 433.00 ± 230.29 168.69 (82.06,255.33)* 92.48 (2.02,182.93) **
Control group 326.43 ± 184.84 402.64 ± 195.21 76.21 (31.37,121.05)*
Dynamic backward sway area (mm2)
Experimental group 171.23 ± 82.37 191.54 ± 95.79 20.31 (0.72,39.90)* −26.19 (−65.01,12.63)
Control group 248.21 ± 160.57 294.71 ± 177.23 46.50 (11.69,81.31)*
LOS total area (mm2)
Experimental group 435.54 ± 193.94 624.54 ± 295.19 189.00 (88.93,289.089)* 66.07 (−36.98,169.12)
Control group 574.43 ± 339.59 697.36 ± 360.17 122.93 (74.15,171.71)*
Secondary outcome
Static sway area (mm2)
Experimental group 21.00 ± 11.44 12.31 ± 8.20 −8.69 (−12.73,-4.65)* −.26 (−5.07,4.54)
Control group 20.00 ± 12.82 11.57 ± 9.83 −8.43 (−11.55,-5.31)*
Static sway length (cm)
Experimental group 7.00 ± 1.91 5.85 ± 1.63 −1.15 (−1.75,-0.56)* .02 (−0.78,0.83)
Control group 6.98 ± 1.83 5.80 ± 1.61 −1.18 (−1.78,-0.57)*
a
Values are denoted as the mean ± SD.
b
Values are denoted as the mean (95% CI)
*Statistically significant (p < .05).
**The experimental group improved more than the control group (interaction).
Experimental group: Trunk rehabilitation with kinesio taping; Control group: Trunk rehabilitation with placebo taping. LOS, limit of stability; SD,
standard deviation.

taping does not affect muscle strength. 36 There is
also a lack of evidence supporting the effect of
taping on individuals with musculoskeletal
injuries.37 In this study, placebo tape was attached
to the control group.
In previous studies, kinesio and placebo taping
showed no significant difference in BBS score. 38
However, kinesio taping showed significantly
increased LOS than placebo taping in BioRescue. 39
To demonstrate the effect of kinesio taping, an
inter- vention period of at least 4 weeks is
required.38 Thus, we conducted an 8-week
intervention with trunk rehabilitation to compare
the effects of kinesio and placebo taping. In
addition, infarct or hemorrhage was not associated
with balance disability in patients with stroke.40
Weakness, sensation, and neglect affected the
balance disability of such patients, 40 and, thus, we
excluded patients with neglect or severe sensory
deficits.
The elastic tape used in the present study was
applied to paraspinal muscles on both sides of
patients with stroke. The application of an elastic
tape to the posterior surface of the torso of seated
male workers with a rounded shoulder posture was
found to increase the pectoralis minor length and
reduce the rounded shoulder posture and total scap-
ular distance.28 Likewise, in children with cerebral
palsy, spinal correction by taping the back muscle
reduced the Kyphotic and Cobb’s angles and
increased the Gross Motor Function Measure
Sitting scores.29 Such taping was more effective for
sitting assessment compared to the control group
without taping.41 As shown, taping can correct
spinal alignment, by improving the sitting
postural control ability. However, our findings
showed no significant differences between the
experimental and control groups, except for
forward sway. This could be attributed to the
sufficiency of trunk reha- bilitation exercises to
improve the trunk control ability of patients with
stroke,42–44 and the difficulty to observe the effect
of taping in directions other than the direction of
attachment.45 Taping is known to have various
effects, including pain reduc- tion, joint assistance,
muscle relaxation and facilita- tion, and
enhancement of proprioception.18 Another effect of
taping is the increased body movement in the
direction of the elasticity of the tape applied.
Taping the back muscles had no effect on the range
8 Y.-H. CHO ET

of motion for trunk lateral flexion and extension distance of patients with stroke.10 The LOS
compared to non-taping, but improved the range
of motion for trunk flexion. 45 Moreover, taping
applied to the calf muscle of patients with
multiple sclerosis significantly reduced the length
of sway in the antero-posterior plane when the eyes
were closed compared to the results before
taping.46 Kinesio taping can improve body
movement depending on the direction of
attachment.45,46 In our study, for- ward sway was
calculated as the longest distance the trunk can
lean forward in the sitting position, and was
significantly higher in the experimental than in the
control group. Therefore, we speculated that
when the patients leaned forward, the tape
stretched and the elasticity of the tape
contributed to trunk holding, which resulted to
increased forward sway.
Patients with stroke generally exhibit decreased
sitting postural control than the elderly individuals
in their 70s, as those who have greater impairment
in their ability to perform daily activities show
increased postural sway in the sitting position. 47 As
our parti- cipants were hospital-bound patients with
stroke, the trunk rehabilitation program was
designed including exercises that could be easily
performed by those who could assume a sitting
posture. The exercise method was focused on
improving motor control and trunk muscle strength
by controlling weight shifting and movement with
the trunk erect while performing functional
activities.
Trunk rehabilitation for 3–6 weeks increased the
peak torque of trunk flexion and extension, and
improved the total TIS score, dynamic sitting bal-
ance, and coordination in patients with stroke.10
Performance of core stability exercises for 5 weeks
resulted in improved Tinetti’s balance, gait, and
total scores.34 TIS and Tinetti’s balance scores were
found to be significantly correlated with changes in
pres- sure shift in a standing position for patients
with stroke,48–50 while TIS was found to be
significantly correlated with changes in the sitting
posture.51 As trunk muscles play a role in
preventing falls and maintaining balance, and
sitting postural control can be improved through
postural adjustments by shifting the center of mass
toward the support surface,52 trunk rehabilitation
is expected to have a positive effect on the
dynamic and static sitting stability. Trunk
rehabilitation increases the forward and lateral
(affected and unaffected sides) seated reach
 TOPICS IN STROKE 9
area in this study was measured as the seated rehabilitation exercises with attached kinesio taping
reach distance evaluated with COP excursion. to
Therefore, the increase of COP excursion
improved sitting pos- tural control.
Static COP displacement (sway area and
length) decreased significantly after intervention
in this study. Patients with stroke have greater
static COP displacement than healthy
individuals. 53
Therefore, trunk rehabilitation
should aim to reduce static COP displacement
to a level closer to that of healthy individuals.
Based on the present findings, trunk rehabilita-
tion may be effective for improving dynamic and
static sitting stability in patients with stroke who
have weak trunk muscles, and the sway area may
increase even further in the direction of taping.
The strength of this study was that it was the
first in literature that examined the effect of trunk
rehabilita- tion with kinesio taping in sitting
postural control in patients with stoke admitted to
a rehabilitation hospi- tal. We found that taping is
relatively safe and could be applied after simple
training. Conversely, as the tape loses
adhesiveness over time, it should be removed and
replaced with a new one, highlighting a higher
socioeconomic cost.
However, our study has several limitations.
First, the daily activities of the hospital-bound
patients with stroke were not controlled. In
addition, patients were allowed to rest for safety
after trunk exercise, but we did not control the rest
time accurately. This could prevent us to
generalize the findings to all patients with stroke.
Second, muscular changes after trunk exercises
could not be identified objec- tively. Regarding
BioRescue system, there are no studies
concerning its psychometric characteristics
(including minimal detectable change) for this
spe- cific population. Therefore, a study should be
per- formed to confirm the effects of kinesio
taping in patients with stroke using other balance
tests.
To sum up, we identified changes in the sitting
posture pressure shift, which could not be
identified in many previous studies, a fact that
highlights our study’s clinical significance. Indeed,
forward sitting postural control is an important
assessment for people who cannot stand. The lack
of ability to safely move the center of mass can
limit patient’s wheelchair mobility and activities of
daily living.54 We managed to increase the dynamic
forward sway area by performing trunk
 1 Y.-H. CHO ET
the paraspinal muscles. Our work may have
significant application in patients with stroke with
poor sitting postural control. However, there is
need for future studies to develop new methods that
can replace taping during trunk rehabilitation to
benefit patients with stroke in daily life”
Conclusions
We aimed to identify whether a combination of
trunk rehabilitation with kinesio taping, compared
with trunk rehabilitation with placebo non-elastic
tape, could improve static and dynamic postural
control while sitting. Trunk rehabilitation
combined with kinesio taping of the back trunk
muscles can improve forward mobility in a sitting
position.
ORCID
Yong-Hun Cho http://orcid.org/0000-0002-2609-6288
Kyun-Hee Cho http://orcid.org/0000-0002-0150-0379
Shin-Jun Park http://orcid.org/0000-0001-6138-3090
References
1. Duncan PW. Stroke disability. Phys Ther. 1994;74
(5):399–407. doi:10.1093/ptj/74.5.399.
2. Jette AM. Physical disablement concepts for physical
therapy research and practice. Phys Ther. 1994;74
(4):380–386. doi:10.1093/ptj/74.5.380.
3. Oliveira CBD, Medeiros IRTD, Frota NAF,
Greters ME, Conforto AB. Balance control in hemi-
paretic stroke patients: main tools for evaluation.
J Rehabil Res Dev. 2008;45(8):1215–1226. doi:10.1682/
JRRD.2007.09.0150.
4. Karthikbabu S, Chakrapani M, Ganeshan S,
Rakshith KC, Nafeez S, Prem V. A review on assess-
ment and treatment of the trunk in stroke: a need or
luxury. Neural Regen Res. 2012;7(25):1974. doi:10.3969/
j..1673-5374.2012.25.008.
5. Perlmutter S, Lin F, Makhsous M. Quantitative analysis
of static sitting posture in chronic stroke. Gait Posture.
2010;32(1):53–56. doi:10.1016/j.gaitpost.2010.03.005.
6. Van Criekinge T, Truijen S, Schröder J, et al. The
effectiveness of trunk training on trunk control, sitting
and standing balance and mobility post-stroke:
a systematic review and meta-analysis. Clin Rehabil.
2019;33(6):992–1002. doi:10.1177/0269215519830159.
7. Ryan AS, Dobrovolny CL, Smith GV, Silver KH,
Macko RF. Hemiparetic muscle atrophy and increased
intramuscular fat in stroke patients. Arch Phys Med
Rehabil. 2002;83(12):1703–1707. doi:10.1053/apmr.2002.
36399.
8. Jeon HJ, Hwang BY. Effect of bilateral lower limb
strengthening exercise on balance and walking in
hemiparetic patients after stroke: a randomized con-
trolled trial. J Phys Ther Sci. 2018;30(2):277–281.
doi:10.1589/jpts.30.277.
9. Fujiwara T, Sonoda S, Okajima Y, Chino N. The rela-
tionships between trunk function and the findings of
transcranial magnetic stimulation among patients with
stroke. J Rehabil Med. 2001;33(6):249–255. doi:10.1080/
165019701753236428.
10. Chan BK, Ng SS, Ng GY. A home-based program of
transcutaneous electrical nerve stimulation and task-
related trunk training improves trunk control in patients
with stroke: a randomized controlled clinical trial.
Neurorehabil Neural Repair. 2015;29(1):70–79.
doi:10.1177/1545968314533612.
11. Cabanas-Valdés R, Cuchi GU, Bagur-Calafat C. Trunk
training exercises approaches for improving trunk per-
formance and functional sitting balance in patients
with stroke: a systematic review. NeuroRehabilitation.
2013;33(4):575–592. doi:10.3233/NRE-130996.
12. Karthikbabu S, Solomon JM, Manikandan N, Rao BK,
Chakrapani M, Nayak A. Role of trunk rehabilitation
on trunk control, balance and gait in patients with
chronic stroke: a pre-post design. Neurosci Med.
2011;2(2):61–67. doi:10.4236/nm.2011.22009.
13. Ko EJ, Chun MH, Kim DY, Yi JH, Kim W, Hong J.
The additive effects of core muscle strengthening and
trunk NMES on trunk balance in stroke patients. Ann
Rehabil Med. 2016;40(1):142–151.
doi:10.5535/arm.2016.40.1.142.
14. Jung KS, Jung JH, In TS, Cho HY. Effects of weight-
shifting exercise combined with transcutaneous electri-
cal nerve stimulation on muscle activity and trunk
control in patients with stroke. Occup Ther Int.
2016;23:436–443. doi:10.5535/arm.2016.40.1.142.
15. Tamburella F, Scivoletto G, Molinari M. Somatosensory
inputs by application of kinesio taping: effects on
spasticity, balance, and gait in chronic spinal cord injury.
Front Hum Neurosci. 2014;8:367.
doi:10.3389/fnhum.2014.00367.
16. Firth BL, Dingley P, Davies ER, Lewis JS, Alexander CM.
The effect of kinesiotape on function, pain, and
motoneur- onal excitability in healthy people and people
with Achilles tendinopathy. Clin J Sport Med.
2010;20(6):416–421.
doi:10.1097/JSM.0b013e3181f479b0.
17. Lin JJ, Hung CJ, Yang PL. The effects of scapular
taping on electromyographic muscle activity and pro-
prioception feedback in healthy shoulders. J Orthop
Res. 2011;29(1):53–57. doi:10.1002/jor.21146.
18. Jaraczewska E, Long C. Kinesio taping in stroke:
improving functional use of the upper extremity in
hemiplegia. Top Stroke Rehabil. 2006;13(3):31–42.
doi:10.1310/33KA-XYE3-QWJB-WGT6.
19. Dos Santos GL, Souza MB, Desloovere K, Russo TL.
Elastic tape improved shoulder joint position sense in
chronic hemiparetic subjects: a randomized sham-
controlled cross- over study. PloS ONE.
2017;12(1):e0170368. doi:10.1371/
 TOPICS IN STROKE 1
journal.pone.0170368.eCollection2017.
1 Y.-H. CHO ET

20. Huang YC, Chang KH, Liou TH, Cheng CW, Lin LF, doi:10.1080/09638280500052872.
Huang SW. Effects of Kinesio taping for stroke patients
with hemiplegic shoulder pain: a double-blind, rando-
mized, placebo-controlled study. J Rehabil Med.
2017;49(3):208–215. doi:10.2340/16501977-2197.
21. Rojhani-Shirazi Z, Amirian S, Meftahi N. Effects of
ankle kinesio taping on postural control in stroke
patients. J Stroke Cerebrovasc Dis. 2015;24(11):2565–
2571. doi:10.1016/j.jstrokecerebrovasdis.2015.07.008.
22. Koseoglu BF, Dogan A, Tatli HU, Ozcan DS, Polat CS.
Can kinesio tape be used as an ankle training method in
the rehabilitation of the stroke patients? Complement
Ther Clin Pract. 2017;27:46–51.
doi:10.1016/j.ctcp.2017.03.002.
23. Borello-France DF, Burdett RG, Gee ZL. Modification
of sitting posture of patients with hemiplegia using seat
boards and backboards. Phys Ther. 1988;68(1):67–71.
doi:10.1093/ptj/68.1.67.
24. Iyengar YR, Vijayakumar K, Abraham JM, Misri ZK,
Suresh BV, Unnikrishnan B. Relationship between
postural alignment in sitting by photogrammetry and
seated pos- tural control in post-stroke subjects.
NeuroRehabilitation. 2014;35(2):181–190.
doi:10.3233/NRE-141118.
25. Mountain AD, Kirby RL, MacLeod DA, Thompson K.
Rates and predictors of manual and powered
wheelchair use for persons with stroke: a
retrospective study in a Canadian rehabilitation center.
Arch Phys Med Rehabil. 2010;91(4):639–643.
doi:10.1016/j.apmr.2009.11.025.
26. Capecci M, Serpicelli C, Fiorentini L, et al. Postural
rehabilitation and kinesio taping for axial postural dis-
orders in Parkinson’s disease. Arch Phys Med Rehabil.
2014;95(6):1067–1075. doi:10.1016/j.apmr.2014.01.020.
27. Bennell KL, Matthews B, Greig A, et al. Effects of an
exercise and manual therapy program on physical
impairments, function and quality-of-life in people
with osteoporotic vertebral fracture: a randomised,
single-blind controlled pilot trial. BMC Musculoskelet
Disord. 2010;11:36. doi:10.1186/1471-2474-11-36.
28. Han JT, Lee JH, Yoon CH. The mechanical effect of
kine- siology tape on rounded shoulder posture in
seated male workers: a single-blinded randomized
controlled pilot study. Physiother Theory Pract.
2015;31(2):120–125.
doi:10.3109/09593985.2014.960054.
29. Badawy WM, Ibrahem MB, Shawky KM. The effect of
kinesio taping on seated postural control in spastic
diplegic cerebral palsy children. Med J Cairo Univ.
2015;83:37–44.
30. Verheyden G, Nieuwboer A, Mertin J, Preger R,
Kiekens C, De Weerdt W. The trunk impairment
scale: a new tool to measure motor impairment of the
trunk after stroke. Clin Rehabil. 2004;18(3):326–334.
doi:10.1191/0269215504cr733oa.
31. Verheyden G, Nieuwboer A, Feys H, Thijs V, Vaes K,
De Weerdt W. Discriminant ability of the trunk
impairment scale: a comparison between stroke patients
and healthy individuals. Disabil Rehabil.
2005;27(17):1023–1028.
 TOPICS IN STROKE 1
32. Folstein MF, Robins LN, Helzer JE. The mini-mental
state examination. Arch Gen Psychiatry. 1983;40(7):812.
doi:10.1001/archpsyc.1983.01790060110016.
33. Nather A, Neo SH, Chionh SB, Liew SC, Sim EY, Chew
JL. Assessment of sensory neuropathy in diabetic
patients without diabetic foot problems. J Diabetes
Complications. 2008;22(2):126–131.
doi:10.1016/j.jdiacomp.2006.10.007.
34. Cabanas-Valdés R, Bagur-Calafat C, Girabent-Farrés
M, Caballero-Gómez FM, Hernández-Valiño M,
Urrútia Cuchí G. The effect of additional core stability
exercises on improving dynamic sitting balance and
trunk control for subacute stroke
patients: a randomized controlled trial. Clin Rehabil.
2016;30 (10):1024–1033.
doi:10.1177/0269215515609414.
35. van Dijk MM, Meyer S, Sandstad S, et al. A cross-
sectional study comparing lateral and diagonal
maximum weight shift in people with stroke and
healthy controls and the correlation with balance, gait
and fear of falling. PloS One. 2017;12(8):e0183020.
doi:10.1371/journal.pone.0183020.
36. Csapo R, Alegre LM. Effects of kinesio® taping on
skeletal muscle strength—a meta-analysis of current
evidence. J Sci Med Sport. 2015;18(4):450–456.
doi:10.1016/j.jsams.2014.06.014.
37. Montalvo AM, Cara EL, Myer GD. Effect of
kinesiology taping on pain in individuals with
musculoskeletal injuries: systematic review and meta-
analysis. Phys Sportsmed. 2014;42(2):48–57.
doi:10.3810/psm.2014.05.2057.
38. Hu Y, Zhong D, Xiao Q, Chen Q, Li J, Jin R. Kinesio
taping for balance function after stroke: a systematic
review and meta-analysis. Evid Based Complement
Alternat Med. 2019:8470235.
doi:10.1155/2019/8470235.
39. Bae YH, Kim HG, Min KS, Lee SM. Effects of lower-leg
kinesiology taping on balance ability in stroke patients
with foot drop. Evid Based Complement Alternat Med.
2015:125629. doi:10.1155/2015/125629.
40. Tyson SF, Hanley M, Chillala J, Selley A, Tallis RC.
Balance disability after stroke. Phys Ther.
2006;86:30–38. doi:10.1093/ptj/86.1.30.
41. Şimşşek TT, Türkücüoğğlu B, Çokal N, Üstünbaşş G,
Şimşşek İE. The effects of kinesio® taping on sitting
posture, functional independence and gross motor
function in chil- dren with cerebral palsy. Disabil
Rehabil. 2011;33(21–- 22):2058–2063.
doi:10.3109/09638288.2011.560331.
42. Saeys W, Vereeck L, Truijen S, Lafosse C, Wuyts FP,
Van de Heyning P. Randomized controlled trial of
truncal exercises early after stroke to improve balance
and mobility. Neurorehabil Neural Repair. 2012;26
(3):231–238. doi:10.1177/1545968311416822.
43. Karthikbabu S, Nayak A, Vijayakumar K, et al.
Comparison of physio ball and plinth trunk exercises
regi- mens on trunk control and functional balance in
patients with acute stroke: a pilot randomized
controlled trial. Clin Rehabil. 2011;25(8):709–719.
doi:10.1177/026921551039 7393.
1 Y.-H. CHO ET

44. Yu SH, Park SD. The effects of core stability strength

NeuroRehabilitation. 2013;32(2):323–325. doi:10.3233/
exercise on muscle activity and trunk impairment scale
NRE-130851. ̂
in stroke patients. J Exerc Rehabil. 2013;9(3):362–367.
50. Corriveau H, Hébert R, Raıche M, Prince F. Evaluation of
doi:10.12965/jer.130042.
postural stability in the elderly with stroke. Arch Phys
45. Yoshida A, Kahanov L. The effect of kinesio taping on
Med Rehabil. 2004;85:1095–1101. doi:10.3233/NRE-
lower trunk range of motions. Res Sports Med. 2007;15
130851.
(2):103–112. doi:10.1080/15438620701405206.
51. Li XL, Lau GK, Lo CK, Wong SH, Zhuo HT,
46. Cortesi M, Cattaneo D, Jonsdottir J. Effect of kinesio
Tsang WW. The reliability and validity of sitting bal-
taping on standing balance in subjects with multiple
ance control tests in stroke survivors. Yangtze Med.
sclerosis: a pilot study. NeuroRehabilitation. 2011;28
2017;1(1):20. doi:10.4236/ym.2017.11003.
(4):365–372. doi:10.3233/NRE-2011-0665.
52. Willardson JM. Core stability training: applications to
47. Harley C, Boyd JE, Cockburn J, et al. Disruption of
sports conditioning programs. J Strength Cond Res.
sitting balance after stroke: influence of spoken output.
2007;21(3):979–985. doi:10.1519/R-20255.1.
J Neurol Neurosurg Psychiatry. 2006;77(5):674–676.
53. Genthon N, Vuillerme N, Monnet JP, Petit C,
doi:10.1136/jnnp.2005.074138.
Rougier P. Biomechanical assessment of the sitting
48. Helmy H, Emara T, Mously SE, Arafa M, Mansour W,
posture maintenance in patients with stroke. Clin
Kafrawy NE. Impact of trunk control on balance and
Biomech (Bristol, Avon). 2007;22(9):1024–1029.
functional abilities in chronic stroke patients. Egypt
doi:10.1016/j.clinbiomech.2007.07.011.
J Neurol Psychiatry Neurosurg. 2014;51(3):327–331.
54. Thompson M, Medley A. Forward and lateral sitting
49. Jijimol G, Fayaz RK, Vijesh PV. Correlation of trunk
func- tional reach in younger, middle-aged, and older
impairment with balance in patients with chronic
adults. J Geriatr Phys Ther. 2007;30(2):43–48.
stroke.
doi:10.1519/00139 143-200708000-00002.