PRESENTASI JURNAL

MAUSHALY ADANI
J130170157

PROFESI FISIOTERAPI
UNIVERSITAS MUHAMMADIYAH
SURAKARTA
 INTRODUCTION
CP
Wright et al
Simsek et al POOR POSTURAL CONTROL (2012)
(2011) NMES has
KT has been been effective
effective on IMPERATIVE SITTING AND MOBILITY on sitting and
sitting. posture in CP
children as
well
DECREASE ABILITY FOR ADL.

COMPARE
 MATERIALS - METHODS
KRITERIA INKLUSI KRITERIA EKSKLUSI

HYPERSENSITIVI
CP SPASTIK TY
DIPLEGI WITH TO KT
HIP CONTRACTURE
KYPHOSIS SCOLIOSIS

SITTING PROBLEM SEVERE COGNITIVE

DISORDERS
COOPERATIVE HIP DISLOCATION
SEVERE SPASTICITY
 MATERIALS - METHODS
75 CHILDREN WITH CP
SPASTIC DIPLEGIC DROP OUT 14
ALLERGIC KT
NOT TOLERATE NMES

CONTROL NMES KT
GROUP GROUP GROUP
(19) (23) (19)

4 weeks, change every 3-4days

NDT 4X/week for 4X/week for 4weeks
4weeks I : 20-30mA, P:
Each ± 75 min 250µs, F: 25Hz
 MATERIALS - METHODS
SITTING BALANCE  GMFM
EVALUATION
MEASUREMENTS
POSTURAL CONTROL  KYPHOTIC
ANGLES (X-RAY)

SHAPIRO WILK TEST

(NORMALITY DATA)
STATISTICAL ANALYSIS
ANOVA TEST
(HYPOTHESIS TEST)
RESULTS
 RESULTS

The mean decrement levels in kyphosis values were 15.3, 7.68, and 4.32 in the
NMES, KT, and control groups, respectively (all p < 0.01).
Exemplary radiographs illustrating the change in kyphotic angles.
 DISCUSSION
NMES has been used particularly for muscle re-education and strengthening where the stimulation
is designed to create a motorneuronal response resulting in a muscle contraction. Stimulation aims to
provide feedback to the brain about the muscles that are activated during therapy. Stimulation at
sensory level helps the child to ‘localize’ the muscle he/she is trying to use. The feedback information
from the child’s own movements facilitates motor learning . Electrical stimulation applied
transcutaneously at an intensity sufficient to evoke a perception analogous to a ‘tapping’ or ‘tickling’
feeling is presumed to activate sensory nerve fibres. The stimulation is applied so that the child is able
to detect a sensation, but a muscle contraction is neither visible nor palpable. It is hypothesized that this
kind of sensory stimulation increases the awareness of the involved extremity, thereby improving
function.
 DISCUSSION
Callaghan et al found that taping can modulate brain activity in several areas of the brains, especially,
sensory motor cortex during a proprioception movement. The stimulus of cutaneous mechanoreceptors
achieved thought KT which applies pressure to the skin or even stretches seem to result in physiological
changes such as adequate firing and recruitment pattern of the muscles. Those physiological changes probably
are related to improvements in postural and neuromuscular control.
It is believed that activation of the cutaneous receptors could influence neuromuscular functions. The
cutaneous sensory system provides preliminary information about body positions and muscle forces to the
central nervous system for monitoring and controlling body movements, planning actions, and providing
fluent movement. Kinesiotaping might influence the cutaneous receptors of the sensory motor system,
resulting in the improvement of voluntary control and coordination for children with CP.
 LIMITATIONS
 Although GMFM gives some idea about sitting balance, lack of evaluation by important scales or
tests such as functional independence measure, sit-to-stand movement, Gross motor functional
classification scale, and pediatric balance scale

 The children could be followed-up after interventions

 Duration of NDT could be more than four weeks
 Although the X-rays were evaluated by the same physiatrists, lack of intrarater reliability is a
limitation.
 CONCLUSION

The results of this study suggest that KT or NMES application for at least four weeks in addition to NDT
seem to be effective on improving kyphosis and GMFM. Besides, NMES is more effective than KT.

Further studies concerning the combination of KT and NMES with different rehabilitation modalities in
different CP samples are awaited.
THANK YOU