Effects Of Kinesio Taping On Balance, Functionality, And Participation In Children With Cerebral Palsy?
Condition: Cerebral Palsy, Spastic; Gait Disorders, Neurologic; Hemiplegic Cerebral Palsy
MeSH terms: Muscle Spasticity; Paralysis; Cerebral Palsy; Nervous System Diseases; Gait Disorders, Neurologic
Study type: Interventional

Summary: 
      BACKGROUND: Walking and balance problems are among the most common problems in individuals
      with cerebral palsy (CP). Hip abduction and extension muscle function insufficiencies are
      common in children with CP.

      OBJECTIVE: The aim of this study was to investigate the immediate and long-term effects of
      Kinesio® Taping (KT) applied on the gluteus maximus and gluteus medius muscles on walking,
      functionality, balance, and participation in children with unilateral spastic CP.

      METHOD: This study was designed as a randomized controlled trial. The study included 20
      children with unilateral spastic CP: 11 in the taping group and 9 in the control group. KT
      was applied in the taping group for 4 weeks in addition to a physiotherapy program. The
      control group received only the physiotherapy program. Body structure and functions were
      evaluated with the Pediatric Berg Balance Scale (PBBS). Activity was evaluated with the Timed
      Up and Go Test (TUG), Functional Mobility Scale (FMS), Gross Motor Function Scale (GMFM-88),
      the BTS G-Walk Spatiotemporal Gait Analysis System. Participation was evaluated with the
      Canadian Occupational Performance Measure (COPM). Evaluations were made at the beginning of
      the study and 30 minutes after the first tape application, and at the end of 4 weeks in the
      taping group. The level of significance was accepted as p<0.05.
    

Detailed description: 
      INTRODUCTION Walking and balance problems are frequently seen in individuals with cerebral
      palsy (CP). In individuals with CP, co-contraction of the distal and proximal muscles
      increase and muscle activation patterns are not fluent. Spasticity causes a decrease in
      muscle strength and length and a reduction in muscular coordination. Secondary to all this,
      decreases are seen in the energy production of the muscles.

      Insufficiencies in hip abduction and extension muscle function are common in CP. Excessive
      muscles tonus in the hip adductors and flexors and a loss of reciprocal inhibition cause a
      weakness in the gluteus medius and maximus. This weakness negatively affects the movement
      patterns of the lumbar spine, pelvis, and hip region, and also causes incorrect loadings in
      hip joint and abnormalities in hip biomechanics. Gait anomalies occur and pelvis
      stabilization is impaired. In particular, negative impacts on participation are a concern.
      With the physiotherapy and rehabilitation approaches, these negative effects may be minimized
      by facilitating the gluteal muscles. Gait training and exercises to strengthen the gluteal
      muscles are routinely used in the rehabilitation of CP. With these approaches, it is aimed to
      maximize the gait function and promote independence and participation.

      The somatosensory system may be affected in unilateral spastic CP. These children often
      suffer sensory impairments that could affect the development of future motor skills. Kinesio
      Taping® (KT) is used for pediatric rehabilitation to reduce pain, facilitate or inhibit
      muscle activity, prevent injuries, reposition joints, aid the lymphatic system, support
      postural alignment, and improve proprioception.

      Yasukawa et al. stated that the use of KT for children with CP might influence the cutaneous
      receptors of the sensory motor system, resulting in an improvement in voluntary control and
      coordination via a physiotherapy program. Therefore, facilitating the gluteal muscles by KT
      may affect walking and balance positively.

      In the literature, the clinical use of KT techniques in children with CP is generally at the
      upper extremity. In studies in which KT is applied to the lower extremity, it is generally
      applied to the distal part of extremity. In addition, most of the studies have investigated
      the immediate effect. There are few studies investigating the effects of KT applied to the
      gluteus medius and gluteus maximus muscles, which are located in the proximal hip with
      important contributions in stabilization.

      The aim of this study was to investigate the immediate and long-term effects of KT applied to
      the gluteus maximus and gluteus medius muscles on walking, functionality, balance, and
      participation in children with unilateral spastic CP.

      MATERIAL AND METHODS The permission of the University Ethics Committee was received
      (91610558-302.08.01) and written informed consent was obtained from each participant and/or
      guardian.

      Participants

      The inclusion criteria were: having unilateral spastic CP; being in an age between 6 years
      and 12 years; being classified in levels I or II of the Gross Motor Function Classification
      System (GMFCS); having spasticity at lower extremity 2 or less according to Modified Ashworth
      Scale, and being able to follow and accept verbal instructions. The exclusion criteria were
      having any orthopedic surgery or botulinum toxin injection in the past 6 months and having
      allergic reactions to the adhesive compound of KT.

      Procedure

      This study was designed as a randomized controlled trial. Twenty children (10 girls, 10 boys)
      were included in the study. The children were divided into two randomized groups using a
      computer program. Of the 20 participants, 11 were randomized to the taping group and 9 to the
      control group.

      Measurements In the taping group, measurements were made at the beginning of the study, 30
      minutes after the first tape was applied, and at the end of the 4th week. In the control
      group, measurements were made at the beginning of the study and at the end of the 4th week.
      The BTS G-Walk Spatiotemporal Gait Analysis System was administered by the third author (S.
      Ö.). All other measurements were administered by the same physiotherapist (S. N. K.). Gross
      motor function was classified using the GMFCS.

      Body Structures and Functions Body composition was evaluated by body mass index (BMI)
      calculated with the following formula: weight in kilograms divided by the square of the
      height in meters. Balance was evaluated with the Pediatric Berg Balance Scale (PBBS).

      Activity functioning Functionality was assessed using the Timed Up and Go test (TUG) and the
      Functional Mobility Scale (FMS). The TUG measures various components such as walking speed,
      postural control, functional mobility, and balance . The walking ability of the participants
      was evaluated with the Functional Mobility Scale at 3 different distances (5 meters-indoor,
      50 meters-school, 500 meters-community). Inter-observer reliability of the FMS, which can
      reveal changes that cannot be detected with the GMFCS, was also demonstrated. Gross motor
      function was assessed using dimensions D and E of the Gross Motor Function Measurement
      (GMFM), which consists of standing, walking, running, and jumping. The GMFM is a valid,
      reliable, and sensitive method, which demonstrates the change in motor functions in children
      with CP and other disabilities via videotape recordings.

      Gait parameters were assessed using the BTS G-Walk Spatiotemporal Gait Analysis System. In
      this system, the analysis results of the sensor attached to the L5-S1 level of the patient
      was transferred to a computer via Bluetooth. This system allows gait analysis by comparing
      the left and right extremities with normal values, and it also enables a 3-dimensional
      kinematic analysis of the pelvis. The track length was preset as 10 meters. The children with
      CP were asked to walk the 10-meter track three times. Three measurements were averaged in the
      analysis.

      Participation Participation was assessed using the Canadian Occupational Performance Measure
      (COPM). The COPM is a client-centered outcome measure to identify and prioritize everyday
      issues that restrict individuals' participation in everyday life.

      Intervention

      Every group received routine traditional physiotherapy twice a week over the period of 4
      weeks. This routine traditional treatment consisted of stretching, weight bearing, functional
      reaching, walking, and electrotherapy. Sessions were 40 minutes. The children in the taping
      group were taped 6 days per week for 4 weeks. The children were checked for allergies before
      applying the tape. A 5-cm tape was applied and kept in position for 3 days, and the region
      was then left to rest for 24 hours.

      KT was applied to the gluteus maximus and gluteus medius muscles. The KT muscle facilitation
      technique was used to support and facilitate the function of the muscles. For the gluteus
      maximus, a "Y" tape was used. The child was placed in a side lying position and the beginning
      of the tape was applied to the origin of the muscle (center of the sacrum). The leg flexed
      and adducted, and the first tail was applied to enclose the lower part of the gluteus maximus
      muscle. The second tail was applied diagonally from the sacrum to the greater trochanter. For
      the gluteus medius muscle, 2 "I" tapes were applied. The first tape was applied from the
      spina iliaca anterior superior to the greater trochanter, the second tape was applied from
      the spina iliaca posterior superior to the greater trochanter. During the applications, the
      hip was adducted and extended, and all tape ends were applied without tension.

      Statistical analysis Post-hoc power analysis was performed when 20 participants (11 in the
      taping group, 9 in the control group) were enrolled in our study. Power analysis was
      conducted using G*Power (version 3.0.10 Universitat Düsseldorf, Düsseldorf, Germany) to
      compare pairs of independent sample means. In the post-hoc power analysis, when the
      statistical significance of alpha was 5% and the confidence interval was 95%, the power of
      the study (1-β) was found to be 99%. The study was completed by deciding that a sufficient
      sample size was reached. The Statistical Package for the Social Sciences (SPSS) version 26
      was used to analyze the obtained data. The level of significance was set at p<0.05.
      One-sample Kolmogorov-Smirnov Tests were used to evaluate distribution of variables before
      test selection. Descriptive analyses are presented using medians and the interquartile ranges
      for the non-normally distributed and ordinal variables. In the comparison of two independent
      nominal variables, while the Chi-Square Test was used, the Fisher Test was preferred
      according to the expected values in the table cells. The Mann-Whitney U test was used to
      compare non-normally distributed ordinal data in independent groups. The Wilcoxon Signed
      Ranks Test or the Friedman was used in dependent groups. The Student's t-test was used to
      compare normally distributed numerical data. Repeated Measures Anova was used to compare
      normally distributed numerical data in more than two dependent groups. Groups were compared
      with each other using the paired T test.
    

Intervention name(s): Kİnesio Taping
Intervention type(s): Other
Intervention description(s): Kinesio Taping® (KT) is used for pediatric rehabilitation to reduce pain, facilitate or inhibit muscle activity, prevent injuries, reposition joints, aid the lymphatic system, support postural alignment, and improve proprioception
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized Controlled Trial
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: cerebral palsy; gait; balance; kinesio taping