Taping and Traditional Exercises in Upper Limb Function in Hemiplegic
Condition: Hemiplegic Cerebral Palsy
MeSH terms: Cerebral Palsy
Study type: Interventional

Summary: 
      The aim of this research is to determine the Effects of taping verse traditional exercises on
      scapular stabilization and upper limb function in hemiplegic cerebral palsy.Taping and
      traditional exercises effects on scapular stabilization and support upper limb fuction in
      Hemiplegic cerebral palsy patients. A randomized controlled trial will be done at hayatabad
      Medical Complex Peshawar. The sample size is 26. The Participants will be divided into two
      groups, 13 participants in group A and 13 in Group B. The study duration will 6 months.
      Sampling technique will purposive non probability sampling technique. Only 6 to 8 years
      participants with Hemiplegic cerebral palsy will be included. Tools will be used in this
      study are Quality of upper extremity skill test, The Functional Independence Measure for
      Children (WeeFIM): Data will be analyzed through Statistical Package of Social Sciences
      version23.
    

Detailed description: 
      Cerebral palsy (CP) is a non-progressive group of developmental motor disorders that may
      result in spasticity, paralysis, or abnormal posture. Muscle weakness has been recognized as
      a primary clinical feature in CP. It is the most common cause of physical disability in
      children, with a prevalence of 2 to 2.5 per 1000 live births in Western countries .
      Hemiplegia is a form of spastic Cerebral Palsy (CP) in which one arm and leg on either the
      right or left side of the body is affected. There are several sub-types of CP, one of which
      is spastic hemiplegic CP, which occurs in approximately23%ofchildren with spastic CP. Because
      CP is a lifelong condition, all aspects of an individual's development and independence are
      impacted. The upper limb is usually more severely involved than lower one. This limits
      reaching, grasping and object manipulation, interfering also with exploration, play,
      self-care and other activities of daily living. Children with hemiplegic cerebral palsy often
      have marked hand involvement with excessive thumb adduction and ﬂexion and limited active
      wrist extension from infancy. Deficits in upper limb motor function can affect a 53 child's
      participation in self-care and play, and thus interfere with development in 54 multiple
      domains. Chronic hemiplegic patient with residual scapular weakness has the spasticity of
      some of the scapular muscles, which disturb the proximal stability of the scapulothoracic
      joint.This limits reaching, grasping and object manipulation, interfering also with
      exploration, play, self-care and other activities of daily living. Becoming independent in
      activities of daily living requires amongst others a smooth coordination between both hands

        -  Though motor deficits have been emphasized, sensory dysfunction may exist and may
           contribute to diminished use of the affected hand. Several studies have emphasized the
           impact that sensory deficits may have on hand function, because precise motor ability is
           dependent on sensory input. Common treatments include botulinum toxin, orthopedic
           surgery constraint induced movement therapy, pharmacotherapy for muscle tone,
           occupational therapy and traditional physiotherapy. As impairments in these children
           involve a variable range of functions, the children need comprehensive rehabilitation
           therapy

        -  A study conducted on ''Neuromuscular taping for the upper limb in Cerebral Palsy''
           discussed that, the data showed that, after the intervention, the movement of the
           affected arm was faster, in particular in the adjusting and returning phase. The
           movement was also smoother and with a more physiological range of motion at shoulder and
           elbow. After the taping removal, Researcher found in fact a reduction of the adjusting
           and returning phase duration, a lower value of average jerk parameter and improved upper
           limb ranges of motion if compared to pre-test condition . A study on ''the effect of
           taping on scapular stability and upper limb function in recovering hemiplegics with
           scapular weakness'' shows that scapular taping has improved the functional outcome in
           upper extremity hemiplegics with scapular weakness. Scapular taping has improved the
           alignment of the scapula by inhibiting the hyperactive upper trapezius and facilitating
           the weak serratus anterior muscle by altering length-tension properties of muscles and
           providing kinesthetic awareness of scapular position during rest and movement of upper
           extremity. A study on Functional Impact of Shoulder Taping in the Hemiplegic Upper
           Extremity reported relief of pain symptoms immediately after being taped. Reduction in
           the patient's subjective sense of pain was associated with improvements in the ability
           to perform activities of daily living (ADL) and in range of motion (ROM). The patient
           showed improvements in the ability to dress, toilet, and bathe himself following
           shoulder taping and concomitant reduction in pain. The reported changes in ROM were less
           dramatic than the ADL improvement .A systematic review on the effects of elastic
           therapeutic taping on motor function in children with motor impairments. From the
           studies analyzed, it appears that interest in the use of elastic therapeutic taping as
           an adjunct and assistance resource to conventional treatment has grown over the last
           decade.
    

Intervention name(s): Taping plus Traditional exercises
Intervention type(s): Other
Intervention description(s): The children will be taped 6 days per week for a total a period of 08 weeks. The tape will be used and keep the scapula in position for 3 days and the region will then be left to rest for 24 hours. Kinesio Taping will then be re-applied by the same experienced research assistants for another 3 days.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment