The Functional Effects of Kinesio Taping

The purpose of this study was to evaluate the effectiveness of the Kinesio Taping Method for the upper extremity in order to enhance functional motor skills with children admitted into an acute rehabilitation program. The participants were 15 children (10 females and 5 males); 4 to 16 years of age, receiving rehabilitation services at the Rehabilitation Institute of Chicago. The Melbourne Assessment of Unilateral Upper Limb Function (Melbourne Assessment) was used to objectively measure upper-limb functional change prior to being Kinesio Taped, immediately after application of the tape, and 3 days after wearing of the tape. Children’s performances were compared over the 3 assessments using analysis of variance. These results suggest that Kinesio Taping is an effective adjunct to treatment in improving upper extremity control and function.

Introduction

Children admitted into an acute pediatric rehabilitation program most often present with a combination of muscle weakness or muscle imbalance, decreased postural control, muscle spasticity, and/or poor voluntary control. The children are seen for a comprehensive in-patient therapy program on a daily basis to improve their ability to perform self-care, play, mobility, and increase function to return home and back to school. Reaching and hand control are highly skilled movements necessary for daily functional tasks. Children in rehabilitation programs often have common problems of decreased movement and initiation, limitation of reach, and impaired efficiency affecting the accuracy of reach with a decline in overall hand function. The overall ability of the child to functionally use the affected arm and hand may be diminished due to the muscle weakness or imbalance, muscle tone, or poor alignment.

Kinesio Taping is a relatively new technique used in rehabilitation programs. It is commonly used in sports injuries; however, it is gradually becoming useful in treating other impairments. The use of Kinesio Taping in conjunction with the child’s regular therapy program may assist with improving joint stability with subsequent improvement of voluntary control and coordination of the upper limb. When applied properly the tape can theoretically improve the following: strengthen weakened muscles, control joint instability, assist with postural alignment, and relax an over-used muscle. The properties of Kinesio Tape do not constrict movement as ‘conventional’ rigid tape.The non-stretch rigid tape is used to limit unwanted joint movement, to protect and support a joint structure (Macdonald 1994, McConnell 1995).  Taping allows immediate patient feedback regarding possible functional benefits. With the Kinesio Tape on the patient can report symptom relief, comfort level or stability of the involved joint. The elastic property of Kinesio Tape conforms to the body, allowing for movement. The tape is latex free, very thin, and stretches in the longitudinal plane.  Dr. Kenzo Kase developed the Kinesio Taping techniques as an alternative to the conventional taping method.

Dr. Kenzo Kase designed the brand of tape Kinesio Tex which is a flexible, thin, porous cotton fabric with adhesive backing. The tape is latex free and will only stretch longitudinally from 30 to 40% more than its original length. The intent of Kinesio Taping is to improve the dynamic stability of the weak muscle or the painful muscle by providing improved alignment and cutaneous stimulation to enhance muscle contraction. The elastic quality and proprioceptive input as well and subtle biomechanical factors may account for the functional changes observed (Kerr 1996).

The Kinesio Tex Tape can be cut into an “I”, “Y”, “X” or a fan shape. When the application procedure is followed correctly, the taped area can be used to facilitate a weakened muscle or to relax an overused muscle. To support a weak muscle the tape is attached at the base of the origin of the muscle, then with the muscle in elongation, the tape is applied around the muscle to the insertion. The method for applying the tape will vary depending on the specific technique used to improve active range of motion, relieve pain, adjust misalignment or to improve lymphatic circulation (Kase et al. 1996, Kase 1994, Kase et al 2003).

Taping has been utilized by athletic trainers to provide stability and protection to joints for athletes who participate in sports that require repeated overhead motions, such as swimming, baseball, tennis. For sports injuries taping has been commonly use for reducing pain to facilitate gains in range of motion, strength and function (Penny and Welsh 1981, Hawkins and Kennedy 1980).   The principles and techniques of taping have been adapted to be used clinically in rehabilitation centers for patients who present with shoulder subluxation or shoulder pain. Taping can be used as an adjunct during the rehabilitation program for the patient to enhance functional recovery (Host 1995, Schmitt and Snyder-Mackler 1999).

Murray (2002)described in a case study the effects of Kinesio Tape applied to the anterior aspect of the thigh following anterior cruciate ligament reconstruction. In this preliminary study it was found that Kinesio Tape enhanced the joint active range of motion and that the increase was correlated with an increase in surface EMG of the muscles of the anterior compartment of the thigh. Maruko(2000)described the use of Kinesio Taping as an adjunct to aqua-therapy for the pediatric neurological population. The application of the tape prior to the aqua therapy program has been found beneficial in providing support, alignment and muscle balance. The benefit of using aqua-therapy is that gravity is eliminated and the child is able to work on specific exercises and postural re-training that is otherwise difficult to perform on land. Kinesio Taping can be used to provide alignment and further facilitate specific muscles for strengthening while the child is in the water.

Children admitted into a rehabilitation program receive more intensive daily therapies throughout their in-patient stay. Limited data exist to support the effectiveness of Kinesio Taping as an adjunct to treatment to facilitate attainment of functional motor skills. Therapists often use subjective clinical observation, anecdotal reporting or descriptive terminology to assess upper extremity movement quality. The primary objective of this study is to determine whether functional hand and arm skills in children admitted into a rehabilitation program are amenable to change following Kinesio Taping Method.

Participants

The study participants consisted of 15 children (5 males and 10 females) admitted to the pediatric in-patient program at the Rehabilitation Institute of Chicago. The children ranged in age from 4 years to 16 years of age, with decreased muscle strength of the upper extremity as measured by manual muscle testing (poor to good range) and/or abnormal muscle tone interfering with functional movement as measured by the Modified Ashworth Scale (MAS). Table I describes the physical characteristics and taping technique applied to the subjects.

Criteria for selection included children with enough motivation and cognition to follow direction to the Melbourne Assessment of Unilateral Upper Limb Function (Melbourne Assessment) (Randall et al., 1999), and had no significant behavioral problems. Children with dense sensory and motor loss (muscle grade at zero to trace) in the area to be taped were eliminated. Also children with significant spasticity of the MAS of 3 or 4 ((3) considerable increase in tone; passive movement difficult or (4) affected parts rigid in flexion or extension) were eliminated.

Measures

The Melbourne Assessment scores quality of upper limb function based on 16 criterion-referenced items with 37 sub scores (Table II). The Melbourne Assessment is an objective standardized measure evaluating the quality of upper extremity function of reach, grasp, release and manipulation. Each subject’s performance was recorded on a videotape for scoring. The scoring was done on each test items with specific criteria for that specific movement with a score sheet and point scale. (appendix A) The score of the sub score is recorded as a raw score and converted to a percentage score. A higher percentage score indicates better quality of arm and hand movements based on the specific test items.

Procedure

Consent forms were obtained for each subject. Subjects identified as having upper extremity movement problems interfering with function were evaluated with the Melbourne Assessment.  The Melbourne Assessment was administered by a qualified occupational therapist familiar with the requirements of each test item and the components of movements scored for each test. A certified occupational therapy assistant was trained to videotape the assessment following the guidelines and specific instructions of the assessment. Scoring of each child’s performance was accomplished following the specific instructions for scoring by a separate occupational therapist also trained to score the Melbourne to prevent bias.

The Melbourne Assessment was given prior to taping and immediately after application of the Kinesio Tape during the same session to prevent possible practice of the skills of the assessment. The Melbourne was again given after 3 days of wearing the tape. The elasticity of the Kinesio tape can last 3-4 days. The palmar stability tape was the only tape that required application daily to some of the children that did frequent hand washing.

An occupational therapist certified in the application technique of Kinesio Taping evaluated the upper limb that required taping per the Kinesio Taping protocol. Taping was used to facilitate a weakened muscle, provide joint stability and alignment (figures 1 & 2).

Results

Table III lists the means and standard deviations for the Melbourne Assessment before taping, immediately after taping, and 3 days of wearing the tape. We used analysis of variance to compare the Melbourne Assessment scores across the 3 time periods. Overall, the Melbourne scores improved over time (F (2,14) = 17.7, p < .001).  Further, the improvement from pre- to post-taping was statistically significant (F (1,14) = 18.9, p < .02).  Figure 3 shows a box-plot of the scores at the 3 time points. The solid line in the middle of the box-plot illustrates the median at each time point; the top and bottom of the box illustrates the 25^th and 75^th-percentile, respectively. The 10^th and 90^th percentiles are illustrated by the “whisker” below and above each box.

Discussion

The results confirm that the effects of Kinesio Tape has improved upper limb function as demonstrated with the Melbourne Assessment over time. Although the sample size was small, a statistical significant improvement was found when the data was analyzed. Assessing clinical change in the upper extremity in children admitted into a rehabilitation program is a complex measurement task. This study demonstrated that clinical change in function can be measured supporting the use of Kinesio Taping as an adjunct to treatment. The Melbourne Assessment was sensitive to measure the subtle motoric progress that was exhibited before and after a subject was Kinesio Taped. The Melbourne Assessment was able to detect change in upper extremity control and quality of movement in children judged by parents and therapist to have changed.

The use of the Kinesio Taping Method appeared to have facilitated and improved movement, provided needed stability and alignment to perform the task for reach, grasp, release and manipulation. Bourke-Taylor (2003) investigated the performance on the Melbourne Assessment as it related to the child’s ability to perform functional skills using the Pediatric Evaluation Disability Index (PEDI). The results confirmed a strong correlation between the Melbourne Assessment as a measure for upper limb function and functional living skills. 

Clinically this study demonstrated that by using Kinesio Tape as a treatment tool, that improvement was seen in upper extremity function. The Melbourne Assessment detected a gradient of performance change with Kinesio Taping. After performing the initial assessment the child was then immediately taped and re-assessed to prevent the possibility of practice to factor in for the probable change in the quality of arm movement. The immediate change seen after the application of the tape can be attributed to the input provided by the Kinesio Tape. The continued improvement in upper limb functional skills seen on day three may be the combination of both the taping input and the continued therapy program.

Summary

This study demonstrated that clinical change in function can be measured supporting the treatment outcome of the Kinesio Taping intervention. Kinesio Taping is a relatively new treatment technique used in rehabilitation centers. The Melbourne Assessment validated measures that were responsive to clinically important functional change through the use of the Kinesio Tape. As clinicians we have an obligation to evaluate the effects of a new treatment technique with objective validation of measure for assessing change in function. The use of Kinesio Taping may become a more acceptable and utilize method of treatment for muscle weakness, spasticity and its associated problems. By carefully selecting children that may benefit from the Kinesio Taping Method it has been found to be an effective adjunct to treatment in children admitted into a rehabilitation program. The Melbourne Assessment is a useful tool to assist clinicians with measurement of upper-limb function, however further studies comparing the use of Kinesio Taping with a control group tested with the Melbourne Assessment alone to investigate the possibility of change with practice may further support the treatment effectiveness of Kinesio Taping.

Acknowledgement

The research was supported by the Buchanan Family Fellowship in Occupational Therapy. We would also like to thank Dr. Allen Heinemann for his statistical assistance.

Table I:  Physical Characteristic and taping techniques of the subjects

Subject

Age

Sex

Impairments

Area Taped

1.

4 yrs

F

R Hemiplegia, Encephalitis

forearm supination, triceps, finger extension, thumb extension, palmer stability

2.

7 yrs

F

L Hemiplegia, CVA

supination, wrist extension, thumb extension

3.

7 yrs

F

L Hemiplegia, encephalomyelitis, seizure

scapula stability, supination, palmer stability

4.

8 yrs

F

C2-C6 SCI lesion, brain tumor

wrist extension, thumb extension, plamer stability, scapula stability

5.

10 yrs

F

R Hemiplegia, CVA, brain tumor

wrist extension, plamer stability, thumb extension, scapula stability

6.

11 yrs

F

Left shoulder septic arthritis, sickle cell disease, multifocal osteomyelitis

scapula stability, deltoid

7.

12 yrs

F

R Hemiplegia, brain tumor

scapula stability, supination, palmer stability

8.

12 yrs

M

Traumatic brain injury

scapula stability, wrist extension, deltoid

9.

12 yrs

M

R Hemiplegia, brain stem CVA

back extensor, palmer stability, thumb extension, postural correction

10.

14 yrs

M

generalized muscle weakness, cerebral palsy

wrist extension, palmar stability, deltoid, thumb extension

11.

14 yrs

F

SCI C5-6 incomplete, tetraplegia

finger extensor, wrist stability

12.

15 yrs

F

SCI C5-6 incomplete, tetraplegia

finger flexors, wrist extensors, scapula, deltoid

13.

15 yrs

F

SCI C5-6 incomplete, tetraplegia

wrist extensors, palmar stability, deltoid

14.

16 yrs

M

R Hemiplegia, traumatic brain injury

scapula stability, deltoid, supination, palmar stability

15.

16 yrs

M

SCI C6-7 incomplete, tetraplegia

finger flexors, thumb opposition, palmer stability

Table II:  Melbourne Assessment test items (Randall et al. 1999)

Items

Task

1

Reach forwards

2

Reach forwards to an elevated position

3

Reach sideways to an elevated position

4

Grasp of crayon

5

Drawing grasp

6

Release of crayon

7

Grasp of pellet

8

Release of pellet

9

Manipulation

10

Pointing

11

Reach to brush from forehead to back of neck

12

Palm to bottom

13

Pronation/supination

14

Hand to hand transfer

15

Reach to opposite shoulder

16

Hand to mouth and down

Table III. Means and standard deviations for the Melbourne Assessment before, immediately after taping and 3 days of wearing the tape

Mean

Standard Deviation

Pre-Taping

60.5

23.6

Post-Taping

65.5

23.1

3 day follow-up

70.1

23.3

Figure 1. Before and after supination and wrist extension taping

Figure 2. Before and after palmar stability taping

Figure 3.  Distribution of Melbourne Assessment scores over the 3 times point

Appendix A

Sample scoring criteria

Item 1:  reach forwards

Sub-skills 1:  Range of motion

Pause the video on the initial point of contact with the target and score at this point.

Scoring criteria

3 Required range of movement:

·         some forward trunk flexion (ie.<30º) and head righting if required to reach target after range of movement listed below has been achieved

·         shoulder flexion within 30º - 80º range

·         internal rotation of shoulder

·         elbow extension within 135º - 180º range

·         wrist in neutral or extension

2 Compensatory movements and/or abnormal movement patterns involving one or two joints, observed at the:

·      Trunk

·      Neck

·      Shoulder

·      Elbow

·     Wrist

1 Compensatory movements and/or abnormal movement patterns involving three or more joints, as observed in 2 above.

0 Insufficient range of movement to complete task.

Comments:  note abnormal movement patterns or compensatory movements observed and at which joints they occur.

Sub-skill 2:  Target accuracy

Pause the video on the initial point of sustained contact with the target and score at this point.

If the child touches two of the below criteria simultaneously score at the lowest level.

Scoring criteria

3 Reaches smiley face on initial point of sustained contact.

2 Reaches coloured circle on initial point of sustained contact.

1 Reaches switch on initial point of sustained contact.

0 Does not reach switch

Comments: note if two or mote areas of switch are touched simultaneously.

Sub-skill 3:  Fluency

View the movement of reaching at normal speed.  Score the fluency of any attempted movement even if the movement did not result in successful contact with the switch.

1 Clearly noticeable jerkiness or tremor present, requiring increased effort to achieve task.

0 Unable to achieve task due to excessive jerkiness or tremor of movement preventing required contact.

Comments:  note at which point in the reach movement the jerkiness or tremor is apparent.