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THE EFFICACY OF KINESIOTAPING ON LOCOMOTOR ABILITIES IN

CEREBRAL PALSY: A CASE STUDY

Deepika P. Metange*, Madhavi V. Lokhande



ABSTRACT
Abstract- Objective of the study was to investigate the effect of kinesiotaping along with conventional
treatment protocol on locomotor abilities in a patient with spastic diplegic cerebral palsy. Design: A
single case study. Patient: A 5 year 3 months old female patient diagnosed as cerebral palsy shortly
after birth. Intervention:Motor ability of the patient was assessed using clinical measures ankle and
knee tardieu scale, and Gross Motor Function Measure-88, [GMFM]. The goal area score was
71.66% which included standing and locomotion dimension. Intervention included a session of
conventional physical therapy consisting of 1 hour session repeated 3 days a week for a period of 4
weeks based on neurodevelopmental treatment. It included stretching, weak muscle strengthening
exercises, postural, balance and gait training exercises and kinesiotaping Taping was applied to
lateral hamstring muscle bilaterally using facilitatory approach. Changes in locomotor abilities were
observed by means of video recording and observing changes in the gait parameters. There was an
increase of 18.85% in the GMFM goal score. Also the gait pattern demonstrated more stable and
symmetrical locomotor pattern.. Conclusion: The findings show that kinesiotaping when combined
with conventional physical therapy can improve locomotor abilities and thereby can be a useful
adjunct to therapy.
Keywords: Kinesiotaping; cerebral palsy; locomotor abilities; gait
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INTRODUCTION
Limitations in the motor activity of children
with cerebral palsy (CP) are the consequence of
a failure to acquire appropriate motor schemas,
caused by arrested normal brain maturation.
Nevertheless, some of these children,
exploiting their few available resources
1
,
manage to walk, thanks to the emergence of
atypical but still functional locomotor patterns
2,
3
. However, these patterns can lead to long-
term instability, contractures, and deformities
4
.
Common treatments for children with CP
include botulinum toxin, serial casting,
orthopaedic surgery, and orthoses
5
. These
interventions are designed to act at the
peripheral level, without particularly aiming at
promoting more normal motor development at
the central level. Kinesiotaping may be a
solution in trying to reach this objective. .
Although it has been used in the orthopaedic
and sports settings, it is gaining acceptance as
an adjunct in the treatment of other
impairments. The use of Kinesiotaping in
conjunction with the childs regular therapy
program may favourably influence the
cutaneous receptors of the sensorimotor system
resulting in subsequent improvement of
voluntary control and coordination
6, 7
. This
intervention could favour the integration of
therapy and daily activities and increase
participation in social life. Nevertheless, it has
been only applied infrequently in these
children
8, 9
. Important intervention objectives
are to strengthen weakened muscles, to
improve the quality and active range of motion,
and to improve the childs level of
independence with activities of daily living.
Kinesiotaping, when applied properly, can
theoretically improve the following: strengthen
weakened muscles, control joint instability,
assist with postural alignment, and relax an
over-used muscle. When the application
procedure is followed correctly, the taped area
can be used to facilitate a weakened muscle or
to relax an overused muscle. The method for
applying the tape varies depending on the
specific goals: improve active range of motion,
relieve pain, adjust malalignment, or improve
lymphatic circulation (Kase, Wallis, &Kase,
2003)
10
. The variables in tape application
include the amount of prestretch applied to the
tape, position of the area to be taped, treatment
goals (pain reduction, subcutaneous blood flow,
improved muscle function)
11
. Therefore the
purpose of the case study was to investigate the
efficacy of kinesiotaping along with
conventional physical therapy on gait in a
patient diagnosed as spastic diplegic cerebral
palsy.

METHODOLOGY

Patient was a 5 year 3 months old female
diagnosed as spastic diplegic cerebral palsy
shortly after birth. She was going to normal
school and parents came with chief complaints
of walking on toes and difficulty in
independent walking. She was on regular
physiotherapy treatment 2 years back which
Scientific Research Journal of India Volume: 3, Issue: 2, Year: 2014
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was later stopped and was not using any
orthosis. Informed consent was taken from the
parents and the patient prior to the study. Motor
ability of the subject was assessed using
clinical measures ankle and knee tardieu scale,
and Gross Motor Function Measure-88,
[GMFM]
12.
On observational gait analysis the
patient walked on toes, had bilateral in toeing,
mild hip and knee flexion and scissoring gait.
The total score on GMFM was 46.8%. The
grand total score or goal area score was 71.66%
which included standing and locomotion
dimension. Intervention included a session of
conventional physical therapy consisting of 1
hour session repeated 3 days a week for a
period of 4 weeks based on
neurodevelopmental treatment (derived from
the Bobath concept)
13
. It included stretching,
weak muscle strengthening exercises, postural,
balance and gait training exercises and
kinesiotaping. After thorough assessment it was
found that lateral hamstrings on either side
were weak while medial hamstrings on both the
sides were overactive. Specifically right side
hamstring showed more hypertonia and over
activity while walking which was manifested as
in-toeing gait. Also bilateral plantar flexors
showed hypertonia, which manifested as toe
walking. Ankle plantar flexors showed more of
static component of spasticity, due to which
plantar flexors were not assessed for
kinesiotaping.
Prior to kinesiotaping, basic assessment was
done to decide on the technique of application.
Active knee flexion in prone position was used
as outcome measure. Active knee flexion in
prone showed excessive internal rotation of
tibia right more than left because of hyperactive
medial hamstrings which could be the cause of
bilateral scissoring during gait. Change in
lateral hamstring strength was assessed by
using muscle technique of kinesiotaping.
Assessment revealed that the muscle gliding
towards origin i.e. ischial tuberosity gave better
recruitment of lateral hamstrings and thus better
quality of active knee flexion.
2 Inches wide, pink coloured kinesio tape was
applied by using I technique. Pink coloured
tape was preferred as it has facilitatory effect
on a muscle performance. The length of the
tape was measured with the muscle in
maximally stretched position .Because of
balance issues in standing this measurement
was done in supine with hip knee flexion. Base
of the tape was applied in prone position near
ischeal tuberosity with the muscle in resting
position (without any stretch).The base of tape
was activated by rubbing a tape. The rest of the
tape was applied carefully over the lateral
hamstrings without giving any stretch to the
tape. Again tape was activated by rubbing it.
Lateral hamstring function was reassessed by
active knee flexion, which showed significant
improvement in prone as well as in standing &
walking. Changes in gait pattern were observed
by means of video recording.

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Fig 1. Findings seen on observational gait analysis.

RESULTS AND DISCUSSION
Results showed the acquisition of more
incremented GMFM. The improvement in the
goal GMFM score was 90.4% which was with
the difference of 18.85% post treatment. Also
the gait pattern demonstrated more stable
(reduced step width) and symmetric (more
similar step length and reduced scissoring)
locomotor patterns. However, the equines foot
was not corrected by the taping. Muscles which
are usually tackled are antagonist to spastic
muscles. But as spastic muscles are also weak,
and there is need to work upon these weak
muscles too. Also, kinesiotaping increases
proprioceptive and tactile information and
therefore restores optimal muscle length,
thereby providing a foundation for normal
firing and recruitment patterns.
Observed functional improvements were not
accompanied by evident changes in the ankle
and knee tardieu scale values. This result could
represent a specific difference between
kinesiotaping and serial casting. Serial casting,
in fact, typically leads to short-term
improvements on passive range of motion, but
does not always improve active functioning
14, 15

since it may lead to muscle wasting, and
weakening spastic and non-spastic muscles
5
.
Kinesiotaping, conversely, provides support to
the weak muscles, facilitating their normal
activity. Further randomized controlled
investigations on wider samples are certainly
needed to assess effectively the effects of the
taping treatment. Nevertheless, the fact that
observed gait improvements occurred during
the treatment period, demonstrate the efficacy
of kinesiotaping along with conventional
physical therapy. Also, parents reported
positive feedback about the effects of the
kinesiotaping on childs participation in social
activities, locomotor ability, and tolerability to
the treatment which could also be an advantage
Scientific Research Journal of India Volume: 3, Issue: 2, Year: 2014
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over use of orthosis. In conclusion,
kinesiotaping seems to be a promising
intervention for improving locomotor function
in children with CP and a very useful adjunct to
the conventional therapy.

Fig. 2. Graph demonstrating effect on GMFM
scores pre and post intervention.


Fig 3. Changes seen in the gait pattern pre and
post intervention.

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CORRESPONDENCE
* Assistant professor, Terna Physiotherapy College, Nerul, Navi Mumbai, INDIA. Email:
deepikapuri12@gmail.com