©

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© 2019 EDIZIONI MINERVA MEDICA European Journal of Physical and Rehabilitation Medicine 2019 October;55(5):551-7
Online version at http://www.minervamedica.it DOI: 10.23736/S1973-9087.19.05684-3

ORIGINAL ARTICLE

Effects of kinesio taping on hemiplegic hand

in patients with upper limb post-stroke spasticity:
a randomized controlled pilot study
Yu-Chi HUANG 1, 2, Po-Cheng CHEN 1, 2, Hui-Hsin TSO 1, 2,
Yu-Chien YANG 1, 2, Tzai-Lun HO 1, 2, Chau-Peng LEONG 1, 2 *

1Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 2Chang Gung
University College of Medicine, Kaohsiung, Taiwan
*Corresponding author: Chau-Peng Leong, Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung,
Taiwan. E-mail: cpleong@cgmh.org.tw

ABSTRACT
BACKGROUND: Post-stroke spasticity is a common complication in patients with stroke and a key contributor to impaired hand function after
stroke.
AIM: The purpose of this study was to investigate the effects of kinesio taping on managing spasticity of upper extremity and motor performance
in patients with subacute stroke.
DESIGN: A randomized controlled pilot study.
SETTING: A hospital center.
POPULATION: Participants with stroke within six months
METHODS: Thirty-one participants were enrolled. Patients were randomly allocated into kinesio taping (KT) group or control group. In KT
group, Kinesio Tape was applied as an add-on treatment over the dorsal side of the affected hand during the intervention. Both groups received
regular rehabilitation 5 days a week for 3 weeks. The primary outcome was muscle spasticity measured by modified Ashworth Scale (MAS).
Secondary outcomes were functional performances of affected limb measured by using Fugl-Meyer assessment for upper extremity (FMA-UE),
Brunnstrom stage, and the Simple Test for Evaluating Hand Function (STEF). Measures were taken before intervention, right after intervention
(the third week) and two weeks later (the fifth week).
RESULTS: Within-group comparisons yielded significant differences in FMA-UE and Brunnstrom stages at the third and fifth week in the con-
trol group (P=0.003-0.019). In the KT group, significant differences were noted in FMA-UE, Brunnstrom stage, and MAS at the third and fifth
week (P=0.001-0.035), and in the proximal part of FMA-UE between the third and fifth week (P=0.005). Between-group comparisons showed
a significant difference in the distal part of FMA-UE at the fifth week (P=0.037).
CONCLUSIONS: Kinesio taping could provide some benefits in reducing spasticity and in improving motor performance on the affected hand
in patients with subacute stroke.
CLINICAL REHABILITATION IMPACT: Kinesio taping could be a choice for clinical practitioners to use for effectively managing post-stroke
spasticity.
(Cite this article as: Huang YC, Chen PC, Tso HH, Yang YC, Ho TL, Leong CP. Effects of kinesio taping on hemiplegic hand in patients with upper
limb post-stroke spasticity: a randomized controlled pilot study. Eur J Phys Rehabil Med 2019;55:551-7. DOI: 10.23736/S1973-9087.19.05684-3)
Key words: Stroke rehabilitation; Muscle spasticity; Athletic tape; Hemiplegia.

P ost-stroke spasticity (PSS) is a common complication

in patients who had a brain damage from a stroke, lead-
ing to limbs weakness and impaired coordination between
agonist and antagonist muscle contraction.1 Spasticity is
defined as a motor disorder resulting from a velocity-de-
pendent hyperexcitability of muscles to the tonic stretch
reflex.2 Previous studies have reported that 24-42% of
PSS occurred within 12 months after a stroke event.3-5,
The possible risk factors for PSS included lower Barthel
Index score, degree of paresis, pain caused from stroke,
and sensory impairments.2, 4 Stroke survivors experienc-
ing spasticity in their upper limbs might have difficulties

Vol. 55 - No. 5 European Journal of Physical and Rehabilitation Medicine 551

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HUANG KINESIO TAPING IN STROKE PATIENTS

obtaining a full range of motion (ROM) of the shoulders,
elbows, wrists, and fingers flexors. These limitations can
interfere with the functions of reach, grasp, and release
while performing daily activities. Reduced ROM and
PSS can result in secondary limb deformities, functional
impairments, and reduced quality of life. Rehabilitation
post-stroke focuses on facilitation of the motor functions,
regaining sensory function, and reducing the progression
of abnormal muscle tone of affected limbs to improve the
functional performance and quality of life.
Several therapeutic interventions for post-stroke spas-
ticity control have been previously described. Stretching
exercises could increase muscle length and maintain joint
motion.6 Neuromuscular or transcutaneous electrical stim-
ulation also had positive effects on managing spasticity.6, 7
Pharmacological interventions, such as oral medications
and local injection with phenol or botulinum toxin, have
been widely used to decrease PSS and improve functional
ability after stroke.1, 6, 8, 9
In recent years, Kinesio taping (KT) has been imple-
mented as a therapeutic technique for hemiplegic patients.
The KT results in improved upper extremity function and
increased patient independence in engaging in activities of
daily living post-stroke.10, 11 KT has also been reported to
be helpful in improving walking balance in patients with
stroke and hemiplegia.12-14 Jaraczewska et al.10 mentioned
that KT combined with other interventions may facilitate
muscle function, provide joint support and proprioception
feedback, and reduce pain after stroke. However, there was
limited evidence to support the benefits of KT in improv-
ing upper extremity function, especially hand function
among stroke patients. We hypothesized that the applica-
tion of KT may provide sensory feedback to promote mo-
tor recovery on affected upper extremities and minimize
spasticity in upper extremities during recovery. The aim
of this study was to investigate the effect of KT on upper
extremity spasticity and motor performance in subacute
stroke patients with hemiplegia.
by the research assistant and their caregivers. No change
was made after the allocation. The study protocol was ap-
proved by the institutional review board (IRB number:
104-A152A3). All participants understood the procedures
and signed a written informed consent. This study was also
registered at ClinicalTrials.gov (Clinical Trial Identifier:
NCT03024190).
Participants
Patients with stroke enrolled in this study were diagnosed
by a neurologist according to the history, physical exami-
nation, and brain imaging. The investigator screened their
hand function within 1 day of receiving the referral. The
inclusion criterion was as follows: patients had stroke
within 6 months with unilateral hemiplegia and were able
to perform at least minimal hand grasp when recruited, and
the Brunnstrom stage of the distal hand should be between
2 to 4. The exclusion criteria were as follows: younger
than 18 years or older than 80 years, MAS scored equal
to or more than 3, a previous history of upper extremity
tendon or neuromuscular injury, previous history of other
systemic neuromuscular diseases, cognitive or language
impairment leading to communication difficulty, or any
history of allergy to KT.
Interventions
After the allocation, medical history, associated diagnosis,
and basic clinical characteristics were obtained. For the
participants in the KT group, Kinesio tape (Nitto Kogyo
Corporation, Japan) was applied as an add-on treatment
on the dorsal side of the affected upper limbs by an occu-
pational therapist. The applied area was from the proximal
one-third of the forearm to the wrist and then was split
into 5 straps into the distal interphalangeal joint of five
fingers (Figure 1). The forearm was full pronated with the
wrist kept in neutral position and five fingers in resting

Materials and methods

Research design
This study was a randomized controlled pilot trial from
October 2016 to August 2018. All participants were re-
ferred from one hospital center. The randomization proto-
col was operated by giving the participant two envelopes
that contained a paper written with the group name in- Figure 1.—The method of the application of kinesio taping.
In general, the tape was applied over the extensor muscles, which started
side, and the participant needed to open the envelope to from the 1/3 upper part of the affected forearm and went into the dorsal
check the allocation. The whole process was witnessed hand and finger tips as shown in the picture.

552 European Journal of Physical and Rehabilitation Medicine October 2019

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or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other means which may allow access
COPYRIGHT 2019 EDIZIONI MINERVA MEDICA
cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo, or other proprietary information of the Publisher.
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies (either sporadically
to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is not permitted. It is not permitted to remove,
KINESIO TAPING IN STROKE PATIENTS HUANG
position. 3M paper tape surrounded the finger tips without
tension to maintain the adhesion on finger joints. While
taping, about 1 inch of the paper on the back of the Kine-
sio tape was removed and applied with neutral tension as
an anchor. Subsequently, to facilitate the wrist and finger
extensors, the tape was applied with 20-30% tension over
the muscle belly and 50% tension over tendon areas, in-
cluding 10% of neutral tension. At last, 1 inch at the dis-
tal end of the tape was used as the second anchor, and it
was applied without any stretch. The tape was applied for
7 days per week for 3 weeks. The control group did not
receive any taping during the intervention. Stretching ex-
ercises and repetitive task training for hand function was
executed for 20 minutes per session, two times a day, for
5 days during this three-week intervention in both KT and
control groups. Participants were allowed to receive regu-
lar rehabilitation programs including occupational therapy
and physical therapy during this period.
Outcome measures
All patients received evaluations before intervention
(baseline), immediately postintervention (the third week),
and 2 weeks after intervention (the fifth week). For par-
ticipations with KT, all the assessments at the third week
were performed after the removal of KT. In this study,
the primary outcome was muscle spasticity measured by
modified Ashworth Scale (MAS). Secondary outcomes
were functional performances of affected limb measured
by using Fugl-Meyer assessment for upper extremity
(FMA-UE), Brunnstrom stage, and the Simple Test for
Evaluating Hand Function (STEF). The five-point modi-
fied Ashworth Scale was used for measuring spasticity and
is ranked in the following way: 0 - no increase in muscle
tone; 1 - slight increase in muscle tone, manifested by a
catch at the end of ROM; 2 - marked increase in muscle
tone through most ROM such that the affected limb is
easily movable; 3 - considerable increase in muscle tone
but difficult passive movement of the affected limb; and
4 - rigid affected limb.15 Brunnstrom motor recovery stage
is defined as follows: stage I, flaccid with no voluntary
movement; stage II, spasticity begins to develop with pres-
ence of minimal voluntary movement; stage III, voluntary
control of movement within a flexor synergy pattern and
moderate to severe spasticity; stage IV, spasticity begins
to decline with more selective activation of muscles out-
side the flexor synergy; stage V, master of more selective
and independent muscle activation without dominated by
flexor synergy; stage VI, individual joint movement and
well-coordinated movement are present without abnormal
Vol. 55 - No. 5 European Journal of Physical and Rehabilitation Medicine 553
muscle tone.16 Sensation of light touch, pinprick touch,
and proprioception were assessed only at baseline as one
of the demographic factors. Impaired sensation was de-
fined as an inability to correctly respond to instructions
during testing. Hand function was assessed using FMA-
UE.17 In this assessment, part A includes the upper extrem-
ity, indicating the proximal motor function. Part B and part
C included wrist motions and hand motions, which repre-
sented the distal hand function. Hand function was also
measured using STEF, which was originally designed in
Japan and has been applied to stroke patients.18 In this test,
patients were asked to catch or pinch 10 different objects
of various shapes and sizes, and carry them to a designated
target place. Ten subtests were listed as the following: 5
spheres (big, medium, and small), 5 rectangles, 6 cubes
(medium and small), 6 small disks (wooden and metal), 6
thin pieces of clothes, and 6 pins.
Statistical analysis
IBM SPSS 20 (IBM, Armonk, NY, USA) was used to ana-
lyze the collected data. In this study, per-protocol analysis
was adopted due to the uncertainty of the reasons of loss to
follow-up. Nonparametric methods of statistical analysis
were used on ordinal and numerical variables. Fisher exact
tests were used to analyze the categorical variables includ-
ing sex, stroke type, hemiplegic side, sensation, and the
ability to perform subtests in STEF. Mann-Whitney U tests
were used to compare between-group differences of nu-
merical variables including ages, heights, weights, onset
duration since stroke, FMA-UE, MAS, and Brunnstrom
motor recovery stage. Wilcoxon sign-rank tests were
used for within-group comparisons of FMA-UE, MAS,
and Brunnstrom motor recovery stage. An alpha level of
P<0.05 was set for statistical significance. As it was de-
signed to be a pilot study, post hoc analysis of power for
sample size calculation was done (β>0.8).
Results
Thirty-one patients with stroke completed all interventions
and measurements in this study. Thirteen patients (5 wom-
en and 8 men; median age: 50±15.5 years; duration since
stroke was from 16 days to 165 days) were allocated to the
control group, and 18 patients (2 women and 16 men with
median age: 51.5±16.5 years; duration since stroke was
from 17 days to 141 days) were allocated to the KT group
(Figure 2). Table I showed the basic characteristics of
participants. There were no significant differences in age,
sex, height, weight, stroke types, hemiplegic sides, and the
 ©
or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other means which may allow access
COPYRIGHT 2019 EDIZIONI MINERVA MEDICA
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HUANG KINESIO TAPING IN STROKE PATIENTS

Table I.—Clinical characteristics of stroke patients in the control

Enrollment Assessed for eligibility (N.=187)
and KT groups.
Control group KT group
Excluded (N.=151) P
(N.=13) (N.=18)
- Not meeting inclusion criteria
(N.=148) Age, years (median [IQR]) 50 (15.5) 51 (16.5) 0.753
- Declined to participate (N.=3) Gender, female/male, N. 5/8 2/16 0.099
Height, cm (median [IQR]) 168 (10) 170 (10.75) 0.714
Weight, kg (median [IQR]) 68 (15.8) 67.5 (28.9) 0.636
Baseline evaluation Stroke type, N. (%) 0.532
Infarction 5 (38.5) 12 (66.7)
Hemorrhage 8 (61.5) 6 (33.3)
Randomized (N.=36)
Hemiplegic side, N. (%) 0.667
Left 2 (15.4) 5 (27.8)
Right 11 (84.6) 13 (72.2)
Duration since stroke, days (median 82 (79.5) 80 (73.5) 0.172
Allocation [IQR])
KT group (N.=20) Control group (N.=16) MAS (median [IQR]) 2 (1.5) 1 (1) 0.361
FMA-UE, proximal (median [IQR]) 10 (7.5) 12 (12.25) 0.712
FMA-UE, distal (median [IQR]) 3 (2) 3 (6) 0.129
Drop out Brunnstrom stage of distal part 3 (0.5) 3 (0.75) 0.610
- Reluctance to
cooperate with the (median [IQR])
Post-intervention procedure (N.=2) Sensory, normal/abnormal
evaluation Light touch 10/3 13/5 0.552
Pinprick 9/4 12/6 0.597
Evaluated at3rd
week Evaluated at 3rd
week
(N.=20) (N.=14) Proprioception 5/8 8/10 0.516
Fisher exact test was used for gender, stroke type, hemiplegic side, and sensation.
Mann-Whitney U Test was used for between-groups comparisons of age,
Drop out Drop out height, weight, duration since stroke, MAS, FMA-UE proximal and distal and
- Reluctance to re- - Reluctance to re- Brunnstrom stage.
evaluation (N.=2) evaluation (N.=1) IQR: interquartile range; MAS: Modified Ashworth Scale; FMA-UE: Fugl-Meyer
Assessment-upper extremity.

Evaluated at 5th week Evaluated at 5th week

(N.=18) (N.=13)
duration since stroke between the control and KT groups.
No significant differences were found in the physical find-
Analysis
ings of sensation impairment, Brunnstrom motor recovery
Analyzed (N.=18) Analyzed (N.=13)
stage, FMA-UE, and MAS on affected upper extremities
Figure 2.—Flow diagram of participants. between these two groups prior to intervention. Besides,

Table II.—Comparisons of functional outcomes between the control and KT groups.

Baseline 3rd week 5th week P1 P2 P3
Control group (N.=13)
FMA-UE, proximal, median (IQR) 10 (7.5) 13 (3.5) 14 (6.5) 0.019* 0.006** 0.080
FMA-UE, distal, median (IQR) 3 (2) 7 (4.5) 7 (6.5) 0.004** 0.003** 0.258
MAS, median (IQR) 2 (1.5) 1.5 (1.5) 1 (1) 0.999 0.258 0.258
Brunnstrom stage of distal part, median (IQR) 3 (0.5) 3.5 (1) 3.5 (0.75) 0.011* 0.006** 0.414
KT group (N.=18)
FMA-UE, proximal, median (IQR) 12 (12.25) 16 (14.25) 20 (12.75) 0.001** 0.001** 0.005**
FMA-UE, distal, median (IQR) 3 (6) 8.5 (7.25) 10.5 (12.25) 0.001** 0.001** 0.081
MAS, median (IQR) 1 (1) 1 (0.75) 1 (1.75) 0.035* 0.034* 0.276
Brunnstrom stage of distal part, median (IQR) 3 (0.75) 4 (0.75) 4 (1.5) 0.001** 0.001** 0.194
Wilcoxon sign-rank tests were used for within-group comparisons of FMA-UE, MAS, and Brunnstrom motor recovery stage.
P1: comparisons of the results within group between baseline and the 3rd week; P2: comparisons of the results within group between baseline and the 5th week; P3:
comparisons of the results within group between 3rd week and the 5th week; PA: comparisons between two groups at 3rd week; PB: comparisons between two groups at
5th week.
IQR: interquartile range; MAS: Modified Ashworth Scale; FMA-UE: Fugl-Meyer Assessment-Upper extremity.
*P<0.05; **P<0.01.

554 European Journal of Physical and Rehabilitation Medicine October 2019

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cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo, or other proprietary information of the Publisher.
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies (either sporadically

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KINESIO TAPING IN STROKE PATIENTS HUANG

Big sphere Medium sphere observed in most subtests (big sphere, medium sphere,
100%
90%
100%
90% rectangle, and small cube) at the third week and either in-
creased or remained stable until the fifth week.
80% 80%
70% 70%
60% 60%
50% KT 50% KT
40% Control 40% Control
30% 30%
20%
10%
0%
20%
10%
0%
Discussion
Baseline 3rd week 5th week Baseline 3rd week 5th week

In this study, we found that stroke patients in both control

Rectangle Medium cube
100%
90%
100%
90%
and KT groups had significant improvements on FMA-
80%
70%
60%
80%
70%
60%
UE and Brunnstrom stage at the third and fifth weeks. The
50%
40%
KT
Control
50%
40%
KT
Control
patients in the KT group had significant improvement on
the proximal part of FMA-UE at fifth week than that at
30% 30%
20% 20%
10% 10%
0%
Baseline 3rd week 5th week
0%
Baseline 3rd week 5th week third week. At fifth week, stroke patients with the KT in-
tervention had better hand performance (the distal part of
Disks Small cube
100%
90%
100%
90%
FMA-UE) than that of the control group. Additionally, pa-
80%
70%
80%
70% tients in the KT group had significant reductions in PSS,
which was not observed in the control group. To the best
60% 60%
50% KT 50% KT
40% Control 40% Control
30%
20%
30%
20% of our knowledge, this study is the first to support KT in
10% 10%
0%
Baseline 3rd week 5th week
0%
Baseline 3rd week 5th week
preventing the progression of PSS. As such, KT may play
an adjunctive role in improving motor hand function dur-
Figure 3.—The line graphs indicated the changes of percentages of the ing hand rehabilitation in stroke patients at subacute stage.
ability to execute the subtests in baseline, the third week and the fifth
week of each group. KT has become an increasingly popular therapeutic
tool in the field of sports medicine. Japanese Chiropractor
Dr. Kenzo Kase invented it to alleviate pain and improve
there were no significant differences showing in the us- the healing in soft tissues.19 KT comprises polymer elas-
age of antispastic agents or muscle relaxants between two tic wrapped in 100% cotton fibers, which make it easy to
groups during the time period of intervention and postint- evaporate sweat. There is a thin layer of glue attached to
ervention till follow-up. the tape, and the glue is applied in a wave-like pattern to
Within-group comparisons (Table II) produced signifi- imitate the qualities of the fingerprint on the fingertip. KT
cant differences in the proximal and distal parts of FMA- can be worn during exercise, showering, and even swim-
UE, and the distal part of Brunnstrom stage at the third and ming because of its waterproof characteristic. It is hypoth-
fifth week in the control group (P=0.003~0.019). There esized that KT provides a prolonged stretch of a muscle that
was no significant difference of MAS in the control group. could lead to autogenic inhibition to hypertonic muscles.
In the KT group, significant differences were noted in the Furthermore, the application of KT can allow for greater
proximal and distal parts of FMA-UE, MAS, and the dis- sensorimotor input during rehabilitation. Simoneau et al.20
tal part of Brunnstrom stage at the third and fifth week and Callagan et al.21 showed the positive effect of KT on
(P=0.001-0.035), and in the proximal part of FMA-UE be- proprioception. The effects of KT could be attributed to the
tween the third and fifth week (P=0.005). Between-group cutaneous stimulation of sensorimotor and proprioception
comparisons showed a significant difference in the distal systems, both of which may enhance functional outcomes.
part of FMA-UE at the fifth week (P=0.037). Other researchers proposed that improved motor function
There was no statistical significance between the per- might result from increased recruitment in the motor units
centages of the ability to execute each subtest in STEF of the muscles due to increased proprioceptive stimulus.22
between the two groups (Figure 3). However, a higher per- There are many methods of applications depending on its
centage of participants in the KT group could manipulate expected physiological outcomes, but the theories under
medium spheres, medium cubes, and small cubes. This these methods still lack enough evidence and require fur-
might imply that KT could be helpful for increasing the ther studies.
process of motor recovery. Furthermore, in the control There is growing evidence that KT use can improve the
group, the scores improved in all tests from baseline to pain or function of affected upper extremities in hemiple-
the third week, but then they either maintained or declined gic patients.10, 23-27 Most studies focus on improving po-
later. However, in the KT group, upward trends were sition, alignment, or stability of the scapula on the chest

Vol. 55 - No. 5 European Journal of Physical and Rehabilitation Medicine 555

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or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other means which may allow access
COPYRIGHT 2019 EDIZIONI MINERVA MEDICA
cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, logo, or other proprietary information of the Publisher.
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies (either sporadically
to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use is not permitted. It is not permitted to remove,
HUANG KINESIO TAPING IN STROKE PATIENTS
wall to ameliorate ROM of the affected shoulders. Skeletal
disorders (such as the humeral head not properly placed
in the glenoid cavity), or muscular problems (serratus
anterior muscle weakness or upper trapezius tightness),
would lead to painful shoulders affecting functional use
of the affected upper extremities. These impairments are
especially prevalent in post-stroke patients with hemiple-
gia. KT could correct these impairments in various ways.
There are two randomized controlled trials about KT for
post-stroke patients with hemiplegic shoulder pain,24, 25
but the results were inconsistent. No clinical trial exists to
prove the functional improvement of hemiplegic shoulders
through KT use. However, in our study, we focused on
hand motor function of stroke patients, and KT was ap-
plied on the wrist extensor muscles instead of shoulder
girdle muscles. Santamato et al.28 compared the effective-
ness of KT versus manual muscle stretching and splint-
ing for reducing spasticity of the wrist and finger flexor
muscles after botulinum toxin injections in stroke patients.
KT was reported to have significantly greater decrease in
spasticity scores. In our study, we found the benefits of KT
not only in reducing spasticity scores of the affected upper
extremities, but also in improving the functional scores of
hand motor performance. Bell et al.29 also focused on the
application of KT to forearm muscles in stroke patients,
but they evaluated the efficacy of KT for reducing hand
edema. There is one study which discusses the effects of
KT for thumb motor function, but the participants were
children with cerebral palsy.30
Limitations of the study
Our study had some limitations. First, the sample size was
small and all participants were recruited from a single med-
ical center. Second, the period of intervention was only 3
weeks, which might be too short to reach more positive
progress. There was also a lack of long-term follow-up to
measure the improvements of functional outcome. Third,
sham KT taping was not used to blind the participants.
Therefore, a clinical trial with larger sample size, longer
period of intervention, and long-term follow-up should be
designed to confirm the effect of KT on reducing spasticity
and improving function of the affected hand motor perfor-
mance. Sham KT might be used to balance the outcome
expectation from the participants.
Conclusions
Rehabilitation combined with KT could provide positive
effects on post-stroke spasticity and improve functional
556 European Journal of Physical and Rehabilitation Medicine October 2019
motor performance of the affected hand in patients with
subacute stroke. Despite the fact that KT has been applied
mostly in the field of sports medicine, its use in stroke re-
habilitation has gained recent attention from physicians
and therapists. Additional clinical trials would be neces-
sary to prove its effect.
References
1.  Francisco GE, McGuire JR. Poststroke spasticity management. Stroke
2012;43:3132–6.
2.  Wissel J, Manack A, Brainin M. Toward an epidemiology of poststroke
spasticity. Neurology 2013;80(Suppl 2):S13–9.
3.  Sommerfeld DK, Eek EU, Svensson AK, Holmqvist LW, von Arbin
MH. Spasticity after stroke: its occurrence and association with motor im-
pairments and activity limitations. Stroke 2004;35:134–9.
4.  Urban PP, Wolf T, Uebele M, Marx JJ, Vogt T, Stoeter P, et al. Oc-
curence and clinical predictors of spasticity after ischemic stroke. Stroke
2010;41:2016–20.
5.  Wissel J, Schelosky LD, Scott J, Christe W, Faiss JH, Mueller J. Early
development of spasticity following stroke: a prospective, observational
trial. J Neurol 2010;257:1067–72.
6.  Thibaut A, Chatelle C, Ziegler E, Bruno MA, Laureys S, Gosseries O.
Spasticity after stroke: physiology, assessment and treatment. Brain Inj
2013;27:1093–105.
7.  Yan T, Hui-Chan CW. Transcutaneous electrical stimulation on acu-
puncture points improves muscle function in subjects after acute stroke: a
randomized controlled trial. J Rehabil Med 2009;41:312–6.
8.  Olvey EL, Armstrong EP, Grizzle AJ. Contemporary pharmacologic
treatments for spasticity of the upper limb after stroke: a systematic re-
view. Clin Ther 2010;32:2282–303.
9.  Ghasemi M, Salari M, Khorvash F, Shaygannejad V. A literature re-
view on the efficacy and safety of botulinum toxin: an injection in post-
stroke spasticity. Int J Prev Med 2013;4(Suppl 2):S147–58.
10.  Jaraczewska E, Long C. Kinesio taping in stroke: improving func-
tional use of the upper extremity in hemiplegia. Top Stroke Rehabil
2006;13:31–42.
11.  Kim EB, Kim YD. Effects of kinesiology taping on the upper-extrem-
ity function and activities of daily living in patients with hemiplegia. J
Phys Ther Sci 2015;27:1455–7.
12.  Boeskov B, Carver LT, von Essen-Leise A, Henriksen M. Kinesthetic
taping improves walking function in patients with stroke: a pilot cohort
study. Top Stroke Rehabil 2014;21:495–501.
13.  Kim WI, Choi YK, Lee JH, Park YH. The effect of muscle facilitation
using kinesio taping on walking and balance of stroke patients. J Phys
Ther Sci 2014;26:1831–4.
14.  Rojhani-Shirazi Z, Amirian S, Meftahi N. Effects of Ankle Kinesio
Taping on Postural Control in Stroke Patients. J Stroke Cerebrovasc Dis
2015;24:2565–71.
15.  Brashear A, Zafonte R, Corcoran M, Galvez-Jimenez N, Gracies JM,
Gordon MF, et al. Inter- and intrarater reliability of the Ashworth Scale
and the Disability Assessment Scale in patients with upper-limb post-
stroke spasticity. Arch Phys Med Rehabil 2002;83:1349–54.
16.  Naghdi S, Ansari NN, Mansouri K, Hasson S. A neurophysiological
and clinical study of Brunnstrom recovery stages in the upper limb follow-
ing stroke. Brain Inj 2010;24:1372–8.
17.  Sanford J, Moreland J, Swanson LR, Stratford PW, Gowland C. Reli-
ability of the Fugl-Meyer assessment for testing motor performance in
patients following stroke. Phys Ther 1993;73:447–54.
18.  Shindo K, Oba H, Hara J, Ito M, Hotta F, Liu M. Psychometric prop-
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KINESIO TAPING IN STROKE PATIENTS HUANG

erties of the simple test for evaluating hand function in patients with
stroke. Brain Inj 2015;29:772–6.
19.  Kase K, Wallis J, Kase T. Clinical therapeutic applications of the ki-
nesio taping method (2nd edition). Tokyo, Japan: Ken Ikai Co. Ltd.; 2003.
20.  Simoneau GG, Degner RM, Kramper CA, Kittleson KH. Changes
in ankle joint proprioception resulting from strips of athletic tape applied
over the skin. J Athl Train 1997;32:141–7.
21.  Callaghan MJ, Selfe J, Bagley PJ, Oldham JA. The Effects of Patellar
Taping on Knee Joint Proprioception. J Athl Train 2002;37:19–24.
22.  Słupik A, Dwornik M, Białoszewski D, Zych E. Effect of Kinesio
Taping on bioelectrical activity of vastus medialis muscle. Preliminary
report. Ortop Traumatol Rehabil 2007;9:644–51.
23.  Dall’Agnol MS, Cechetti F. Kinesio Taping Associated with Acu-
puncture in the Treatment of the Paretic Upper Limb After Stroke. J Acu-
punct Meridian Stud 2018;11:67–73.
24.  Hochsprung A, Domínguez-Matito A, López-Hervás A, Herrera-
Monge P, Moron-Martin S, Ariza-Martínez C, et al. Short- and medium-
term effect of kinesio taping or electrical stimulation in hemiplegic shoul-
der pain prevention: A randomized controlled pilot trial. NeuroRehabilita-
tion 2017;41:801–10.
25.  Huang YC, Chang KH, Liou TH, Cheng CW, Lin LF, Huang SW. Ef-
fects of Kinesio taping for stroke patients with hemiplegic shoulder pain:
A double-blind, randomized, placebo-controlled study. J Rehabil Med
2017;49:208–15.
26.  Kalichman L, Frenkel-Toledo S, Vered E, Sender I, Galinka T, Alp-
erovitch-Najenson D, et al. Effect of kinesio tape application on hemi-
plegic shoulder pain and motor ability: a pilot study. Int J Rehabil Res
2016;39:272–6.
27.  Lee DH, Kim WJ, Oh JS, Chang M. Taping of the elbow extensor
muscle in chronic stroke patients: comparison between before and after
three-dimensional motion analysis. J Phys Ther Sci 2015;27:2101–3.
28.  Santamato A, Micello MF, Panza F, Fortunato F, Picelli A, Smania
N, et al. Adhesive taping vs. daily manual muscle stretching and splint-
ing after botulinum toxin type A injection for wrist and fingers spastic
overactivity in stroke patients: a randomized controlled trial. Clin Rehabil
2015;29:50–8.
29.  Bell A, Muller M. Effects of kinesio tape to reduce hand edema in
acute stroke. Top Stroke Rehabil 2013;20:283–8.
30.  Keklicek H, Uygur F, Yakut Y. Effects of taping the hand in children
with cerebral palsy. J Hand Ther 2015;28:27–32, quiz 33.

Conflicts of interest.—The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.
Funding.—The study was funded by Chang Gung Memorial Hospital (CMRPG8F1101).
Acknowledgements.—We thank our colleagues from the hospital who provided expertise that assisted the research.
Article first published online: June 13, 2019. - Manuscript accepted: June 12, 2019. - Manuscript revised: June 6, 2019. - Manuscript received: January 4,
2019.

Vol. 55 - No. 5 European Journal of Physical and Rehabilitation Medicine 557