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Kinesiotaping-Hipotonia 0
Kinesiotaping-Hipotonia 0
Introduction:
Children with autism and pervasive developmental disorder often present with hypotonia,
joint laxity, and postural impairments. Akshoomoff and colleagues (2006) found the most
common motor deficits in children with pervasive developmental disorders to be
hyporeflexia, stereptypies, and hypotonia. Hypotonia can be defined as, a decrease in the
amount of tension or resistance to movement in a muscle (Long, 2002). Hypotonia is an
impairment associated with disorders that affect motor neurons (Long, 2002). Children with
hypotonia may have delays in gross motor and fine motor skills. Hypotonic infants are late in
lifting their heads while lying on their stomachs, rolling over, lifting themselves into a sitting
position, crawling, and walking. Fine motor delays occur in grasping a toy or finger,
transferring a small object from hand to hand, pointing out objects, following movement with
the eyes, and self feeding. Additionally, hypotonia can interfere with axial muscle
contractions, initiation of movement, and the length of time that a posture can be maintained
(Long, 2002). Severe cases of hypotonia can lead to a lack of contraction at proximal joint
and limited voluntary movements (Long, 2002).
Kinesio Taping was developed in Japan in 1973 by Dr. Kenzo Kase. It was later introduced
to the United States in 1995 and the technique gained more popularity when it was used on
athletes during the Beijing Olympics in 2008 (Kase, 2006). Kinesio Taping has been a
growing intervention in the physical therapy field of practice. The intervention can be utilized
with orthopedic and sports injuries, acute rehab, lymphatic therapy, neuromuscular rehab, and
in pediatrics. It allows patients to receive a therapeutic intervention over a twenty four hour
period of time (Kase, 2006).
Kinesio Taping has four major functions: support joint function by exerting an effect on
muscle function; enhance activity of the lymphatic system and improve microcirculation;
alleviate pain; and support weak muscle groups (Kase, 2006). The method of Kinesio Taping
involves taping over and/or around muscles to either support a muscle group or prevent
overuse of a muscle group. Kinesio Tex Tape functions by lifting the skin in order to increase
interstitial space and relieve pressure from neural and sensory receptors. This relieved
pressure results in reducing painful symptoms and aides in lymphatic drainage. There are five
different corrective applications of Kinesio Tex Tape which include the following:
mechanical correction; fascia correction; space correction; ligament/tendon correction; and a
functional correction (Kase, 2006). Mechanical correction uses inward pressure to provide for
positional stimuli through the skin in order to assist with postural alignment. Fascia correction
involves creating or gathering fascia in order to align tissue in a desired position. The space
correction method involves creating more space above the target area of pain, inflammation,
and edema in order to relieve these symptoms. The ligament/tendon correction creates
increased stimulation over a ligament and/or tendon resulting in an increased stimulation of
mechanoreceptors. The functional correction method is used to create sensory stimulation to
assist or limit a motion by placing the muscle facilitated in a shortened position (Kase, 2006).
Kinesio Tex Tape may be an effective intervention for children with autism and pervasive
developmental disorder who present with hypotonia. Additionally, children with autism and
pervasive developmental disorder often present with decreased body awareness, decreased
core stability and impairments in posture, balance, and movement skills. Kinesio Tex Tape
may improve these impairments as it functions to improve body alignment, muscle balance,
and functional mobility. Therefore, the goal of this study is to evaluate the effectiveness of
Kinesio Tex Tape as an intervention for children with hypotonia and decreased core stability.
The purpose of this study is the following: to determine if Kinesio Taping the internal and
external oblique muscles would affect the performance of the task of high kneeling and
reaching at a ninety degree angle with the right upper extremity to grasp a toy.
Literature Search:
The literature search I conducted on Kinesio Tex Tape revealed minimal amounts of
research on the use of Kinesio Tex Tape in the pediatric setting. Most of the research found
on Kinesio Tex Tape involved treating impairments associated with orthopedic injuries.
Yoshida and Kahanov (2007) studied the effects of Kinesio Taping on the trunk flexion,
extension, and lateral flexion. The study found that Kinesio Tex Tape applied on healthy
subjects with no history of back pain can increase active trunk flexion range of motion.
Slupik, Dwornik, Bialosezewski, and Zych (2007) studied the effects of Kinesio Taping on
the bioelectrical activity of the vastus medialis muscle and on changes in the tone of the
muscle during isometric contractions. The study found increased bioelectrical activity of the
muscle after twenty four hours of Kinesio Tex Tape application as determined by a
transdermal EMG. Fu and colleagues (2006) studied the effects of Kinesio Taping on
quadriceps and hamstring muscle strength in athletes. Muscle strength was assessed by
isokinetic dynamometer and the results revealed no significant difference between muscle
strength in subjects with and without Kinesio Tex Tape application. Finally, one study was
found on utilizing Kinesio Tex Tape to enhance the lymphatic system. Tsai and colleagues
(2009) compared the treatment and retention effects between standard decongestive lymphatic
therapy and a modified lymphatic therapy using Kinesio Tex Tape in subjects with unilateral
breast cancer. The study found that excess circumference and excess water conposition were
reduced significantly in subjects receiving the Kinesio Tex Tape intervention. Additionally,
subjects in the Kinesio Tex Tape group reported increased comfort with thet tape, longer
wearing time, and less difficulty with application.
Two studies were found on the use of Kinesio Tex Tape in the pediatric setting.
Yasaukawa, Patel, and Sisung (2006) studied the effects of Kinesio Taping the upper
extremity and functional mobility in an acute pediatric rehabilitation setting. The study found
improvements with upper limb control in children with neurological disorders including
encephalitis, brain tumors, cerebral vascular accidents, traumatic brain injuries, and spinal
cord injuries secondary to the sensory input provided by the Kinesio Tex Tape. Footer (2006)
examined the effects of therapeutic taping the paraspinal muscles in children with
quadriplegic cerebral palsy. However, the results showed that therapeutic taping did not
significantly impact seated postural control.
I found no specific research on utilizing Kinesio Tex Tape to increase core stability in
children with hypotonia. However, numerous research studies have been conducted on core
stability in athletes and in typically developing adults. Liemohn and colleagues (2005) studied
core stability and measurement schedules to maximize internal consistency and statistical
reliability. The results of their study found that administering five trials and one practice trial
on a testing day is sufficient to obtain a test score with adequate reliability. Additionally, their
study further revealed that a kneeling arm raise and quadruped parallel arm raise were the
most reliable core stability tests.
Purpose:
To determine if Kinesio Taping the internal and external oblique muscles would affect the
performance of the task of high kneeling and reaching at a ninety degree angle with the right
upper extremity to grasp a toy.
Subjects:
Five special needs students from a special service school in Bergen County, New Jersey
were selected to participate in the study. Selection of subjects was based on the following
inclusion criteria: hypotonia of the abdominal muscles, decreased core stability, impairments
in high kneel and reaching tasks, and the cognitive ability to follow verbal commands and/or
physical prompts.
Before the start of the study, an informed consent form (Appendix 2) was sent home to the
five selected subjects' parents and/or guardians. One subject was excluded from the study
after guardians declined to sign the informed consent form for personal reasons. Ther
informed consent form was signed by the other four subjects. After receiving the completed
informed consent form, a patch test was applied to each of the subjects' upper back at
approximately the C7 region. The patch test is necessary to examine the subject's skin
integrity and to assess for tape allergies. Subjects were excluded from the study if they had
any of the following contraindications to Kinesio Taping: open wounds; fragile skin; poor
skin integrity; abrasion; and/or tape allergies. All four subjects tested negative for tape
allergies and decreased skin integrity.
Procedure:
Pre Testing Measurements
The pre testing procedure was conducted in a quiet room to avoid distractions and to
increase attention to the task. A yardstick was placed on the wall and lined up with the
subjects' glenohumeral joint. The yardstick was utilized in order to measure the distance the
subjects reached for the object, such as, a functional reach test. Additionally, a line of tape
was placed on the floor and the subjects knees were brought to the edge of the line of tape to
ensure the same knee placement for each trial. In order to make sure the subjects were using a
shoulder width base of support, two boxes of tape were also drawn to indicate proper knee
placement. For the high kneel task subjects 2, 3, and 4 kneeled on the line of tape and reached
with their right upper extremity for a light up toy that was held parallel to their body. Subject
1 reached for puzzle pieces with his right upper extremity in order to increase his attention
and motivation to complete the task. The right upper extremity was chosen to maintain
consistency between all subjects and consistency between the pre and post testing measures.
A functional reach test was scored based on the distance the subject's reached to obtain the
toy. The distance on the yardstick was measured from where the toy lined up on the yardstick
when the grasp was achieved. The high kneel task was administered for five trials with one
practice trial and the number of times balance was lost during the five trials. Pre test
measurements were videotaped in both sagittal and anterior views in order to analyze the
subjects' movement strategies to accurately collect pre test data.
Results:
Questionnaire to Teachers and Other Therapy Disiplines
The questionnaire provided additional information on the subjects' presentation and
progress outside the physical therapy setting. All subjects demonstrated improvements on
some of the areas listed on the questionnaire. Subject 1's occupational therapist reported
improvements in sitting posture and task attention. The occupational therapist reported, "the
student will sit for short periods of time on a regular school chair." Additionally, subject 1's
teacher noticed improvements in sitting posture and speech. She reported the following, "the
student sits with a more erect posture and has been attempting to verbalize more during class."
Subject 2's occupational therapist reported improvements in sitting posture, fine motor skills,
and attention to task. She reported, "the students sitting posture in more erect on T-stools and
he will participate in fine motor tasks for longer periods of time with out losing balance on the
T-stool." Additionally, the subject 2's father reported that he noticed improvements at home
since the tape had been applied. Subject 3's occupational therapist reported improvements in
fine motor skills. She stated, "the student has been improving with fine motor skills and is
able to maintain attention to task for longer periods of time." Additionally, the student
physical therapist observed that subject was able to ascend a step 12 inches high for the first
time since the tape has been applied. Subject 4's occupational therapist reported
improvements in sitting posture, body awareness, speech, fine motor skills, and attention to
tasks. The occupational therapist stated, "the student's sitting posture is more erect and the
student is able to sustain sitting with out external supports for longer periods of time."
Additionally, the occupational therapist reported, "the student is moving quicker, has made
balance improvements especially during postural changes, and has achieved a more mature
fine motor grasp pattern."
Graphs:
References:
Akshoomoff, N., Farid, N., Courchesne, E., & Hass, R. (2006). Abnormalities on the
neurological examination
and EEG in young children with pervasive development disorders. Journal of Autism and
Developmental
Disorder, 35(5), 887-893.
Cowley, P & Swenson, T. (2008). Development and reliability of two core stability field tests.
Journal of
Strength and Conditioning Research, 22(2), 619-625.
Footer, C. B. (2006). The effects of therapeutic taping in gross motor function in children with
cerebral palsy.
Pediatric Physical Therapy, 18, 245-252.
Fu, T., Wong, A., Pei, Y., Wu, K., & Lin, Y. (2006). Effect of Kinesio Tape on muscle
strength in athletes.
Journal of Science and Medicine in Sports, 11(2), 198-201.
Leimohn, W., Baumgartner, T., & Gagon, L. (2005). Measuring core stability, Journal of
Strength and
Conditioning Research, 19(3), 583-586.
Long, T. & Toscano, K. (2002). Handbook of pediatric physical therapy. New York:
Kase, K., Martin, P., & Yasukawa, A. (2006). Kinesio Taping in Pediatrics. Tokyo: Kinesio
USA, LLC
Slupik, A., Dwornik, M., Bialoszewski, D., & Zych, E. (2007). Effect of Kinesio Tape on
bioelectical activity
of the vastus medialis muscle. Ortopedia Traumatologia Rehabilitacja, 9(6), 644-651.
Tsai, H., Hung, H., Yang, J., Huang, C., & Tsauo, J. (2009). Could Kinesio Tape replace the
bandage in
decongestive lymphatic therapy for breast cancer related lymphedema? Supportive Care in
Cancer.
Yasukawa, A., Patel, P., & Sinsung, C. (2006). Pilot study: Investingating the effect of
Kinesio Taping in an
acute pediatric rehabilitation setting. American Journal of Occupational Therapy, 60, 104-
110.
Yoshida, A., & Kahanov, L. (2007). The effects of Kinesio Taping in lower trunk range of
motions. Research
in Sports Medicine, 15, 103-112.
Volkman, G. K. et al. (2009). Factors affecting functional reach scores in youth with typical
development.
Journal of Pediatric Physical Therapy, 21(1), 38-44.