Clinical Notes 4 2017

Current best practice use of S-tape application in the submental or suprahyoid space.

History:

When we originally started using this tiny tape application under the chin to correct excessive
drooling, it did not have a name. Many colleagues kept asking what it was called and what this tape
was exactly doing. This was in the time that everyone thought that we needed to tape on the muscle
from origin to insertion or visa-versa to have a positive effect. The application did not seem to target
one muscle only. Which muscle was this tape influencing? What was it called? To make
communicating easier the application was named the s-tape and the S-tape Protocol was developed.
The letter s is present in the words saliva and/or swallowing in a number of languages. It was also
very clear that we were sending sensory information to the brain. We realized that the skin can be
regarded as our outer brain1.

The application was thought up by author and colleague working in different countries and the first
studies2 describing its use were published months apart in 2009. The application was aimed at
decreasing excessive drooling and 2 different outcome measures3 were used. Oliveira Ribeiro de M et
al used the Thomas-Stonell and Greenberg drooling scale to measure drooling severity and
frequency, and de Ru E. (author of this paper) the QETED, a new patient outcome measure designed
by her to specifically measure reactions to the s-tape. Oliveira Ribeiro published research of tape on
42 children (4-15 years old) with CP. De Ru published a case study of a 6 year old girl with Rett
Syndrome. Both found positive effects and did not use the Drooling Impact Scale as described by
Reid et al in Developmental Medicine & Child Neurology journal in October 2009.4 When the author
learnt of this scale she compared it to the QETED and found that they were very similar.5

The tapes described in the above two studies were in the same anatomical region and differed in two
ways: application size and amount of stretch used. De Ru used a minimum amount of tape, applied
with the ligament technique (space correction- stretching tape in the middle with 10% stretch), while
Oliveira Ribeiro used the same technique with 100% stretch and used a larger sized tape.

Studies:

A number of years have passed and the S-tape protocol has been modified, updated and translated
into many languages. There are more than one way to apply. We now have eight years of experience
using it and we have seen a number of studies6 describing this application published during this time.

1 Tobin DJ Biochemistry of human skin--our brain on the outside. Chem Soc Rev. 2006 Jan;35(1):52-67. Epub 2005 Oct 26.
2
Ru de E. Bol.de Noticias VNM Vol. 3 2009.
Oliveira Ribeiro de M; Oliveira Rahal de R; Siqueira Kokanj A; Pimenta Bittar D (2009) The use of the Kinesio taping method in the control
of sialorrhea in children with cerebral palsy. Actafisiatrica.vol.16.nr4.dec.2009.
3 QETED by de Ru, Own check 24 point list and Thomas-Stonell and Greenberg drooling scale by Oliveira
4 Reid SM , Johnson HM, Reddihough DS http://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.2009.03519.x/pdf
5
https://www.academia.edu/31104177/Open_letter_to_colleagues_using_the_S-tape_application
6 Araújo S, Hilton J, Santos R (2014) Atividade elétrica da região supra-hióidea durante a deglutição pré e pós uso de Kinesio Taping Ma

thesis ESTSP Portugal

Goodwin E (2016) integrated physiotherapy and speech pathology dysphagia assessment and treatment ; a single pediatric case study.
SIG13vol1.part 1 2016 ASHA
Furtado Caneschi W, Alves Neves de Paiva CC, Ladeira Frade R, Rodrigues Motta A. Use of elastic bandage associated with speech therapy
in the control of sialorrhea http://www.scielo.br/scielo.php?pid=S1516-18462014000501558&script=sci_arttext&tlng=en
González-Sánchez B, Rodríguez-Mansilla J, Álvarode-Toro-García. M, González-López-Arza V 2015 Eficacia del vendaje neuromuscular en el
tratamiento de la sialorrea en pacientes con trastorno del espectro autista Revista de Logopedia, Foniatría y Audiología Volume 35, Issue 3,
July–September 2015, Pages 143-146
López Tello, C., Escuder González, S., Oliván Blázquez, B. & Campo Escacho, M. (2012). Eficacia del kinesiotaping en la sialorrea en niños con
necesidades educativas especiales: un ensayo clínico abierto. Fisioterapia, 34 (6), 275-281. doi:10.1016/j.ft.2012.05.002
Vilchez-Barrera, M., Lozano-Céspedes, I. & Matias-Quintana, G. (2016). Uso del neurotaping en el control de la sialorrea en niños con
patología neurológica central: un estudio clínico no controlado. TOG, 13 (23), 1-14.
Araújo S 2014 found changes in electromyography signal variation pre and post Kinesio Taping in the
suprahyoid muscles in 11 women (mean age 27 years). This Master thesis SLP is written in
Portuguese.
Furtado Caneschi W, 2014 applied the s-tape on eleven 4-10 year old children with various neuro-
developmental disorders. They found that the tape was effective after 30 days of use. The results
were not maintained in a 3 months rest period after removal. Language: Portuguese and English.
Goodwin E 2016 published a single pediatric case study using tape integrated into feeding and
postural treatment. Video fluoroscopy showed that in absence of being able to create a change in
superior hyo-laryngeal excursion, elastic therapeutic tape potentially altered the swallow pattern
positively.
Gonzalez-Sanchez B 2015 studied 2 children aged 7 & 17 years with autism. They used the QETED
and found that the tape did not have a statistically significant effect over time (12 months) in fact in
one case some of the symptoms had increased slightly. Language Spanish.
López Tello, C. 2012 studied the effects of the s-tape on 10 children with unspecified neurological
disorders (mean age 9.8 +/- 2.04 years) using the QETED and monitoring tape use for 7 months. An
interesting find in this study was that when comparing the mean outcomes of the QETED
questionnaires a difference of opinion was seen between the staff and the parents.
Vilchez-Barrera, M 2016 applied the tape for 3 months on twelve 14-18 year old children. Significant
improvement in a number of the 9 items of test (similar to QETED) were reported.

All studies have in common that the use of a control group was not deemed necessary. As a matter
of fact, in some cultures using a control group is considered unethical. The application time in the
studies varied greatly. The application size varied and tape size had been standardized in few cases.
The number of participants was not high: from one single case study to 12 participants being the
highest number of cases described. Some studies have looked at the effects of the tape only and
others had incorporated tape into normal treatment.

One study is currently ongoing and titled: The results of applying the s-tape in adult patients with
neurological disorders. It is being investigated by Acosta Montelongo A. 7 He will be working
according to the S-tape protocol and using the QETED.

Results found so far:

The s-tape influences

 Drooling frequency and severity,

 Tongue movement,
 Swallow pattern,
 Pronunciation.

This application is being used by physiotherapists and speech language therapists all over the globe.
It is a safe and non-aggressive manner of addressing all the issues related to excessive drooling in a
variety of disorders in patients of all ages. It does not work in all cases but is worth a try as a
treatment modality.8

7 Acosta Montelongo A 2017 Eficacia del uso del Kinesiotaping para el tratamiento de la sialorrea en pacientes adultos con patología
neurológica.
https://www.researchgate.net/publication/317015442_Research_Proposal_Efficacy_of_Kinesio_tape_use_on_sialorrhea_treatment_in_ad
ult_patients_with_neurological_diseases
8 https://www.academia.edu/15690223/S-Tape_effective_but_not_for_everyone_current_state_of_affairs
We have found it does not seem to have a carry-over effect in patients with a central neurological
deficits and some genetic disorders. In these cases the tape works when it is on and stops working
when removed. In patients with a normal CNS a carry-over effect is often seen.

This tape can be applied in a variety of ways, in different sizes and with various amounts of stretch.
To this clinicians’ dismay, it is not always used as a first choice in the case of drooling. Many still
prefer using Botox or applying tape to the orbicularis-oris muscle instead.

We welcome more research especially using Video fluoroscopy and looking at the long term effects.

Esther de Ru Netherland August 2017

First s-tape 2009 Area to apply tape to Application Tiny s-tape