Disability and Rehabilitation, 2011; 33(21–22): 2058–2063

RESEARCH PAPER

The effects of Kinesio1 taping on sitting posture, functional

independence and gross motor function in children with cerebral palsy


TÜLAY TARSUSLU ŞIMŞEK1, BAHRIYE TÜRKÜCÜOGLU 2
, NILAY ÇOKAL3,
4 _
GONCA ÜSTÜNBAŞ & IBRAHIM ENGIN ŞIMŞEK1

1
Department of Physical therapy and Rehabilitation, Abant Izzet Baysal University School of Physical Therapy and
Disabil Rehabil Downloaded from informahealthcare.com by RMIT University on 03/12/13

Rehabilitation, Bolu 14100 Turkey, 2Sakarya Özel Konuk Özel E g itim ve Rehabilitasyon Merkezi, Sakarya, Turkey,
3 _
Zonguldak Özel Ilkcan Özel E _
g itim ve Rehabilitasyon Merkezi, Zonguldak, Turkey, and 4Düzce Özel Ilgim Özel E
g itim ve
Rehabilitasyon Merkezi, Düzce, Turkey

Accepted January 2011

Abstract
Purpose: The aim of this study was to investigate the effects of Kinesio1 tape (KT) application on sitting posture, gross
For personal use only.

motor function and the level of functional independence.

Method: The study included 31 cerebral palsied children scored as level III, IV or V according to gross motor functional
classification system (GMFCS). Children were randomly separated into two groups as study (n ¼ 15, receiving KT and
physiotherapy) and control (n ¼ 15, receiving only physiotherapy). KT application was carried out for 12 weeks. Gross motor
function measure (GMFM), functional independence measure for children (WeeFIM) and Sitting Assessment Scale (SAS)
were used to evaluate gross motor function, independency in the activities of daily living and sitting posture, respectively.
Results: Compared to initial assessments, both groups showed a significant difference in parameters of GMFCS sitting
subscale, GMFCS total score and SAS scores (p 5 0.05). At the end of 12 weeks, only SAS scores were significantly different
in favour of the study group when the groups were compared (p 5 0.05). Also, post-intervention WeeFIM scores of the study
group were significantly higher compared to initial assessment (p 5 0.05), however, no difference was detected in the control
group (p 4 0.05).
Conclusions: No direct effects of KT were observed on gross motor function and functional independence, though sitting
posture (head, neck, foot position and arm, hand function) was affected positively. These results may imply that in clinical
settings KT may be a beneficial assistive treatment approach when combined with physiotherapy.

Keywords: Kinesio taping, cerebral palsy, sitting, motor function and children

Introduction of the children [1,5]. Children with CP often rely

Cerebral palsy (CP) is a non-progressive motor and
postural disorder and also the most common cause
of severe physical disability in children [1,2].
Children with CP may encounter several neurologi-
cal deficits (muscle tone and balance problems,
coordination disorders and muscle weakness) inter-
fering with their motor function and, thus, affecting
activities of daily living [1,3].
One of the most important problems in cerebral
palsied children is the disturbance of normal postural
control mechanisms [4,5], which seriously affect
both functional activities and activities of daily living
upon inappropriate control strategies and faulty
feedback mechanisms when learning to maintain
both static and dynamic sitting postures, which
inevitably leads to ‘postural dyscontrol’ and func-
tional dependency [5–8]. The postural control
system cannot effectively control the body’s position
and motion in space because it lacks the ability to
generate appropriate muscular force and to coordi-
nate and integrate the sensory information received
from various receptors throughout the body [8]. The
fundamental thought behind the therapeutic ap-
proaches applied in CP relies on achieving normal
postural control and regaining motor functions and

Correspondence: Tülay Tarsuslu Şimşek, School of Physical Therapy and Rehabilitation, Abant Izzet Baysal University, Bolu 14100, Turkey.
E-mail: tulay_tarsuslu@yahoo.com
ISSN 0963-8288 print/ISSN 1464-5165 online ª 2011 Informa UK, Ltd.
DOI: 10.3109/09638288.2011.560331
 The effects of kinesiotape in cerebral palsy 2059

maximum possible independency in the activities of Table I. Subjects’ demographics.

daily living. There are different types of treatment Study group Control group
methods (i.e. neurodevelopmental therapy, hippo (n ¼ 15) (n ¼ 15)
therapy, horseback-riding, etc.) [9–12]. Kinesio1
taping (KT) is relatively a new technique used in X + SD X + SD
Age (year) 8.27 + 3.43 6.87 + 2.10
rehabilitation programmes and in conjunction with
Height (cm) 115.14 + 20.23 105.64 + 13.24
other therapeutic interventions it may facilitate or Weight (kg) 22.57 + 9.98 21.07 + 8.42
inhibit muscle function, support joint structure, n (%) n (%)
reduce pain and provide proprioceptive feedback to GMFCS
achieve and maintain preferred body alignment 13– Level III 4 (26.7) 3 (20)
Level IV 6 (40) 8 (53.3)
16]. Although physical therapists use KT in clinical
Level V 5 (33.3) 4 (26.7)
practice in different areas, scientific evidence inves- Gender
tigating its effectiveness is limited. Female 7 (46.7) 5 (33.3)
There are several studies documenting different Male 8 (53.3) 10 (66.7)
effects of KT under many headings [17–21]. KT is Type of cerebral palsy
Hypotonic 4 (26.7) 1 (6.7)
also used in paediatric clinical settings commonly,
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Spastic 11 (73.3) 14 (93.3)

though, without proper evidence of its effectiveness Extremity involvement
in paediatric applications. Thus, this study may be Dyparetic 10 (66.7) 8 (53.3)
considered as one of the fundamental works inves- Quadriparetic 5 (33.3) 7 (46.7)
tigating the effectiveness of KT on postural control
GMFCS, gross motor function classification system; X + SD,
related to independency in activities of daily living in Mean + standard deviation.
cerebral palsied children.
The aim of this study was to investigate the effects
of KT application on sitting posture, gross motor skin is present and if so to pull out the tape. The trial
function and the level of functional independence. KT application was held in position for 3 days. Only
For personal use only.

in one child there found to be a skin irritation under

Methods
The study included 31 cerebral palsied children
receiving regular physiotherapy in paediatric clinical
settings dealing with cerebral palsied children. The
average age of the children included in the study
and control groups were 8.27 + 3.43 years and
6.87 + 2.10 years, respectively. The data related to
demographics, GMFCS levels, type of CP and
extremity involvement are provided in Table I.
The inclusion criteria were (1) having diagnosed as
CP, (2) rated as level III, IV or V in gross motor
functional classification system (GMFCS) [22],
(3) not having participated in any previous trials with
KT (or with other taping methods) to the trunk
musculature. The exclusion criteria were (1) no
previous spinal surgery, (2) showing allergic reac-
tions to the adhesive compound of KT, (3) being
rated as level I or II in GMFCS, (4) being unable to
understand the commands necessary for the proce-
dure. Children were randomly separated into two
groups as study and control. All the assessments were
conducted by the same physiotherapist, experienced
in paediatric rehabilitation. In order to investigate the
presence of any allergic skin reactions to the KT
application, the children in the study group under-
went a trial of KT application on the trunk
musculature. The families and/or caregivers of the
children were instructed to closely watch for any
irritation (any sign of obvious rush or itchiness) to the
the KT application and thus was excluded. Ethical
approval was obtained from Ethical Commission on
Medical, Surgical and Drug Investigation of Uni-
_
versity of Abant Izzet Baysal (Ref. No. 2009/100-37).
Instrumentation
All the assessments were conducted prior to inter-
vention and at the end of 12 weeks. Following tools
were used as outcome measures,
. Gross motor function measure (GMFM) to
evaluate gross motor function [23,24]
. Functional independence measure for children
(WeeFIM) to evaluate independency in the
activities of daily living [25,26]
. Sitting Assessment Scale (SAS) to assess sitting
posture [27,28]
GMFM. The GMFM is an observational assess-
ment tool composed of 88 items evaluating gross
motor functions in five gross motor function
domains: (1) lying and rolling, (2) sitting, (3)
crawling and kneeling, (4) standing and (5) walking,
running and jumping. In this study, sitting domain
and total score are used [23,24].
WeeFIM. WeeFIM is an 18-item tool used to
evaluate the level functional independence of a child
in six domains related to the activities of daily living.
 2060 T. T. Şimşek et al.

The subsets include self-care (6 items), sphincter

control (2 items), transfers (3 items), locomotion
(3 items), communication (2 items), and social
cognition (3 items). Scoring for each items ranges
between 1 (total dependence) and 7 (total indepen-
dence). Minimum score that can be obtained is 18
and maximum score is 126 [25,26].

SAS. SAS is a standardised observational instru-

ment designed for assessment of sitting in children
with CP. The scale is composed of five items
evaluating head, trunk and foot control and arm
and hand function. Each item is assessed with a score
from 1 to 4 (1 ¼ none; 2 ¼ poor; 3 ¼ fair; 4 ¼ good).
Each score (1–4) has specific descriptors of each item
of the SAS. SAS is developed for use in both clinical
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and research settings [27,28].

Intervention

KT application in this study was utilised to enhance

normal postural alignment by facilitating trunk
stability aiming to decrease functional dependency
[16,29,30]. Figure 1. KT application.
For personal use only.

The tape was applied longitudinally between S1

and C7 to the paraspinal musculature. As Kenzo
Kase [16] advocated the direction of application was
from insertion to origin for the children with
hypertonus in trunk musculature and from origin to
insertion for children with trunk hypotonia. Fan
technique was applied using a 5 cm KT (Kinesio1
Tex, Gold, 5 cm 6 5 cm). The tension of the tape
was minimal to achieve more sensory input to the
trunk extensor muscles as recommended by Kase
(Figure 1) [16].
The tape was held in position for 3 days and then
the region was left to rest for 24 h. Following that,
KT was re-applied by the same physiotherapist for
another 3 days. The application was continued for 12
weeks.
All the children received a 1 h session of phy-
siotherapy three times a week for 12 weeks. The
sessions mainly composed of exercises focusing on
tone regulation, activities of upper extremity like
grabbing–releasing and activities of sitting and
balance reactions related to sitting.
test was utilised. Level of significance was accepted
as p 5 .05.
Results
Compared to initial assessments, both groups
showed a significant difference in parameters of
GMFM sitting subscale, GMFM total score and
SAS scores (p 5 0.05). Also, post-intervention Wee-
FIM scores of the study group were significantly
higher compared to initial assessment (p 5 0.05),
however, no difference was detected in the control
group (p 4 0.05) (Table II).
When the groups were compared for the scores
obtained in GMFM sitting subscale, GMFM total
and SAS scores there were no differences in neither
of the evaluations (p 4 0.05) with the exception that
at the follow-up assessment SAS scores were
different in favour of the study group (p 5 0.05)
(Table III).

Data analysis
Statistical Package for the Social Sciences (SPSS) for
Windows 10.0 statistical package was used to analyse
the obtained data. Mean and standard deviations
(X + SD) were used in descriptive statistics. To
detect difference between groups t test and to analyse
pre- and post-treatment differences paired sample t
Discussion
The primary finding of this study may indicate that
KT application to the trunk musculature does not
seem to affect gross motor function and indepen-
dency in the activities of daily living, rather it
somewhat may enhance postural alignment in sitting.
 The effects of kinesiotape in cerebral palsy 2061

Table II. Before and after KT application differences at 12 weeks compared with baseline assessments.

Study group (n ¼ 15) Control group (n ¼ 15)

Baseline, X + SD 12 weeks, X + SD z p Baseline, X + SD 12 weeks, X + SD z p

GMFM
Sitting domain 57.10 + 24.30 75.66 + 25.12 74.106* 0.001 57.97 + 24.60 61.66 + 22.56 72.958* 0.011
Total score 35 + 20.73 43.89 + 19.99 74.916* 0.000 36.46 + 22.40 39.55 + 21.11 72.194 0.047
WeeFIM 50.67 + 26.66 54.93 + 27.73 72.522* 0.024 55.27 + 28.86 55.53 + 28.90 71.169 0.262
SAS 13.53 + 3.48 16.47 + 1.96 75.634* 0.000 12.47 + 3.64 13.20 + 3.32 72.442 0.028

KT, Kinesio tape; GMFM, gross motor function measure; X + SD, mean + standard deviation; WeeFIM, functional independent measure;
SAS, Sitting Assessment Scale. Values given in bold mean that there is significance between parameters when compared to the groups.
*p 5 0.05, paired t test.

Table III. Before and after KT application comparison of the groups at baseline and 12 weeks.
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Before KT After KT

Study group, Control group, Study group, Control group,

X + SD X + SD t p X + SD X + SD t p

GMFM
Sitting domain 57.10 + 24.30 57.97 + 24.60 70.095 0.925 75.66 + 25.12 61.66 + 22.56 1.574 0.127
Total score 35 + 20.73 36.46 + 22.4 70.183 0.856 43.89 + 19.99 39.55 + 21.11 0.568 0.574
WeeFIM 50.67 + 26.66 55.27 + 28.86 70.453 0.654 54.93 + 27.73 55.53 + 28.9 70.058 0.954
SAS 13.53 + 3.48 12.47 + 3.64 70.820 0.419 16.47 + 1.96 13.20 + 3.32 3.281 0.003*

KT, Kinesio tape; GMFM, gross motor function measure; X + SD, mean + standard deviation; WeeFIM, functional independent measure;
For personal use only.

SAS, Sitting Assessment Scale. Values given in bold mean that there is significance between parameters when compared to the groups.
*p 5 0.05, independent t test.

In general, KT application is used in CP, brachial
plexus palsy and torticollis to facilitate normal
postural alignment, to provide sensorial stimulation,
to enhance functional motor skills and to normalise
or inhibit muscle tone [16,29–31]. Cepeda et al. [31]
reported that KT application to abdominal muscles
in children with hypotonia, may be a therapeutic
approach facilitating the transition from supine
position to sitting. In another study conducted by
Yasukawa et al. [30] in acute paediatric clinics, KT
application was found to be beneficial to increase
upper extremity control and function in children
with different diagnoses (brain tumour, cerebro-
vascular accident, spinal cord injury and traumatic
brain injury). In contrast with these studies, Footer
[8] stated that 12 weeks of paraspinal taping did not
have a positive effect on postural control in sitting,
however, one of the children in the study, diagnosed
as athetoid, had decreased involuntary motor move-
ments and increased trunk stability. In our study,
most of the children were diagnosed as spastic type
CP and all had problems in trunk control. The
average values obtained in gross motor function and
sitting assessments seems to be promising in favour
of KT group compared to baseline; however, similar
to the conclusion of Footer, at the end of 12 weeks of
application, this difference was not significant when
compared to control group values. This may imply
that paraspinal KT application in children with CP
has no benefit in the aspect of gross motor function,
although individual effects (even if they are minimal)
should be considered as a point of remark.
In another study, Jaraczewska and Long [13]
reported that KT application combined with other
therapeutic interventions, increased upper extremity
function in adult hemiplegics. Also, Hsu et al. [17]
showed that KT application had a positive effect on
scapular motion and motor performance in impinge-
ment syndrome, though the authors emphasised that
no exercise was prescribed with KT application
which was accounted for a major limitation of the
study. Likewise, Dr. Kase [32], the inventor of the
KT, pointed out those better results may be achieved
with KT if combined with therapeutic exercises. In
our study, the results did not indicate a significant
difference between the groups in the aspects of gross
motor function and functional independence. Still,
as the success in the activities of daily living can be
gained through better postural alignment in sitting,
the increase in WeeFIM score in the study group
may be explained by the increase in trunk stability.
Another interesting result of this study was the
increase observed in SAS and GMFM (sitting
domain) scores in both groups. However, the only
significant difference detected was in the SAS score
of the study group. This may be explained in a
 2062 T. T. Şimşek et al.
couple of ways. First, the sitting dimension of
GMFM is an assessment primarily related to motor
development and thus insensitive to the changes in
postural control in sitting which is further advocated
by Footer [8]. Second, KT is assumed to have a
positive effect on mechanoreceptors which may be
the cause of change in the study group. The
stimulation of cutaneous mechanoreceptors achieved
through KT application which stretches or applies
pressure to the skin may result in physiological
changes in the taped area. Studies previously
conducted to determine the effects of KT on
cutaneous mechanoreceptors have reported that
KT on the selected muscles and joints may have
improved muscle excitability [19,33–36]. This may
be related to enhance postural control as previously
Disabil Rehabil Downloaded from informahealthcare.com by RMIT University on 03/12/13
hypothesised.
Limitations and further research
At the end of 12 weeks of KT application, the
assessments were conducted after the taping was
pulled out. However, there are also studies in which
the evaluations were conducted when KT is still on
For personal use only.
the body part. We recommend that in future studies,
both methods should be used in order to detect
whether there is actually a weaning effect of KT. This
may be helpful to present any mechanoreceptor
adaptation to the new postural alignment caused by
the application if the aim of intervention is focused
on postural control and its sub-headings.
Another missing point in this study is that
immediate effects of KT were not evaluated, because
the tools used in this study were not primary
objective outcome instruments used to detect mini-
mal and instantaneous changes in postural control.
Thus, immediate effects should be assessed and
compared to short-/long-term effects in order to put
forth a recommended utilisation deadline for con-
sideration at which no further gain should be
expected by the professional advising KT applica-
tion. This will also help to achieve cost-effectiveness
which is a major topic in health care systems.
Moreover, although all the children in this study
had faulty and similar postural control mechanisms
related to sitting posture, the groups were not
clearly homogeneous in terms of the clinical type
of CP. It should be noted that different clinical types
of CP may naturally respond differently to KT
application.
Conclusion
This study is the first study evaluating the effects of
KT application on sitting posture, gross motor
function and functional independence. No direct
effects of KT was observed on gross motor function
and functional independence, though sitting pos-
ture (head, neck, foot position and arm, hand
function) was affected positively which may mean
that KT has beneficial effects on postural alignment
in sitting. However, compared to its widespread
utilisation in many fields of rehabilitation, we
believe that the surprisingly low level of evidence
will urge investigators to conduct more studies
determining the mechanisms underlying KT
application.
Declaration of interest: The authors of this study
declare that no external funding was used in this
research. The authors report no conflicts of interest.
The authors alone are responsible for the content
and writing of the paper.
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