Kinesiotaping Kids:

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Kinesiotaping Kids

• How Do We Measure Up?

Grandview Childrens Centre Karen Koseck
(OT) Andra Duff-Woskosky (PT) Serena Lee
(OT) Winnie Wong (PT)
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Presentation Outline

• Objectives
• What is Kinesiotape (KT)?
• Evidence in Taping
• Case Presentations
• Clinical Impressions
• Measurement Issues
• Questions and Discussions

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Objectives

• Present measurement issues related to
  effectiveness of Kinesiotaping .
• Share our clinical impressions of Kinesiotaping
  as a treatment modality in paediatrics.

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Once upon a time.

• Andra and Winnie went on a KT course in Hamilton,
  taught by Audrey Yasukawa and Patricia Martin
• Audrey Yasukawa taught an UE and trunk KT course
  at Grandview Childrens Centre to OTs

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Taping techniques used in North America

• Athletic taping very firm tape
  applied before the sport and
  removed right after used for
  protection and prevention
• McConnell taping a rigid tape (such as
  Leukotape) applied for different conditions,
  typically patellofemoral pain
• Kinesiotaping

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What is Kinesiotaping

• Invented by Dr. Kenzo Kase (Chiropractor) in 1973
• Muscles and other tissues could be influenced by
  external forces, yet still allow full range of
  motion
• Originally used in rehab settings in Japan
• First used on volleyball players in 1980s
• Now used more in non-athletic population

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Kinesio Tex Tape

• Elasticity of 30-40 stretch
• Stretches along longitudinal axis only
• Activated by heat
• No latex
• Can be worn for several days
• Can shower with it

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Physiological effects of KT

• Endogenous Analgesic System function
• Relieve pain or abnormal feeling on the
  skin muscles
• 2. Muscle function supports the muscle in
  movement
• 3. Lymphatic function lifts the skin and
  promote lymphatic flow
• 4. Joint function hold the joint in better
  alignment

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Literature review

• Many articles on taping for orthopaedic
  conditions (i.e. PFPS, ankle sprains)
• Limited research on taping for neurological
  condition
• Cara, S., and Molteni, F. (2005)
• Kilbreath, S.L., Perkins, Crosbie, J.,
  McConnell, J. (2006)
• Taping and torticollis
• Do, T.T. (2006)
• One pilot study on KT in pediatrics
• Yasukawa, A., Patel, P., Sisung, C. (2006)

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Literature Review

• Yasukawa, Patel Sisung (2006)
• Purpose Describe functional hand and arm skills
  in children subsequent to use of KT
• Subjects (N 15) no control group
• Measurement - Melbourne Assessment of Unilateral
  Upper Limb Function

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Yasukawa et al. (2006) continued

• Treatment
• Goals of KT application
• assist with weakened muscle
• improve joint instability
• alignment for improving function
• Palmar stability tape was reapplied daily
• Received 3 hours of therapy

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Yasukawa et al. (2006) continued

• Results - Improvements in Melbourne scores over
  time
• Conclusion
• KT application may be associated with
  improvements in U/E function while tape is
  applied
• Melbourne Assessment may be able to detect subtle
  changes in U/E control and quality of movement

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Case studies
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Princess H
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Princess H

• Dx Right Torticollis
• Age 3 months
• PROM right rotation ½ range, left side flexion ½
  range
• Gross Motor Skills Age appropriate
• Palpable nodule on right SCM
• Physical exam is otherwise normal

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Princess H

• Goals
• H will have full right cervical rotation within 1
  year.
• H will have full left cervical side flexion
  within 1 year.
• Positional plagiocephaly will be prevented.

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Princess H
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Lady K
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Lady K

• Dx Right torticollis
• Current Age 5
• Admitted to PT after post left SCM release. No PT
  prior to surgery.
• Full ROM achieved as a result of surgery
• Skewed perception of midline after 3 years of
  untreated torticollis
• Several months of unsuccessful attempts to
  strengthen in midline
• Then I took the KT course.

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Lady K

• Goals
• K will maintain her current range of motion
• Scar tissue development will be limited
• K will decrease the amount of right head tilt so
  that she holds her head in neutral alignment
  within 6 months.

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Lady K
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Lady K
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CJ
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CJ

• Dx Cerebral palsy, dyskinetic
• Age 16
• GMFCS 2
• Typical presentation kyphotic posture,
  increased tone in extremities
• Goal CJ will have improved postural alignment
  in her trunk in sitting.

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CJ - Before taping
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CJ - After taping
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Clinical Impressions/Measurement Issues

• Clients understanding of goal
• Proportion of time
• Duration

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The Little Ally
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Case Study Ally

• Age 26mos. at 1st KT trial
• Dx SMA Type 1,2
• Rationale for Using KT
• Other devices were too heavy e.g. splints
• Ability to reach in Kimba stroller (supported
  sitting), difficulty grasping objects (left
  greater than right)
• Client highly motivated to engage in play
• Family highly motivated to follow-up, try new
  things

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Goals of KT - Ally

• Increase use of left arm and hand for play.
• Improve grasping ability with left hand.
• Increase duration of grasp with left hand.

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Measurement Tools - Ally

• Clinical observations, Pictures
• Erdhardt Developmental Prehension Assessment
  (EDPA)
• Kinesiotape Caregiver Satisfaction Questionnaire
  was developed with OT Student, Silvia Hsu

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Photos for Measurement - Ally
Before
After
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Results of EDPA (Erdhart)- Ally

• ability to grasp small objects (pellets) using
  thumb with left hand
• Noticeable improvement in alignment (less thumb
  adduction)
• No improvement in reaching
• No improvement in release

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Kinesiotape Caregiver Satisfaction Questionnaire

• 5 Point Likert scale with questions based on
• 1. application
• 2. alignment
• 3. function (including client specific goals)
• 4. overall satisfaction

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KT Caregiver Satisfaction Questionnaire - Ally

• Application Very easy to apply and tolerated
  very well.
• Alignment Moderate change thumb was outside her
  index finger instead of tucked between her index
  and middle finger. Improved position lasted up
  to 3 days. We found that after tape was removed
  thumb was still out ,not tucked in. Just great!
• Function Significantly helped with functional
  tasks/activities attainment of goals moderate
  increased use of hand, significant improvement in
  grasping, and significant increase in duration of
  grasp.
• Overall Satisfaction Very satisfied

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Areas of Improved Function Parental Report

• Able to pick up toys with left hand
• e.g. little balls, figurines
• Able to assist with holding dinner
• plate with both hands
• Able to independently hold a spoon with
• left hand
• Able to use left arm to reach for Cheesy
• and bring to mouth

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The Story Continues.

• Age 30 mos. (4 months later)
• Ally able to pick-up small objects inconsistently
  using L hand without KT Difficulty with right
  and left release of objects
• Started trial with KT for thumb stability and
  palmar stability bilaterally

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Updated Goals of KT - Ally

• Improve ability to reach/target objects with left
  and right hands.
• Improve ability to grasp a greater variety of
  objects with right and left hands.
• Improve ability to release objects with right and
  left hands.

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Measurement Tools - Ally

• Videotaping instead of photos
• Standardized Assessment (Erhardt)
• KT Caregiver Satisfaction Questionnaire

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Pre-Taping Video (Ally)

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Post-Taping Video (Ally)

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Outcome of KT for thumb and palmar stability -
Ally

• Increased Efficiency (videotaping)
• time to grasp and release objects
• consistency in grasping objects
• Better hand position during grasp bilaterally
  especially with left hand for small objects
  (EDHP)
• Increased Function (KT caregiver questionnaire)

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KT Outcome (Cont.) -Ally

• KT Caregiver Satisfaction Questionnaire
• Application- very easy to apply, but tape only
  lasting 1 day maximum, sometimes only 1 hour
  (summer heat, swimming and Allison starting to
  try to peel it off with R hand)
• Goal Attainment Moderate improvements in
  reaching/targeting, significant improvements in
  ability to grasp more objects and significant
  improvement in ability to release objects.

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and Ally Lives Happily Ever After

• A KT Graduate (32 mos.)
• KT for thumb and palmar stability improved
  alignment and function
• Allison now able to manage McKie thumb splints
  bilaterally

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Measurement Issues - Ally

• Readily available standardized assessments
  (Erdhart) not sensitive enough to measure changes
  in function well.
• Photos work well for measuring alignment.
• Videotaping work well for measuring dynamic
  reaching and efficiency.
• Kinesiotaping Caregiver Satisfaction
  Questionnaire worked well for measurement of
  function and goal attainment.

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AJ
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Case Study- AJ

• Age 4 ½ years old boy
• Dx Cerebral Palsy unspecified
• Rationale for KT
• Immature grasp and decreased dexterity with right
  hand
• Difficulty with release of objects with right
  hand and tends to release objects with wrist
  flexed
• Use as an adjunct to work towards goals

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Goals -AJ

• AJ will hold smaller objects using a mature grasp
  at least 75 of the time.
• AJ will grasp and release objects with his wrist
  slightly extended or in the neutral position.

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Taping -AJ

• Taped for right finger and wrist extension and
  palmar stability
• Parent was shown how to apply tape, informed of
  care and precautions and given pre-cut strips to
  apply at home

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Measurement Tools -AJ

• Standardized tools such as the Quality of Upper
  Extremity Skills Test (QUEST) was used in the
  past however did not detect slight changes gained
  with taping
• Kinesio Tape Caregiver Satisfaction
  Questionnaire completed by family
• Clinical Observation (through photography and
  videotaping)
• Photos and videotaping were taken on separate
  dates

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Application of Kinesio Tape -AJ
Post-Taping
Pre-Taping
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Photos vs. Video -AJ

• Photos captured a moment in time
• Did not demonstrate quality and fluidity of
  movement (e.g. releasing pegs into jar)
• Did not capture true wrist position when grasping
  and releasing object
• Therefore the following week videotaped AJ

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Pre-Taping Video

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Post-Taping Video

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Outcomes -AJ

• Goals attained
• Held objects using a more mature grasp
• Grasped objects with wrist in neutral position
• Increased speed and success with releasing
  objects into container

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Caregiver Satisfaction Questionnaire -AJ

• Application Very easy to apply tape.
• Tape Tolerance Did not tolerate wearing tape
  post Grandview and at home. Independently peeled
  off tape.
• Alignment Moderate change in wrist extension.
• Overall Satisfaction Satisfied with overall
  results of the tape and observed a noticeable
  difference with grasping with tape on.

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Measurement Issues -AJ

• The sensitivity of available assessment posed a
  challenge to measure change in a standardized
  fashion.
• Video vs. Photographs
• Movement based activities vs. positioning and
  alignment
• Photos had limitations in observing quality of
  movement
• Video taping required more time and resources

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Clinical Impressions -AJ

• Improvements were observed in grasp by both
  parent and therapist.
• Family was satisfied with results the tape
  produced.
• Goals were achieved.
• Effects did not continue once tape was removed.
• Challenge keeping the tape on for more than a day.

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Words of Wisdom
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Clinical Impressions of KT treatment

• Difficulty with adhesion due to wear-and-tear
• Skin allergies
• Difficult to determine end of taping
• Cost
• Variable ease of tape application
• Can be used in combination with other treatments
• Easy to remove

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Clinical Impressions of KT treatment

• Difficult to use on clients with behavioural
  issues
• Limited success with clients with Modified
  Ashworth Scale of 3 or higher or with strong
  dystonic movements
• Good to use on clients with low tone
• Full passive ROM needed
• Clients/caregivers cooperation and consent
• May not be beneficial in some diagnoses (eg.
  Idiopathic toe walking, J.A., Brain Tumour)

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Strengths and Limitations of Measurement Tools
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Strengths and Limitations of Measurement Tools
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Strengths and Limitations of Measurement Tools
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Will KT live happily ever after.

• More research needed
• Clinician focus groups
• Dissemination of Information e.g. CanChild
  Intranet

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Special thanks to our clients and colleagues at
Grandview Childrens Centre!
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Resources/References

• Kinesiotaping Association http//kinesiotaping.com
  
• Kinesio Tape in Canada www.kinesiotape.ca
• Erhardt, R.P. (1989). Developmental Hand
  Dysfunction Theory Assessment Treatment.
• Cara, S., and Molteni, F. (2005). Taping versus
  electrical stimulation after botulinum toxin type
  A injection for wrist and finger spasticity. A
  case-control study. Clinical Rehabilitation, 19,
  621-626.
• Do, T.T. (2006). Congenital muscular
  torticollis current concepts and review of
  treatment. Curr Opin Pediatr., Feb 18(1)26-9.
  Review.
• Kilbreath, S.L., Perkins, Crosbie, J.,
  McConnell, J. (2006). Gluteal taping improves
  hip extension during stance phrase of walking
  following stroke. Australian Journal of
  Physiotherapy, 52, 153-56.
• McKie Thumb Splints www.mckiesplints.com
• Randall, Johnson, Reddihough (1999). The
  Melourne Assessment of Unilateral Upper Limb
  Function.
• Yasukawa, A., Patel, P., Sisung, C. (2006).
  Pilot study Investigating the effects of Kinesio
  Taping in an acute pediatric rehabilitation
  setting. American Journal of Occupational
  Therapy, 60, 104-110.