A COMPARATIVE STUDY OF ANKLE EVERSION KINESIOTAPING

Research Paper E-ISSN NO : 2455-295X | VOLUME : 5 | ISSUE : 8 | AUGUST 2019

I N T E R N A T I O N A L E D U C A T I O N A L S C I E N T I F I C R E S E A R C H J O U R N A L

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A COMPARATIVE STUDY OF ANKLE EVERSION KINESIOTAPING TECHNIQUE & SPRING ASSISTED KINESIOTAPING TECHNIQUE ON

DYNAMIC BALANCE AND GAIT VELOCITY IN CHRONIC STROKE PATIENTS WITH FOOT DROP.

DR.SK. RABIYA 1* | DR.V. SRIKUMARI 2 | DR.K. MADHAVI 3

1 MPT (NEUROLOGY), PG STUDENT, COLLEGE OF PHYSIOTHERAPY, SVIMS UNIVERSITY, TIRUPATI – 517507 (AP),

INDIA. 2 MPT (NEUROLOGY), PH.D., ASSISTANT PROFESSOR, COLLEGE OF PHYSIOTHERAPY, SVIMS UNIVERSITY,

TIRUPATI-517507 (AP), INDIA. 3 MPT (CARDIOTHORACIC), PH.D., FIAP, PROFESSOR, HOD AND PRINCIPAL, COLLEGE OF PHYSIOTHERAPY, SVIMS

UNIVERSITY, TIRUPATI-517507 (AP), INDIA.

ABSTRACT:

Stroke survivors are impaired by asymmetric posture, reduced voluntary control of movement, abnormal body balance, and deficit of weight transfer which affects their postural control and walking ability thereby increasing risk of fall. Ankle dorsiflexion plays a major role in balance and gait (1). [Purpose] The purpose of this study was to compare the effect of ankle eversion kinesiotaping technique & spring assisted kinesiotaping technique on dynamic balance and gait velocity in chronic stroke patients with foot drop. [Methods] Design: Randomized controlled trial study. Method: 30 chronic stroke patients with foot drop were randomly divided into two experimental groups. The experimental group-1 received ankle eversion kinesiology taping and ankle proprioceptive exercises (n=15), and the experimental group -2 received spring assisted kinesiology taping and ankle proprioceptive exercises (n=15). Dynamic balance and gait velocity was assessed before and after 8 weeks of kinesiology taping in both groups by using Tinetti index and TUG test. [Results] The demographic variables of patients in both groups were comparable before the treatment (p >0.05). After kinesiology taping application, significant improvement was found in the Tinetti index and the TUG test for patients in the experimental group-1(p=0.01).There were significant differences in the Tinetti index and TUG test between two experimental groups after treatment (p<0.05).In terms of dynamic balance and gait velocity, we found significant improvement in balance ability (p=0.01) and gait speed (p=0.01) of the involved side in the experimental group-1 after ankle eversion kinesiology taping application compared to the experimental group – 2 after spring assisted kinesiology taping application. [Conclusion] Ankle eversion kinesiology taping and ankle proprioceptive exercises improved the dynamic balance and gait velocity of chronic stroke patients with foot drop.

KEYWORDS: ANKLE EVERSION KINESIOLOGY TAPING, SPRING ASSISTED KINESIOLOGY TAPING, DYNAMIC BALANCE, GAIT VELOCITY, CHRONIC STROKE, FOOT DROP.

INTRODUCTION

STROKE is a “brain attack”. It occurs when blood flow to an area of brain is cut off. When this happens, brain cells are deprived of oxygen and begin to die resulting in loss of abilities controlled by that area of the brain such as memory and muscle control (2).Stroke is one of the major causes of disability and mortality (AHA 2014; Bonita 1992; WHO 2014). It is the third most common cause of death in the developed world after coronary disease and cancer (3).The risk factors for stroke include hypertension, elevated lipids, diabetes, smoking, low physical activity levels, unhealthy diet and abdominal obesity (4). Types of stroke include :-(I) Ischemic (Clots), (ii) Haemorrhagic (Bleeds), (iii) TIA(5).F.A.S.T. is an easy way to remember the sudden signs and symptoms of a stroke(6).Patients with stroke typically encounter impaired physical function, making independent walking difficult due to a reduction in balance ability, walking speed, and gait endurance. Sensory systems utilized for balance are the proprioceptive, vestibular, and visual systems. Generally,

patients with stroke experience damage to all three sensory systems, with proprioception being affected the most (7).Lower limb impairment resolves by 70% within 3 months after stroke. This may be because of greater redundancy in the form of alternate descending pathways to the LL, such as the reticulospinal tract and projections from the contralesional cortex (8). Lower limb function plateau earlier than upper limb function(9).Reduced descending neural drive to the paretic ankle joint causes muscle weakness and spasticity, often accompanied with drop foot which is characterized by the foot pointing downward and dragging on the ground during walking. To maintain sufficient foot clearance in swing phase, people with dropped foot have to compensate either by hip hiking with exaggerated flexion in hip and knee joints. These inefficient asymmetric gait patterns hinder the walking ability and contribute to slower walking speed, increasing risk of falling, and greater energy expenditure (10).

EMG studies indicate that, following stroke, many people are capable of only reduced levels of activation of their dorsiflexor muscles during swing and commonly, a



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reduced dorsiflexion in swing phase may be caused by an increased plantar flexor muscle moment attributable either to adaptive shortening or excessive activation of the plantar flexor muscles (11).Although the vast majority (75%) of people after stroke, will have a diminished capacity to voluntarily shift body weight or to withstand external perturbations (12). Previously, many physiotherapy approaches like a robotized AFO holds the foot in a neutral position, that uses a hybrid drive system (electro hydraulic), to apply phase-specific torque perturbations at the ankle joint during walking, a task-oriented progressive resistance training to improve dorsiflexion(13), therapeutic Electrical Stimulation for Dorsiflexion(14), Weight-Shift Training Improves Proprioception, and Balance(15), FES to stimulate the common peroneal nerve, activating the muscles that dorsiflex the foot during the swing phase of gait, used to improve the gait speed and dynamic balance of chronic stroke patients(16). However, they also have some disadvantages; for example, robotic gait training is expensive and difficult to access. Robotic assistive devices are only available in the clinical setting, and their use is difficult for activities of daily living. FES cannot be used as it causes skin irritation and difficult to use for ADL (17). Recent studies reported that applying KT leads to improvement not only in gait symmetry but also in walking speed through muscle facilitation in the paralyzed parts of the body. Kinesiology taping (KT) of the ankle to the paralyzed side of a stroke patient increases stimulation and support depending on the application method of specific muscle. KT is easily applicable and inexpensive. KT to improve balance and gait, usually applied to the ankle to improve feedback of proprioceptive and recruitment of the stabilizing muscles (18). Studies supports that kinesiotape provides a more subtle muscular effect which centres more on increasing neuromuscular recruitment rather than increasing healthy muscle strength (19).Ankle eversion taping is generally a mechanical taping method to correct the alignment, and which consists of two stages to increase the dorsiflexion and eversion of the ankle to increase the dynamic balance and gait ability of chronic stroke patients with foot drop (20). The spring-assisted kinesiotaping technique utilizes both mechanical and sensorimotor stimuli to facilitate the ankle dorsiflexormuscles, spring assisted technique or functional correction technique is corrective application of kinesiotaping in which application are always over structures where their position is to be corrected. This technique is effective to activate ankle dorsiflexors and support ankle thereby improving gait speed and dynamic balance. This technique maintains the foot in dorsiflexion and dropping of foot while walking is avoided which helps the patient in clearing the ground(21). Ankle proprioceptive exercises is more effective in enhancing balance ability in stroke patients(22), ankle proprioceptive control program that consisted of three stages: stage 1; mobility of ankle joint, Stage 2;weight bearing in a static standing position, stage3; weight bearing and assignment training program, which is effective on balance and gait

abilities of stroke individuals (23). Dynamic balance is measured by using balance section of Tinetti index(24) and gait velocity with TUG test(25).

Several studies have been conducted to examine the recovery of the foot drop in chronic stroke patients. Many stroke patients have abnormal gait due to paralysis, limb muscle weakness, spasticity, and sensorimotor control. Equino-varus foot is the most common cause of stroke patients’ abnormal gait, it shift the weight support of the heel to the lateral-plantar surface of the paralyzed foot and causes incomplete weight support. This gait disturbance causes compensatory motion patterns, slows gait speed, and limits functional movements. In severe cases, the risk of falling increases. 84% of the patients with stroke develop contractures in more than one joint, among which 76%havecontracture in the ankle joint (26).There are several therapeutic approaches for foot drop, a new foot-drop stimulator was used in stroke, and it had a 17.8% increase in walking speed after 3 months and 28% after 11 months. The increases in walking speed probably resulted from the improved voluntary control over the TA muscle, but the intervention needs longer time to improve the walking speed (27). Although there are many types of recently designed AFOs, there are no studies on the relationship between AFO design and functional recovery in the post-acute stroke recovery stage (28).Four-channel FES can improve motor function, balance, walking ability, and performance in the activities of daily living in subjects with early ischemic stroke. A larger sample and longer treatment period are necessary to definitively demonstrate its greater efficacy (29). AFO or an FDS used for 30 weeks after stroke had similar effects on gait speed (30). Future studies are planned to investigate potential for seated ankle boot training in the earlier stages of stroke recovery (31). No muscular contraction surrounding the ankle joint due to the fixed walking aid of the AFO (32).

The Kinesiology taping showed an increase in the muscle activity as well as a significant change of joint angle which were not observed in the AFO. It is believed that the elasticity and ankle fixation, and the supporting role of kinesiotaping, caused a significant difference compared to the AFO (33). Further investigation of the effects of long-term KT application on dynamic balance in stroke patients with foot drop is needed (34).

NEED OF THE STUDY:

84 % of stroke patients develop contractures in more than one joint, among which 76% have contracture in the ankle joint. Many approaches like, foot drop stimulator is beneficial but it needs longer time to improve the walking speed, ankle foot orthosis which limits mobility and there are no studies to show its relationship on functional recovery among post stroke subjects, FES which is expensive. Recently studies reported that kinesiology taping showed an increase in the muscle activity. The taping is done with limited sample and also different taping techniques were not compared yet.

Hence the need of the present study is to investigate the

https://www.sciencedirect.com/topics/nursing-and-health-professions/peroneus-nerve-paralysis



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effect of different kinesiology taping techniques on dynamic balance and gait velocity in chronic stroke patients with foot drop.

AIM OF THE STUDY:

The aim of the study is to compare the effect of ankle eversion kinesiotaping technique & spring assisted kinesiotaping technique on dynamic balance and gait velocity in chronic stroke patients with foot drop.

OBJECTIVES OF THE STUDY:

1. To study the efficacy of ankle eversion kinesiotaping technique on dynamic balance measured through Tinetti index and gait velocity by TUG test in chronic stroke patients with foot drop.

2. To study the efficacy of spring assisted kinesiotaping technique on dynamic balance measured through Tinetti index and gait velocity by TUG test in chronic stroke patients with foot drop.

3. To compare the efficacy of ankle eversion kinesiotaping technique & spring assisted kinesiotaping technique on dynamic balance & gait velocity in chronic stroke patients with foot drop.

MATERIALS AND METHODOLOGY

MATERIALS: Plastic Arm chair, Stopwatch, Brown self-adhesive tape, Inch tape, Couch, Pillow, Kinesiotape.

METHODOLOGY

Subjects are randomly divided into two groups: Ankle eversion kinesiotaping group and spring assisted kinesiotaping group by lottery method and the participants are provided with informed consent.

STUDY DESIGN: This is a two-way experimental study.

STUDY SETUP: The study was conducted in the department of SVIMS cop, general ward, neurology department, ayurvedic departments in SVIMS hospital, tirupati, AP, India.

SAMPLING METHOD: Randomized sampling using lottery method.

SAMPLE SIZE: Total number of subjects 30, 15 subjects in each group.

STUDY DURATION: 2 months (8weeks) between November 2018 to March 2019.

INCLUSION CRITERIA:

Subjects with stroke duration of more than one year.

Subjects with chronic stroke between the age group of 40-60 years.

Subjects of both male and female with chronic stroke.

Subjects with ischemic stroke.

Subjects with chronic stroke having unilateral (right/left) foot drop with high step page gait pattern.

Subjects with chronic stroke having impaired gait velocity and balance, with Tinetti index score <8/16, TUG score of>30 seconds.

Subjects with chronic stroke who are able to stand and walk for 10 m independently.

Subjects with chronic stroke of MMSE score >24 were included.

EXCLUSION CRITERIA:

Chronic stroke subjects with non-specific skin diseases.

Chronic stroke subjects with ankle pain due to soft tissue problems.

Chronic stroke subjects with cognitive and perceptual deficits.

Chronic stroke subjects with other neurological disorders.

Chronic stroke subjects with sensory deficits.

Chronic stroke subjects who are fully dependent on others to do their daily activities.

METHODOLOGY:

36 subjects who were diagnosed as stroke patients by neurologist those met the inclusion criteria are taken for the study. All the subjects were explained clearly regarding the study procedure. Demographic data (age, gender, duration of stroke, side of foot drop, etc.) along with their mobile number were documented from the subject sat the first time of their visit to SVIMS COP, Ayurvedic hospital. Instructions were given to subjects before performing Tinetti index, TUG test and pre-values are taken from both the groups.

After assessing dynamic balance by using Tinetti index and gait velocity by TUG test of the subjects, ankle eversion kinesiotaping technique applied to first subject followed by spring assisted kinesiotaping technique applied to second subject and vice-versa for 3 days/week for a total period of 8weeks, but the subjects of both the groups are advised verbally to do ankle proprioceptive exercises in home for 2 days/week for a total period of 8 weeks. Follow up is taken after 8 weeks about dynamic balance and gait velocity.

EXPERIMENTAL GROUP I: Ankle eversion kinesiotaping technique and ankle proprioceptive exercises.

EXPERIMENTAL GROUP II: Spring assisted kinesiotaping technique and ankle proprioceptive exercises.

EXPERIMENTAL GROUP-I:

Ankle eversion kinesiotaping technique for 3days/week, for a total period of 8 weeks.

Ankle proprioceptive control program for 2 days/week, for a total period of 8 weeks.

ANKLE EVERSION KINESIOTAPING TECHNIQUE:

Patient was instructed to shave hair on part of body at anterior aspect of lower leg before one day of taping



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application, sweat is wiped with cotton, ankle is positioned and the patient was made to lie in a comfortable position on a couch and 3: I-strips of kinesiotapewith 3 inches’ width, 10 Inches length was applied on affected ankle and stretched with a tension of 70 – 80%. Taping was applied for 3days in a week and was continued for 8 weeks. The taping is applied in two ways: 1. posterior talar gliding taping applied from talus to calcaneus to increase the dorsiflexion of ankle 2. eversion taping for ankle evertors with the patient’s ankle is positioned in a slightly eversed state and taping begins from 5 cm above the lateral malleolus, passes through the back side and down of medial malleolus and wraps up the sole from the inside to outside. Kinesiology tape is applied twice, with approximately 50% overlapping to reinforce the inversion of ankle through eversion taping application.

ANKLE PROPRIOCEPTIVE CONTROL PROGRAM:

This program has two stages:

STAGE -I:

Repetitive affected ankle dorsiflexion & plantar flexion: Patient is sitting in a chair with affected leg positioned in figure of four manner and asked to do ankle dorsiflexion and plantar flexion repeatedly with his unaffected hand.

Intensity 8-12 repetitions maximum, Frequency 2 sets daily, time 20-25 minutes, with intervals of 2secs each repetition, for a duration-2 days a week for totally 8 weeks.

STAGE-II:

Weight bearing on affected leg in a static standing position: Patient was instructed to do weight bearing on paralyzed side with changing body position from sitting to standing: 10 times with rest of 1 minute each time for a period of frequency 2 sets daily, 20-25 minutes, for a duration-2 days a week for totally 8weeks.

Patient was instructed to do weight bearing in various directions in a standing position: 10 times with rest of 1 minute each time for a period of frequency 2 sets daily, 20-25 minutes, for a duration-2 days a week for totally 8 weeks.

Total duration of ankle proprioceptive control program is 16 days, 32sessions, for 8weeks’ period. Follow up is taken

after 8weeks about dynamic balance and gait velocity.

EXPERIMENTAL GROUP-II:

Spring assisted kinesiotaping technique for 3days/week, for a total period of 8 weeks.

Ankle proprioceptive control program for 2 days/week, for a total period of 8 weeks.

SPRING ASSISTED ANKLE KINESIOTAPING TECHNIQUE:

The spring-assisted kinesiotaping technique utilizes both mechanical and sensorimotor stimuli to facilitate the ankle dorsiflexors muscles. The tape is applied with the patient’s involved ankle passively positioned into full dorsiflexion. The length of the kinesiotape used was measured from the anterior surface of the mid-tibial shaft to the base of the meta-tarsals on the dorsal surface of the foot.

Ten inches of kinesiotape was applied on the anterior surface of the mid-tibial shaft, with no tension. With the ankle still in full dorsiflexion, the tape was applied with 50-75% tension to the base of the metatarsals in the centre of the dorsal surface of the foot. The ankle was passively positioned into full plantar flexion where the tape will be applied to the skin in a proximal to distal direction. The tape is applied for 3days/week, for a total period of 8 weeks.

ANKLE PROPRIOCEPTIVE CONTROL PROGRAM:



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This program has two stages:

STAGE -I:

Repetitive affected ankle dorsiflexion & plantar flexion: Patient is sitting in a chair with affected leg positioned in figure of four manner and asked to do ankle dorsiflexion and plantar flexion repeatedly with his unaffected hand.

Intensity 8-12 repetitions maximum, Frequency 2 sets daily, time 20-25 minutes, with intervals of 2secs each repetition, for a duration-2 days a week for totally 8 weeks.

STAGE-II:

Weight bearing on affected leg in a static standing position: Patient was instructed to do weight bearing on paralyzed side with changing body position from sitting to standing: 10 times with rest of 1 minute each time for a period of frequency 2 sets daily, 20-25 minutes, for a duration-2 days a week for totally 8 weeks.

Patient was instructed to do weight bearing in various directions in a standing position: 10 times with rest of 1 minute each time for a period of Frequency 2 sets daily, 20-25 minutes, for a duration-2 days a week for totally 8 weeks.

Total duration of ankle proprioceptive control program is 16 days, 32sessions, for 8weeks period. Follow up is taken after 8weeks about dynamic balance and gait velocity.

STUDY ALGORITHM:

RESULTS&STATISTICAL ANALYSIS:

Statisticalanalysis for both groups, by using “SPSS 16.0 version”. For this purpose, the data was entered into Microsoft excel spread sheet, tabulated and subjected for statistical analysis. Of total 30 subjects, 15 were randomized into ankle eversion kinesiotaping group and other 15 were randomized into spring assisted kinesiotapinggroup. All the subjects completed the entire

study protocol as defined, by completion of 8 weeks in the training sessions. The outcome measures of this study are: TINETTE INDEX- for dynamic balance, TIMED UP & GO TEST – for gait velocity.

DEMOGRAPHIC CHARACTERISTICS

Demographic characteristics of chronic stroke patients with ankle eversion kinesiotaping group and spring assisted kinesiotaping group are shown in Table 1.The mean age of chronic stroke patients with ankle eversion kinesiotaping (n=15) was 49.23 ± 9.41 and mean age of chronic stroke patients with spring assisted kinesiotaping (n=15) was 49.68± 11.37 .the mean duration of chronic stroke of AET group was 2.51±1.2 and the mean duration of chronic stroke of SAT group was 2.51±2.2.There is no statistical significant difference in the demographic characteristics of chronic stroke subjects with AET and SAT group.

TABLE -1: COMPARISON OF DEMOGRAPHIC

VARIABLES BETWEEN SUBJECTS OF ANKLE

EVERSIONKINESIOTAPINGGROUPAND

SPRING ASSISTED KINESIOTAPING GROUP.

Variable Patients with ankle eversion kinesiotaping

group (n=15)

Patients with spring assisted kinesiotaping group (n=15)

P -value

(2-tailed )

Age* (years) 49.23 ±9.41 49.68 ±11.37 0.624

Gender:-Male: Female ratio

8:7 10:5 X² =1.466 ;P=0.769

Side:- R:L 9:6 7:8 X²=0.671; P=0.994

Stroke Duration*(years).

2.51 2.63 0.12

*Data are expressed as mean ±SD; SD= Standard deviation; R=Right, L=Left; AET= ankle eversion kinesiotaping; SAT = spring assisted kinesiotaping.

TABLE- 2: COMPARISONOF PRE AND POST THERAPEUTIC MEAN VALUES CHANGE IN TINETTIINDEX, TUG TEST FROM BASELINE TO 8TH WEEK OF INTERVENTION IN CHRONIC STROKEINDIVIDUALS WITH FOOT DROP OF ANKLE EVERSION KINESIOTAPINGGROUP.

Variable*

Patients with ankle eversion kinesiotaping (AET) group

n Mean SD t- statistic value

P-value

Tinetti index

Pre

15

5.80 0.95

13.93 0.01 Post

11.60 1.24

TUG test (sec)

Pre

15

17.93 3.05

8.08 0.01 Post

25.86 5.84



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The table 2: shows the descriptive measures such as the mean, standard deviation along with t-statistics and significance.

*Data expressed as mean ± SD; SD = standard deviation; TUG = Timed Up and Go test; sec= seconds;

RESULT: The results shows that the pre and post mean therapeutic values of Tinetti index, TUG are significant at 0.01 in ankle eversion kinesiotaping group.

FIG1& 2: GRAPHICAL REPRESENTATION OF PRE AND POST THERAPEUTIC MEAN VALUES CHANGE IN TINETTI INDEX, TUG TEST FROM BASELINE TO 8TH WEEK OF INTERVENTION IN CHRONIC STROKE INDIVIDUALS WITH FOOT DROP OF ANKLE EVERSION KINESIOTAPINGGROUP.

TABLE-3: COMPARISONOF PRE AND POST

THERAPEUTIC MEAN VALUES CHANGE IN

TINETTIINDEX, TUG TEST FROM BASELINE TO 8TH

WEEK OF INTERVENTION IN CHRONIC STROKE

INDIVIDUALS WITH FOOT DROP OF SPRING

ASSISTED KINESIOTAPING GROUP.

Variable*

Patients with spring assisted kinesiotaping

(sat) group

N Mean Sd T-

statistic value

P-value

Tinetti index

Pre 15

5.86 1.12 5.95 0.01

Post 8.80 1.56

TUG test(sec)

Pre 15

73.33 14.01 4.18 0.01

Post 56.46 11.26

The table 3: shows the descriptive measures such as the mean, standard deviation along with t-statistics and

significance.

*Data expressed as mean ± SD; SD = standard deviation; TUG = Timed Up and Go test; sec= seconds;

RESULT: The results shows that the pre and post mean values of Tinetti index, TUG are significant at 0.01 in spring assisted kinesiotaping group.

FIG 3&4: GRAPHICAL REPRESENTATION OF PRE AND POST THERAPEUTIC MEAN VALUES CHANGE IN TINETTI INDEX, TUG TEST FROM BASELINE TO 8TH WEEK OF INTERVENTION IN CHRONIC STROKEINDIVIDUALS WITH FOOT DROP OF SPRING ASSISTED KINESIOTAPINGGROUP.

TABLE: 4: COMPARISON BETWEENPRE AND POST

THERAPEUTIC MEAN VALUES CHANGE OF

TINETTIINDEX, TUG TEST FROM BASELINE TO 8TH

WEEK OF INTERVENTION IN CHRONIC STROKE

INDIVIDUALS WITH FOOT DROP OF ANKLE

EVERSION KINESIOTAPING GROUP AND SPRING

ASSISTED KINESIOTAPINGGROUP.

Variable* Experimental

group I & group II

N Mean Sd T-

statistic value

P-value

Tinetti index

SAT(Pre-post)

15

5.80 1.16

6.27 0.01

AET (Pre-post) 8.56 1.78

TUG test(sec)

AET (Pre-post)

15

71.93 14.56

10.84 0.01

SAT (Pre-post) 56.46 11.29



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Table 4: shows the descriptive measures such as the mean, standard deviation along with t-statistics and significance.

RESULTS: The results were found to be statistically significant in both Tinetti index (p-value= 0.01*) and TUG test (p-value= 0.01*) parameters. But the mean response in Ankle eversion kinesiotaping group is high in Tinetti index and TUG test parameters when compared to mean response in spring assisted kinesiotaping group.

FIG 5&6: GRAPHICAL REPRESENTATION OF PRE AND POST THE RAPEUTIC MEAN VALUES CHANGE OF TINETTI INDEX, TUG TEST FROM BASELINE TO 8TH WEEK OF INTERVENTION IN CHRONIC STROKE INDIVIDUALS WITH FOOT DROP BETWEEN ANKLE EVERSION KINESIOTAPING GROUP AND SPRING ASSISTED KINESIOTAPING GROUP.

DISCUSSION:

The kinesiotaping method is a rehabilitative taping technique, providing support and stability to muscles and joints without restricting the body’s range of motion within the clinical setting.

The main objective of this study was to evaluatethe effects of ankle eversion kinesiotaping and spring assisted kinesiotaping on dynamic balance and gait velocityof chronic stroke subjects with foot drop. The measurement of variables was done to judge whether the variables had increase or decrease as evaluated by previous studies and to compare it with chronic stroke subjects of the present study.There are no other studies comparing different techniques of kinesiotaping in chronic stroke patients with foot drop. In the present study an attempt was made to compare the effectiveness of ankle eversion kinesiotaping and spring assisted kinesiotaping on dynamic balance and gait velocity in chronic stroke patients with foot drop.

“Foot- drop” has an estimated incidence of 20% after stroke which results in a functional impairment in gait with inability to extend the ankle during swing phase. So the stroke patients will compensate Differently to gain sufficient clearance for the leg to swing. These compensatory mechanisms vary between patients and may include increased plantar flexion of the non-affected side, hip abduction and pelvic tilt of the affected side or lateral flexion of the trunk .As compensation is often insufficient or inefficient, patients tend to drag the hemiparetic foot across the ground with a high risk of falls. Additionally, this abnormal gait pattern leads to slower walking speed and, together with the increased risk of fall, they cause a reduced feeling of safety, necessitating the use of walking aids(35).

In the present study after the application of ankle eversion taping, the dynamic balance abilities and gait velocity of chronic stroke patients were significantly improved compared with the other intervention (spring assisted taping). The results of this study are consistent with earlier studies. Young Jun Shin et al., conducted a study in 9 chronic stroke subjects with foot drop and evaluated their dynamic and static balance abilities. There were 5 males and 4 females ranging in age of the subjects was 64.78 ± 8.12 years, height was 164.78 ± 10.58 cm, weight was 64.22 ± 17.09 kg, and years since onset 7.41 ± 1.87 years. Dynamic and static balance, ability was measured using BIO Rescue and the results of this study are:LOS (mm) 4,362.0 ± 2,700.3, Sway length (cm) 28.9 ± 8.2, Sway speed (cm/s) 0.5 ± 0.1(36).

Woo-Il Kim et al., conducted a study for 6 weeks, in 30 chronic stroke subjects and divided them randomly into two groups, 15 subjects in each group and concluded that applying KT to the paralyzed parts has shown a positive effect on improvement of typical asymmetric gait and walking speed (37).

In the present study, the 30 chronic stroke patients with foot drop were included in the study as per inclusion criteria and randomly allocated into two experimental groups. Group –I received ankle eversion kinesiotaping technique with ankle proprioceptive exercises for 8 weeks, group-II spring assisted kinesiotaping technique with ankle proprioceptive exercises for 8 weeks was given. Tinetti index for dynamic balance and TUG test for gait velocity values are measured before the intervention on first day and after 8weeks’ period.Dynamic balance and gait velocity showed improvement after 8 weeks.Table 4: shows that both the ankle eversion kinesiotaping technique and spring assisted kinesiotaping technique were effective in improving dynamic balance and gait velocity of chronic stroke subjects with foot drop in both the groups, but the subjects in ankle eversion kinesiotaping group showed a significant improvement than spring assisted kinesiotaping technique group in terms of dynamic balance and gait velocity of chronic stroke subjects with foot drop (p = 0.01).The results obtained in this study clearly stated that the AET is more effective than SAT on dynamic balance and gait velocity of



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chronic stroke subjects with footdrop.

The results of this study showed that dynamic balance and gait velocity of chronic stroke subjects with footdrop after ankle eversion kinesiotaping treatment is specific to the treatment (AET than SAT). The study was based on the hypothesis that repeated Ankle eversion kinesiotaping for 4 weeks to ankle dorsiflexors improved functional dynamic balance by supporting the joint structure and improving the joint position sense (20). Our results are similar to those two previous studies. Donghwan Park et al., concluded that the talus stabilizing taping more significantly improved static balance ability, TUG test results, walking speed, cadence, step length on both sides, and stride length in 20 chronic stroke subjects (17).

Rutuja Parab et al., concluded that spring assisted kinesiotaping technique for foot in 10 subjects both male and female stroke for 4 months, stated that this technique facilitates ankle dorsiflexion by proprioceptive control and increased sensorimotor stimuli on targeted tissue by tension of the tape which significantly improves gait speed in chronic stroke subjects with foot drop (21).

With the results of previous studies by Yu-HYung Park et al., conducted a study in 30 chronic stroke subjects with onset of more than six months, concluded that dynamic balance ability was improved by increase of ankle sense of position through proprioceptive control (23).In all studies recruited for the study, kinesiotaping technique to ankle showed improvement on dynamic balance and gait velocity in chronic stroke subjects.KT stimulates cutaneous mechanoreceptors at the taped area, and this stimulation affectsROM(18).The mechanism of taping is improvement of muscle strength by excitation of gamma motor nerves in skeletal muscle, as the taped part raises the tension of the fiber.An additive effect occurs by stimulating many nerve fascicles that compose synapses simultaneously through taping. Finally, an irradiation phenomenon occurs in the area of increased reaction strength.

KT leads to improvement not only in gait symmetry but also in walking speed through muscle facilitation in the paralyzed parts of the body. KT effectively stimulated the proprioceptive sense, muscle spindles, Golgi tendons, etc., and strengthened muscles in the affected parts (18).Spring assisted kinesiotaping technique or functional correction taping application to structures where the position is needed to be corrected is applied for ankle dorsiflexors with tension which increased proprioceptive sense there by getting sensorimotor stimuli for the targeted tissue which enhanced body balance and gait speed in 10 chronic stroke patients with foot drop for four months in anteroposterior direction only (21).

In the present study a statistically significant positive correlation was observed between AET and SAT on dynamic balance and gait velocity in chronic stroke subjects (p=0.01).

CONCLUSION:

The present study on comparison between ankle eversion

kinesiotaping and spring assisted kinesiotaping technique on chronic stroke subjects with foot drop on dynamic balance and gait velocity has shown difference in both groups. Hence, the study concludes that ankle eversion kinesiotaping along with ankle proprioceptive exercises is more effective than spring assisted kinesiotaping technique toimprove dynamic balance and gait velocity in chronic stroke subjects with foot drop.

LIMITATIONS:

The sample size is small.

No follow up period.

Study duration is only 2 months.

RECOMMENDATIONS:

Further studies can be recommended to find out the effect of other kinesiotaping techniques and various ankle exercises also.

Further studies are recommended with long term follow up.

Further studies can be recommended over large samples and longer durations.

SUMMARY:

The present study was done to compare the different techniques of kinesiotaping on improvement of dynamic balance and foot drop in chronic stroke subjects with foot drop. For this subjects were divided into two groups that is ankle eversion kinesiotaping group and spring assisted kinesiotapinggroup,patientwas assessed initially and after 8 weeks. The two outcomes to objectively measure dynamic balance and gait velocity are Tinetti index and TUG test. By comparing both Tinetti index and TUG test in both the groups, the results have shown a significant improvement in AET group when compared with the SAT group.So,it can be concluded that ankle eversion kinesiotaping technique is more effective than spring assisted kinesiotaping technique.

ACKNOWLEDGEMENTS:

1) I would like to thank “ALMIGHTY”.

2) My gratitude and obeisance to Dr. K, Madhavi Mam, MPT(CT), PhD, Professor, HOD, principal, College of Physiotherapy, SVIMS, Tirupati, India.

3) My obeisance to my guide Dr. V. Srikumari Mam, MPT(neuro), Ph.D., Asst.Professor, College of Physiotherapy, SVIMS, Tirupati, India.

4) My heartful gratitude to my parents Sk. Nayeem, Sk. Shahida and to my friend Santhosh.

5) I owe my thanks to all of our faculty members, all staff, administrative members of College of Physiotherapy, SVIMS, Tirupati, India.

6) I am thankful to the Department of Ayurvedic, Department of Neurology and Department of Physiotherapy, SVIMS, Tirupati, India.

7) I thank my friends and my senior Hema Mam for their



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guidance and help provided by them for the completion of my study.

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Documents

A COMPARATIVE STUDY OF ANKLE EVERSION KINESIOTAPING