Kinesiotaping® Kids:How Do We Measure Up?

Grandview Children’s Centre

Karen Koseck (OT)

Andra Duff-Woskosky (PT)

Serena Lee (OT)

Winnie Wong (PT)

Presentation Outline

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

Objectives

1. Present measurement issues related to effectiveness of Kinesiotaping ®.

2. Share our clinical impressions of Kinesiotaping ® as a treatment modality in paediatrics.

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 Children’s Centre to OT’s

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®

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 1980’s

• Now used more in non-athletic population

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

Physiological effects of KT1. Endogenous Analgesic System function: Relieve pain or abnormal feeling on the

skin & muscles2. Muscle function: supports the muscle in

movement3. Lymphatic function: lifts the skin and

promote lymphatic flow4. Joint function: hold the joint in better

alignment

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)

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

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

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

Case studies

Princess H

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

Princess H

Goals:

1. H will have full right cervical rotation within 1 year.

2. H will have full left cervical side flexion within 1 year.

3. Positional plagiocephaly will be prevented.

Princess H

Lady K

Lady K

Dx: Right torticollisCurrent 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….

Lady K

Goals

1. K will maintain her current range of motion

2. Scar tissue development will be limited

3. K will decrease the amount of right head tilt so that she holds her head in neutral alignment within 6 months.

Lady K

Lady K

CJ

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.

CJ - Before taping

CJ - After taping

Clinical Impressions/Measurement Issues

• Client’s understanding of goal

• Proportion of time

• Duration

The Little Ally

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”

Goals of KT - Ally

1. Increase use of left arm and hand for play.

2. Improve grasping ability with left hand.

3. Increase duration of grasp with left hand.

Measurement Tools - Ally

• Clinical observations, Pictures

• Erdhardt Developmental Prehension Assessment (EDPA)

• Kinesiotape Caregiver Satisfaction Questionnaire was developed with OT Student, Silvia Hsu

Photos for Measurement - Ally

Before After

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

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

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

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

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

Updated Goals of KT - Ally

1. Improve ability to reach/target objects with left and right hands.

2. Improve ability to grasp a greater variety of objects with right and left hands.

3. Improve ability to release objects with right and left hands.

Measurement Tools - Ally

• Videotaping instead of photos

• Standardized Assessment (Erhardt)

• KT Caregiver Satisfaction Questionnaire

Pre-Taping Video (Ally)

Post-Taping Video (Ally)

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)

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.

…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

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.

AJ

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

Goals -AJ

1. AJ will hold smaller objects using a mature grasp at least 75% of the time.

2. AJ will grasp and release objects with his wrist slightly extended or in the neutral position.

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

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

Application of Kinesio® Tape -AJ

Pre-Taping

Post-Taping

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

Pre-Taping Video

Post-Taping Video

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

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.

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

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.

Words of Wisdom

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

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)

Strengths and Limitations of Measurement Tools

Tool Strengths Limitations

Anecdotal Reports(caregiver and clinician)

-Easy to obtain-Starting point-Client specific

-Subjective-Not blinded

KT Caregiver Satisfaction Questionnaire

-Specific to KT

-Includes rating of goal attainment

- Subjective - Descriptive not evaluative in nature

Strengths and Limitations of Measurement Tools

Tool Strengths Limitations

Standardized Assessments(eg. Goniometry,

EDHP, QUEST)

-Objective-Quantifies -Easy to readminister

-Depends on which ax used-May not be sensitive enough to pick up changes-Learning factor-Not client goal specific

Strengths and Limitations of Measurement Tools

Tool Strengths Limitations

Pictures -Worth 1000 words-Able to show changes in alignment-Hard copy-Easy to show client/caregiver

-Cannot show dynamic change-Hard to quantify-May not be able to add to client health record

Videotape -Show changes in movement quality-Measure efficiency

-Time and resource consuming-May not be able to add to client health record

Will KT live happily ever after….

• More research needed• Clinician focus groups• Dissemination of Information

e.g. CanChild Intranet

Special thanks to our clients and colleagues at Grandview

Children’s Centre!

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, 1:53-56.

• 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.