Original Research Article Effect Of Neuromuscular Taping .

Jaya Dixit et.al. Effect of Neuromuscular Taping Along with Reactive Postural Adjustment and AnticipatoryPostural Adjustment in Improving Sitting Balance in Children with Spastic Diplegic Cerebral Palsythey had epilepsy, visual or auditoryproblems.6. Children who had structural scoliosis.7. Children who had participated in anyprevious application for therapeutic tapingto the trunk muscles.8. If children demonstrated allergicreactions to the adhesive neuromusculartaping.9. All the children were free from anystructural deformities; however, childrendemonstrated variable degrees of tightnessVariables of StudyApplication of neuromuscular taping andActivities providing Reactive PosturalAdjustments & Anticipatory PosturalAdjustments were provided to the childrenas independent variables & sitting balancewas considered as dependent variable.Instruments Used1) Pediatric Balance Scale (PBS) (MRFranjoine et al 2003) & Pediatric ReachTest (PRT) (Bartlett D 2003) were usedas instruments, to measure the changesin sitting balance in these children.2) A frame was made with plastic toencourage horizontal & cross midlinefunctional reach. This frame has 2vertical plastic tubes placed over thewooden base & small platform made ofether flex secured in three positions. Thewidth of wooden base was 45cm andheight of two vertical plastic pipes was46 cm. Three platforms were position onthe frame each consecutive platform was10cm above previous platform locatedon the far right & the far left of theframe. Two vertical plastic pipe alongwith small platforms were connected tothe wooden base, which allowed theframe to slide forward & away from thechild to accommodate each child’s armlength .Reach was consider successfulwhen child touched the sticker whichwere placed over the platforms in theframe.Childrenwereverballyencouraged to touch the sticker with onehand & then the other. We considerreach to be successful when the childtouched (i.e. not grasped) the sticker. Toassure consistency the motivatorschosen were according to child’spreferences.(Gayle A 2006)3) A platform for providing externalperturbation was made with wood of48x37 cm with 10cm height from thefloor. It had four small wheels in theinferior surface, which made it move inforward & backward directions. Speedof movement was 60 mm at 100-350mm/s. (A Shumway cook 2003)4) Kinesio tape is thin, cotton, porousfabric with acrylic adhesive that is nonmediated and latexfree (Kinesio Tex2005). Kinesio tape can be comfortablyworn for 3–4 consecutive days,(including in the shower), withoutcompromising the adhesive quality(Kase et al. 2003; Kinesio Tex 2005).Furthermore, due to the latex-freequality of Kinesio tape, moisture and aircan flow through this porous fabric,limiting skin irritation (Kase et al. 2003;Kinesio Tex 2005). Kinesio tape can bestretched up to 130%–140% of itsoriginal length and can contract back tothe normal resting position (Kase etal.2003; Kinesio Tex 2005). The elasticproperties of Kinesio tape makes itunique, however, the efficacy of kinesiotape compared with other types ofelastic tapes has yet to be investigated,and, therefore, substitution at thisjuncture cannot be recommended.ProceduresThe parents of the selected childrenwere explained about the application ofneuromuscular taping and activitiesproviding Reactive Postural Adjustments &Anticipatory Postural Adjustments to theirchildren and were told about the outcome ofstudy. Written ethical consent was takenfrom the guardians of children with cerebralpalsy who were taking part in the study.Ethical permission was also obtained fromthe institute for conducting the study. Thisstudy adhered to the tenets of Declaration ofHelsinki. The children who were fulfillingthe inclusion criteria were randomlydistributed into two equal groups,International Journal of Health Sciences & Research (www.ijhsr.org)Vol.8; Issue: 11; November 2018119

Jaya Dixit et.al. Effect of Neuromuscular Taping Along with Reactive Postural Adjustment and AnticipatoryPostural Adjustment in Improving Sitting Balance in Children with Spastic Diplegic Cerebral Palsyexperimental group & control group. Then,the children were engaged in a three-dayskin check to rule out rare toxic responses toadhesive neuromuscular taping before fullinclusion in this study. A baselineassessment score of PBS and PRT wascollected for children present in both thegroups. Therapy for both the groupsconsisted of 1 hour of session(1) Control group who received activitiesproviding RPA and APA.(2)Studygroupwhoreceivedneuromuscular taping in addition to thesame activities providing RPA and APA.Post test scores of Pediatric Balance Scale&Pediatric Reach Test were recorded after 9months of study.ProtocolNeuromuscular tape was applied onthe erector spinae muscles from spinal levelS1 to spinal level of C7 in the way Dr. Kaserecommended (from insertion to origin)(Kase K 1966). KT of 5 cm width was usedin the form of "fan technique" bilaterallyapplied to provide a predominantly sensoryinhibition on the erector spinae muscles.The bands were applied for three days andthen removed leaving the skin free for 24hours, and then neuromuscular taping wasapplied again. In experimental group,Anticipatory Postural Adjustment activitywas provided to the children by placingthem in a comfortable & secured sittingover the mat. They were encouraged totouch cartoon stickers over the platform inthe frame placed in front of them. Forproviding activity of Reactive PosturalAdjustmentchildrenwereplacedcomfortably & securely over the movableplatform & were given forward / backwardperturbations, which caused body to sway,forward &backward. Two mats were placedon either sides of platform to avoid injury tothe children. All the activities given weredemonstrated initially.RESULTSData analysis: The test parameters werecompared before & after therapy. Statisticalcalculations were performed with SPSSversion 16.0 package. Statistical test werecarried with the level of significance setatP 0.05.The raw score of Pediatric BalanceScale & Pediatric Reach Test preintervention &post intervention were added& summed up into final scores. It was 2tailed non parametric study because ofordinal data and small sample size. Thechanges in the Pediatric Balance Scale andPediatric Reach Test within experimentaland control groups were analyzed usingWilcoxon signed rank test. Mann WhitneyU test was performed for knowing thesignificance outside the group.Descriptive characteristics: Number ofsubjects in experimental & control groupwere 30 in each within the age range of 3 to7years in experimental group & 3 to 8 incontrol group. Mean age was 5.20 1.31 inexperimental group and 6.00 1.63 incontrol group. There were 15 male and 15female in experimental group were as therewere 13 male and 17 female in controlgroup. Wilcoxon signed rank test forPediatric Reach Test: Significant results ofexperimental group and control group wereobtained with (P 0.004; 95% CI: 5.34 to10.67 and P 0.014; 95% CI: 4.16 to 7.89respectively) and Z -2.877 &Z 2.449respectively with the level of significanceset at P 0.05.Wilcoxon signed rank test for PediatricBalance Scale: The results (P 0.025; 95%CI: 8.98 to 11.12 for experimental groupand P 0.005; 95% CI: 8.09 to 9.54 forcontrol group) shows that findings weremore significant for experimental group ascompared to control group with Z -2.236 &Z -2.810 respectively with level ofsignificance set at P 0.05.Results of Mann Whitney U test: Z -3.507for Pediatric Balance Scale making it moresensitive to capture changes in balances inchildren as compared to Pediatric ReachTest with Z -3.905 and P 0.002; 95%CI:4.14 to 9.00 and P 0.001; 95% CI: 7.56to 9.70 respectively with level ofsignificance set at P 0.05.International Journal of Health Sciences & Research (www.ijhsr.org)Vol.8; Issue: 11; November 2018120

Jaya Dixit et.al. Effect of Neuromuscular Taping Along with Reactive Postural Adjustment and AnticipatoryPostural Adjustment in Improving Sitting Balance in Children with Spastic Diplegic Cerebral PalsyFigure 1: Showing a Child, Performing an Activity ProvidingAnticipatory Postural Adjustment on frameFigure 3: Showing the fanning technique of kinesiotaping overthe trunk of a childTable 1: Descriptive umber of Subjects3030Age Range (Years)3-83-7Mean Age( Standard Deviation) 6.00 1.63 5.20 1.31Gender (Male/Female)13/1715/15Figure 2: Showing a Child, Performing an Activity ProvidingReactive Postural Adjustment over the platformTable 2:Results of Wilcoxon Signed Rank Test (Pediatric Reach Test)GroupsZ(2 tailed)P (2 tailed)95% Confidence Interval ValueLower LimitUpper 0.0144.167.89*For both the groups P value is significantTable 3:Results of Wilcoxon Signed Rank Test (Pediatric Balance Scale)GroupsZ (2 tailed)P (2 tailed)95% Confidence Interval ValueLower LimitUpper 0.0058.099.54*For both the groups P value is significantTable 4: Results of Mann Whitney U tests (Pediatric Balance Scale & Pediatric Reach Test)Outcome MeasuresZP95% Confidence Interval ValueLower LimitUpper For both the groups P value is significant *PRT: Pediatric Reach Test; PBS: Pediatric Balance ScaleDISCUSSIONSitting balance is commonly affectedin children with cerebral palsy leading todifficulty in functional performance ofupper extremity, as these children frequentlyuse upper extremity for maintaining balancein sitting. Hence sitting is an important areafor intervention to be considered whiletreating children with spastic diplegiacerebral palsy. The pre treatment results ofthe two groups indicated that children withspastic diplegic cerebral palsy often showsthe difficulty to achieve well-balancedsitting posture and display poor trunkcontrol. This agrees with Shumway-Cook Aet al 2000 who revealed that children withCP often rely upon inappropriate controlstrategies and faulty feedback mechanismswhen learning to maintain both static anddynamic sitting postures, which predictablyleads to postural dyscontrol and functionaldependency.International Journal of Health Sciences & Research (www.ijhsr.org)Vol.8; Issue: 11; November 2018121

Jaya Dixit et.al. Effect of Neuromuscular Taping Along with Reactive Postural Adjustment and AnticipatoryPostural Adjustment in Improving Sitting Balance in Children with Spastic Diplegic Cerebral PalsyThe purpose of this study was todetermine that, if children with spasticdiplegic cerebral palsy, who were givenkinesiotape over the trunk muscles alongwith activities providing Reactive PosturalAdjustment & Anticipatory PosturalAdjustment,wouldexhibitgreaterimprovement in sitting balance, than thosewho merely received the RPA and APA.Improvement in experimental groupIn respect to the study group whoreceived kinesio taping which applied overthe paraspinal region in addition to thedesigned RPA and APA therapeutic activityprogram, there was significant improvementin the sitting posture and trunk control inyoung children with spastic diplegic CP.This comes in consistent with Hsu et al.,who reported that neuromuscular taping asan adjunct to the therapeutic procedures canimprove strength, functional activities,proprioception, control and positioning. Thepostural control system in children withcerebral palsy cannot effectively control thebody's position and motion in space becauseit lacks the ability to generate appropriatemuscular force and to coordinate andintegrate the sensory information receivedfrom various receptors throughout the body(Hsu Y.H et al 2009). KT increases bloodcirculation in the taped area (Ogura1998;Oliveria 1999; Vorhies 1999; Wallis 1999;Kase 1994; Kase and Hashimoto 2005;Murray 2005), and this physiologicalchange may affect the muscle andmyofascia functions after the application ofneuromuscular taping helping the childrento generated the necessary force required forthe function. An additional theory is thatneuromuscular taping stimulates sensoryreceptors and cutaneous eptors activate nerve impulseswhen mechanical loads create rs by an adequate stimuluscauses local depolarizations that triggernerve impulses along the afferent fibertraveling toward the central nervous system(Garcia 2001; Goo 2001; Halseth et al.2004; Maruko 1999; Mori 2001; Murrayand Husk 2001; Ogura1998; Vorhies 1999;Wallis 1999; Kase et al. 2003). Theapplication of KT may apply pressure to theskin or stretch the skin, and this externalloadmaystimulatecutaneousmechanoreceptors causing physiologicalchanges in the taped area. Studiespreviously conducted to determine theeffects of neuromuscular taping oncutaneous mechanoreceptors (Garcia 2001;Goo 2001; Halseth et al. 2004; Maruko1999; Mori 2001; Murray and Husk2001;Ogura 1998; Vorhies 1999; Wallis1999) have reported that neuromusculartaping on select muscles and joints mayimproved muscle excitability. There is nostudy in the literature investigating the useof neuromuscular taping application withRPA and APA which is used in CP childrenwith spastic diplegia. The current work isthe first study conducted to investigate theeffect of neuromuscular taping applicationon trunk posture along with RPA and APAin CP children with spastic diplegia.Improvement in control groupThe results of this study indicatethat, there was improvement in controlgroup. Perturbations were given to childrenwith spastic diplegic cerebral palsy, byproviding activities which challenge theirReactivePosturalAdjustment&Anticipatory Postural Adjustment in neck,trunk & lower extremity, which helped themto improve sitting balance. These results canbe supported by the results of A Shumwaycook 2003 he found that typicallydeveloping children showed improvement insitting balance in response to the massedpractice on a moveable platform providingexternal perturbations. Also the results canbe supported by the results of TR Kaminski2001 which suggest that, during theperformance of a functional task, dynamicchanges that occur in the trunk and lowerextremities prior to initiation of armmovement serve to stabilize the body andare used to initiate and assist whole bodyreaching .To maintain a good and stableposture is a challenge, because stabilityInternational Journal of Health Sciences & Research (www.ijhsr.org)Vol.8; Issue: 11; November 2018122

Jaya Dixit et.al. Effect of Neuromuscular Taping Along with Reactive Postural Adjustment and AnticipatoryPostural Adjustment in Improving Sitting Balance in Children with Spastic Diplegic Cerebral Palsyrequires complex interactions betweennervous system, motor system, and thesensory system. In children with CP, theseinteractions are known to be affected, whichmay be a reason of postural controlimpairment and the inability to maintainstability. The sensory system cues theindividual that there has been a perturbationwhich is provided by tactile, verbal andvisual system Motor system organizes&cues appropriate activation of the muscle.While musculoskeletal system providesframe work on which we move and createthe force to produce the postural activity(Westcott Sarah L 2004). The state of any ofthese system affects the overall posturalactivity in the individual .Other system canalso have an effect on the postural activity,like the directions given to the individuals,or the behavioral state and alertness of theindividual (Nashner LM 1982) .Thesecomponents of balance were also taken careof while providing the activities. Theimprovement in balance as measured byPediatric Balance Scale and Pediatric ReachTest can be attributed to an improvement inthe coordination and recruitment of trunkand limb musculature that occurs as a resultofpracticingAnticipatoryPosturalAdjustment & Reactive Postural Adjustmentthrough different type of activities.Repetition of task is a prerequisite to skillacquisition, including balance in sitting,repetition in this study is provided by givingsame activities throughout the studyduration in each session (Dean CM 1997).Activities providing Anticipatory PosturalAdjustmentandReactivePosturalAdjustment which are used in his studyneed both cognition and motor process forperformance.Limitations1. Duration of study was small2. Small sample size3. Overhead reaching activities were nottaken for activities providing Anticipatorypostural Adjustment4. No follow up study done.Recommendations1. Study could be made by providingfunctional activities which provide balanceperturbations along with kinesiotaping overthe trunk musculatures for improving sittingbalance in children with cerebral palsy.2. Additional study can be conducted oflong term benefits on children with cerebralpalsy and other functional disabilities.3. Future efforts also need to examine theeffectiveness of balance perturbations alongwith kinesiotaping over the trunkmusculature with a large sample.4. Future studied in which improvement insitting balance after application ofkinesiotaping is captured by differentmeasure which should include somefunctional measures.CONCLUSIONIt can be concluded that application ofneuromuscular taping along with activitiesproviding Reactive Postural Adjustment &Anticipatory Postural Adjustment canenhance & improve sitting balance amongchildren with spastic diplegic cerebral palsy,so that they can have the functional balancein sitting, to safely meet demands ofeveryday life.ACKNOWLEDGEMENTI thank my patients and their parents for trustingme, and their cooperation during the course ofstudy. Above all I thank God Almighty forproviding me all that I wanted and much more tocarry out my study.REFERENCES Shoals MG. Cerebral palsy: Diagnosis, Riskfactors, Early intervention and Management ofthe spastic child. In: Datta AK, Sachdeva A,editors. Advances in Pediatrics. 1st ed. NewDelhi: Jaypee Publishers; 2007. p. 623. Health Grades Inc; c2011. [Updated 2009 Apr15;Accessedon2013Jan22].Rightdiagnosis.com [homepage on .com/c/cerebral palsy/stats-country.htm . MedIndia Inc; c1997-2013. [Updated on 2010Oct 04; Accessed on 2013 Jan 22].Medindia.net [homepage on the Internet

6. Children who had structural scoliosis. 7. Children who had participated in any previous application for therapeutic taping to the trunk muscles. 8. If children demonstrated allergic reactions to the adhesive neuromuscular taping. 9. All the children were free from any structural deformities; however, children