Kinesiotaping ® Kids: How Do We Measure Up? Grandview Children’s Centre Karen Koseck (OT) Andra...
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Transcript of Kinesiotaping ® Kids: How Do We Measure Up? Grandview Children’s Centre Karen Koseck (OT) Andra...
![Page 1: Kinesiotaping ® Kids: How Do We Measure Up? Grandview Children’s Centre Karen Koseck (OT) Andra Duff-Woskosky (PT) Serena Lee (OT) Winnie Wong (PT)](https://reader030.fdocuments.us/reader030/viewer/2022013115/56649d8e5503460f94a77bfc/html5/thumbnails/1.jpg)
Kinesiotaping® Kids:How Do We Measure Up?
Grandview Children’s 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
1. Present measurement issues related to effectiveness of Kinesiotaping ®.
2. 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 Children’s Centre to OT’s
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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 1980’s
• 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 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
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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:
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.
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Princess H
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Lady K
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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….
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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.
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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
• Client’s 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
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.
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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
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.
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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
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.
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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
Pre-Taping
Post-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
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
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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
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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
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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
Children’s 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, 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.