BANGALORE, KARNATAKA.
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION1 / Name of the Candidate
and Address / VYAS KRISHNABEN BHADRESHKUMAR. SRINIVAS COLLEGE OF PHYSIOTHERAPY AND RESEARCH CENTRE,
PANDESHWARA,
MANGALORE-575001
2 /
Name of the Institute
/ SRINIVAS COLLEGE OF PHYSIOTHERAPY AND RESEARCH CENTER, MANGALORE.3 /
Course of Study and
Subject / MASTER OF PHYSIOTHERAPY2 YEARS DEGREE COURSE.
“NEUROLOGICAL AND PSYCHOSOMATIC DISORDERS”
4 /
Date of Admission
To Course / 03-06-20135 /
Title of the Topic
/ “IMMEDIATE EFFECT OF KINESIO TAPING ON FUNCTIONAL AMBULATION, PLANTAR FLEXORS SPASTICITY & DORSI FLEXORS STRENGTH IN STROKE - A RANDOMIZED SHAM-CONTROLLED TRIAL”6
7
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Brief resume of the intended work:
6.1Need for the study:The World Health Organization (WHO introduced in 1970 and still used ) defined stroke as “ it is a rapidly developing clinical signs of focal or global disturbance of cerebral functions, lasting more than 24 hours or leading to death, with no apparent cause other than of vascular origin.1 It is a global health problem and is the second commonest cause of death, fourth leading cause of disability & major cause of mortality worldwide.2 Stroke in India has already attained epidemic proportions (annual incidence of stroke: 145 per 100,000 per year during 2003-05 and 2005-06).3,4
Stroke is a major health issue, it leaves patient with several residual difficulties like physical dependence, cognition decline, dementia, depression, spasticity, gait disturbance , sensory and motor dysfunction.5 In stroke gait is affected due to muscle weakness, abnormal muscle activities, inadequate muscle coactivation, sensory and visual deficits, noncontractile soft-tissue tightness, and disruption in central generation of programmed muscle activation. Extensor muscle over activity or spasticity is a real cause for gait disturbances.6,7
Efficient ambulation is a key goal in stroke rehabilitation.8 The ability to walk independently with sufficient endurance that permits participation at home and in the community is an important goal of neurologic rehabilitation after stroke, more than 85% after stroke survivors can eventually walk with or without assistance. The common features of walking after stroke include decreased gait velocity and Asymmetrical gait pattern.9
Ankle control during gait is important for normal gait pattern. Adults with hemiplegic often demonstrate common gait impairments: inadequate dorsiflexion Causing “drop-foot,” and plantar flexor spasticity or stiffness causing decreased push off.10 During the toe-off phase, the plantar flexors energy required to move the limbs forward. Because of insufficient energy of plantar flexors we observed decreased gait velocity during gait with stroke patients.11 Plantar flexor spasticity joint and muscle stiffness are 2 common impairments associated with hemiplegic and can contribute to gait abnormality.12
Ankle dorsiflexor weakness may cause inadequate foot clearance during the swing phase and insufficient eccentric contraction during the weight-transfer phase after heel-strike. So if dorsiflexors weakness is there then its cause’s latter deficiencies & it may lead to increased swing time13 decreased single-leg support time, and increased double-leg support time, decreased step length increased risks of falling. Decreased ankle dorsiflexion of the affected leg during the swing phase is a common clinical observation in hemi paretic gait.6,8Weakness of the flexor muscles, spasticity of the extensor muscles, and a synergistic extension motor pattern may be the main causes of gait disturbance.14
The main foci of physical therapy after stroke are to restore motor control in gait and gait related activities to improve functions, activities of daily living to enhance participation in general. Studies have shown that adults with stroke do not push effectively with their plantar flexors during gait.6 `
Some studies suggest spasticity in the plantar flexors may decrease with the dorsiflexors because of reciprocal inhibition. The stretch reflex of plantar flexors in adults with stroke may be reduced by facilitating the dorsiflexors.15,16
Weakness of ankle dorsiflexors usually continues for a long period of time during recovery from a stroke. Ankle impairment on gait performance has not received its deserved attention for stroke patients & The role of dorsiflexors strength for gait velocity has not been clearly verified.7 Various methods are used to improve ambulation due to ankle weakness such as prolonged muscle stretch (PMS) ankle-foot orthoses (AFOs), functional electrical stimulation and peroneal nerve stimulation. They are time taking methods and also their effect comes after applying prolong period of time.17
Kinesiotaping is currently used in rehabilitation as an adjuvant therapy method due to positive effects on pain and gait pattern.18 Kinesio tape (KT) is a kind of elastic tape invented by Dr. Kase (in 1996). Kinesio tape is a unique material which is different from other sports tapes, especially in special weave and elasticity. The kinesiotaping technique utilizes latex free & quick drying tape designed to mimic the qualities of human skin through its specific thickness & high elasticity.19
Kinesiotaping is established as a new and effective intervention in sports medicine but, there are fewer studies on the effect of kinesiotaping in neurological conditions. So, this study is being done. As kinesiotaping is a new type of intervention its effectiveness is to be checked in stroke rehabilitation.
Therefore the aim of the study is to established immediate effect of kinesiotaping on functional ambulation in stroke population.
6.2 Review of Literature:
1) Elisa Pelosin. et al. (2013): conducted a Randomized Crossover Pilot Study to know the Kinesiotaping Reduces Pain and Modulates Sensory Function in Patients with Focal Dystonia. Twenty-five dystonic patients (14 with CD and 11 FHD) were selected. It was concluded that Kinesiotaping may be useful in treating pain in patients with dystonia. In addition, Kinesiotaping treatment is likely to interfere with the mechanism underlying abnormalities in temporal discrimination between tactile stimuli in focal dystonia.20
2) D. Morris. et al. (2013): conducted systematic review to know The clinical effects of Kinesio® Tex taping. They were including Only eight RCTs met the full inclusion/exclusion criteria for this review. In that six studies included patients with musculoskeletal conditions, one included patients with breast-cancer-related lymphedema and one included stroke patients with muscle spasticity. so they were concluded that there currently exists insufficient evidence to support the use of KTT over other modalities in clinical practice and to prove KTT to be more effective high-quality research with long-term outcomes is required.21
3) Simone Dorsch. et al. (2012): conducted A cross-sectional observational study on The Strength of the Ankle Dorsiflexors Has a Significant Contribution to Walking Speed in People Who Can Walk Independently After Stroke. Stroke survivors (N_60; mean age _ SD, 69_11y) selected for the study. They were checked muscle strength by isokinetic device for 12 lower limb muscles & and gait speed by 10 meter walk test. They were concluded that strength of muscle groups other than the lower limb extensors, particularly the ankle dorsiflexors, has an important role in determining walking speed after stroke.22
4) Marco Cortesi. et al. (2011): conducted a pilot study to know the Effect of kinesio taping on standing balance in subject with multiple sclerosis. 15 individuals with multiple sclerosis were assessed. KT Tape was applied directly to the skin of both calves and kept for the next two days. They were concluded that the use of ankle taping may be useful in immediately stabilizing body posture.23
5) Evrim Karadag-Saygi. et al. (2010): conducted single-center, randomized, and double-blind study to know The Role of Kinesiotaping Combined With Botulinum Toxin to Reduce Plantar Flexors Spasticity After Stroke. Twenty hemiplegic patients with spastic equines foot were enrolled into the study and randomized into 2 groups. The first group (n=10) received BTX-An injection and kinesiotaping, and the second group (n=10) received BTX-An injection and sham-taping. They were concluded that the application of kinesiotaping combined with BTX-A provided no superior effect compared to sham taping with BTX-A. To fully understand the additive effect of kinesiotaping on spastic equines. further research on a large number of patients is required.19
6) Greve P. et al. (2008): conducted a case report to know Effect of the bandage kinesio taping in cerebral palsy of diparetic. They were took patient with CP of the diparetic spastic type his age was 4 years, needs help to march and presents an equine ankle pattern. Before using the bandage, a surface electromyography was done on the anterior tibiae and triceps surae muscles in the legs, in rest conditions and in muscular contraction. Two revaluations were done after the beginning of the use of the bandage, the first one 3 days after the application and the second 23 days after. So, they were concluded that through stimulation given by the Bandage Kinesio Taping a decrease of the spasticity was observed.24
7) Ewa jaraczewska. et al. (2006): conducted a study on kinesio taping in stroke: improving functional use of the upper extremity in hemiplegia. They were concluded that the use of taping method in conjunction with an established rehabilitation program may play an important role in the reduction of post stroke shoulder pain, soft tissue inflammation, muscle weakness & postural malalignment. They believed that the kinesio tape improve the position of glenohumeral joint & may provide the proprioceptive feedback to achieve proper body alignment.25
8) Audrey Yasukawa. et al. (2006): conducted a pilot study to know the effect the Effects of Kinesio Taping® in an Acute Pediatric Rehabilitation Setting with Fifteen children (10 females and 5 males; 4 to 16 years of age), The Melbourne Assessment of Unilateral Upper Limb Function (Melbourne Assessment) was used to measure upper-limb functional change prior to use of Kinesio Tape®, immediately after application of the tape, and 3 days after wearing tape. They were concluded that Kinesio Tape may be associated with improvement in upper extremity control and function in the acute pediatric rehabilitation setting. The use of Kinesio Tape as an adjunctive treatment may assist with the goal-focused occupational therapy treatment during the child’s in patient.26
9) Kim KS. et al. (2002): conducted a single group pre-post design to know Effect of taping method on ADL, range of motion, hand function & quality of life in post - stroke Patients for 5 weeks. They were selected 20 hemiplegic patients for the study and each patient treated with kinesio taping and self-help management program was composed of five sessions and each session had health education on stroke. Diet. Risk factor. ROM exercise and recreation. They were concluded that taping therapy is effective for improving ADL. Hand function. ROM. quality of life.27
6.3 Objective of the study
• To determine the immediate effectiveness of kinesio taping (KT) on functional ambulation in stroke.
• To determine the immediate effectiveness of kinesio taping (KT) on plantar flexors spasticity.
• To determine the immediate effectiveness of kinesio taping (KT) on dorsi flexors strength.
6.4 Hypothesis:
Null hypothesis:
There will be no significant improvement in outcome measures after KT application between the experiment and control group.
Experimental hypothesis:
There will be a significant improvement in outcome measures after KT application between the experiment and control group.
Material and Methods:
7.1 Source of data:
Data will be taken from Srinivas hospital, other clinical settings in Mangalore. Study will be conducted in SCPTRC OPD, Mangalore.
Sample design: convenient sampling.
Sample size: 40 stroke population (20 kinesio and 20 sham).
Inclusion Criteria:
ü Age- 40 to 70 year male and female with stroke patients
ü MMSE score >23
ü Patient should be able to walk at least 6meters with or without any aid
ü Brunnstrom recovery stages of lower limb >4
Exclusion criteria:
ü Lower extremities surgery and complications
ü Any other neurological and musculoskeletal disorders
ü Contracture and deformity in lower limb ( hip and plantar flexors)
7.2 Method of collection of data:
All subjects will be asked to sign the written consent form stating the voluntary acceptance to participate in the study. Forty subjects of both genders from the age of 40-70 years will be screened for inclusion and exclusion criteria using pre screening assessment of the subjects will be done which we include Demographic data, Mini Mental State Examination and Brunnstrom lower limb stroke recovery stage. Before intervention subjects will be randomized into experimental group (group 1) and sham control group (group 2) by block randomization method. Prior to treatment baseline data will be collected by using timed up and go test (Functional ambulation), Modified Tardieu scale (Plantar flexors spasticity) & Manual Muscle testing (Dorsi flexors strength). Following this, Hypoallergenic tape will be 1st applied without tension to protect the skin over the plantar flexors and dorsi flexors. On the hypoallergenic tape, kinesio tape will be applied for 1 week.
Method of tapping for group 1:
· FOR PLANTARFLEXORS SPASTICITY:
Patient Position- Patient is in prone lying with hip & knee extension. KT will be applied from just posterior to the calcaneum to medial and lateral gastronomies head at just below the popliteal fossa. Basic Kinesio Taping Technique for the plantar muscle using a Y strip. This is an insertion-to-origin application. Begin base of Kinesio Y strip on the posterior to the calcaneum with no tension. Place the patient in hip & knee extension in prone lying position. Maintain the ankle and foot in a dorsiflexed position. Apply the medial strip of the Y cut around the medial head of the gastronomies. This is an insertion-to-origin technique using very light to light tension (15-25% of available) or paper-off tension. Lay the final 1-2 inches down with no tension. Initiate glue activation prior to any further patient movement.28
· FOR DORSIFLEXORS WEAKNESS:
Patient Position- For dorsiflexors direction of taping is origin to insertion. The length of the tape is it should be cover half of the shin and foot. Pt is in supine lying with hip & knee extension and asks the pt to do actively dorsi flexion with slightly aversion. Being base of kinesio L strip on the middle of the shin to the 1st and 2nd metatarsal joint in a longitudinal line (on origin of tibialis anterior muscle) with provide high tension in middle part. Initiate glue activation prior to any further patient movement.
Method of taping for group 2:
· FOR PLANTAR FLEXORS SPASTICITY:
Subjects will be in prone lying and hip & knee is in neutral position. KT will be applied from cacaleneum to the medial and lateral head of gastronomies muscle without any tension provide to the tape.