RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name Of The Candidate and Address / SNEHAL P. PATILB-103 Nageshkar Heights 1225 E ward ,
2nd lane Rajarampuri, Kolhapur, Maharashtra.
416008.
2. / Name Of The Institution / K.T.G COLLEGE OF PHYSIOTHERAPY
Hegganahalli Cross, Peenya 2nd Stage,
Sunkadakatte Main Road, V. N. Post
Bangalore.
3. / Course Of Study And Subject / MASTER OF PHYSIOTHERAPY
(Masters of Physiotherapy in Pediatrics)
4. / Date Of Admission To Course / 13 July 2011
5. / Title Of The Topic:
“EFFECT OF KINESIO TAPPING ON ABDOMINAL MUSCLES IN HYPOTONIC CHILDREN WITH DIFFICULTY IN FUNCTIONAL KNEELING. ”
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8. / BRIEF RESUME OF THE INTENDED WORK:
6.1 Need for the study:
Hypotoniais a state of decreased muscle tone. Hypotonia is potential manifestation of many different diseases and disorders that affect motor nervecontrol by thebrainor muscle strength.1 Children with normal muscle tone are expected to achieve certain physical abilities within an average timeframe during development after birth. Children with hypotonia have delayed developmental milestones, but the length of delay can vary widely. The hypotonic disabilities affect gross motor skills,fine motor skills or both. Hypotonic children are delayed attaining lifting their heads while lying on their stomachs, rolling over, lifting themselves into a sitting position, crawling, kneeling, quadruped, sit to stand activities standing and walking.2 A child with hypotonia has muscles that are slow to initiate a contraction against an outside force, and also cannot sustain a muscle contraction as long.
Functional kneeling is the human position in which the weight is distributed on the knees and feet on the surface close to horizontal. Kneeling posture helps in gaining stability and mobility of trunk without pelvic rotation.3 The stability of trunk and pelvis is needed to maintain posture during standing, walking and sit to stand activites.3,4,5 Abdominal muscles play a major role in pelvic, trunk and balance control. Internal and external obliques are the primary muscles of abdomen which stabilize trunk and control pelvic tilts. Obliques also have maximal voluntary contraction while co-contraction of trunk, rising up, standing, walking, rolling, kneeling and sit to stand activities.6 All these factors alters when there is neuromuscular problems in abdominal muscles. Among various neurological disorders, these factors are altered in hypotonia.
Physiotherapeutic approaches are widely applied in hypotonic child and rehabilitation approaches aim to increase muscle power, tone and gross and fine motor functions of the child. Various methods like Acoustic vibrations, Corticospinal facilitation, Phasic stretch reflex, Corticomagnetic stimulation, Kinesio taping, etc. used with conventional methods in abdominal muscles aiming to improve stability and mobility of trunk and pelvis.7,8,9 Kinesio taping method has shown to be improve strength of weak muscles, control joint stability, increase sensory stimulation, increase functional motor skills, help with postural control and support functionality in pediatric rehabilitation. Also studies suggested that Kinesio taping method of intervention may be associated with improvement in upper-extremity control, sitting posture and sit to stand transition and in the acute pediatric rehabilitation setting.10 The Kinesiotapingmethod in conjunction with other therapeutic interventions and to be used for facilitate or inhibit muscle function, support joint structure, reduce pain, and provide proprioceptive feedback to achieve and maintain preferred body alignment.
There were no studies found on effect of Kinesio taping on abdominal muscles in improving stability and mobility of trunk in functional kneeling. Therefore, there is need to evaluate the effect of Kinesio taping on functional kneeling in children with hypotonia. Hence, the purpose of this study is to study the effect of Kinesio taping on internal and external oblique muscles on performance of functional kneeling task and reaching at a ninety degree angle upper extremity to grasp a toy using Functional Reach Test and Functional measurement using GMFM-66 of crawling and kneeling domain in children with hypotonia.
HYPOTHESIS:
Null hypothesis
Kinesio taping on abdominal muscles does not improve functional kneeling in children with hypotonia.
Alternate hypothesis
Kinesio taping on abdominal muscles improve functional kneeling in children with hypotonia.
6.2 REVIEW OF LITERATURES:
Gallagher S. et. al. (1997) Studied trunk extension strength and muscle activity in standing and kneeling postures. In their study they concluded that the kneeling posture was associated with 15% decrease in peak torque output when contrasted with standing. And they found reduced extensor capability in the kneeling posture, despite equivalent trunk muscle activity.3
Martin et. al. (2007) Studied on the most common clinical characteristics of hypotonia, examination tools, interventions and prognosis in the pediatric population. In their studies they found that the most common characteristics are decreased strength, hypermobile joints and increased flexibility.11
ManuelaGalli and VeronicaCimolin et. al. (2011) Studied on the effects of musclehypotoniaand weakness on balance in Prader–Willi and Ehlers–Danlos syndrome. In their study they found that musclehypotonia and weakness accounts for reduced balance capacity and postural instability.12
Michaela Linder-Lucht and Verena Othmer et. al. (2007) Studied on validation of the Gross Motor Function Measure for use in children and adolescents with traumatic brain injuries. In their study they found that both Gross Motor Function Measure change scores correlated significantly with all of the clinical judgments of change. The degree of correlation that we postulated, that the Gross Motor Function Measure change score would correlate highest with the video rating followed by physiotherapists and parents, was fully confirmed by the Gross Motor Function Measure-88 and largely confirmed by the Gross Motor Function Measure-66.13
Russell DJ and Avery LM et. al. (2000) Studied reliability and validity on improved scaling of the gross motor function measure for children with cerebral palsy. In their study they examined the reliability, validity and responsiveness to change of measurements obtained with a 66-item version of the Gross Motor Function Measure (GMFM-66) developed using Rasch analysis. They found that the GMFM-66 has good psychometric properties.14
Bartlett D and Birmingham T et. al. (2003) Studied the validity and reliability of a Pediatric reach test. The Functional Reach Test was modified to incorporate side reaching in addition to forward reaching in both sitting and standing. The concurrent supported with a high correlation between the total PRT score and Gross Motor Function Classification System level (rs = -0.88) among the sample of children with cerebral palsy.15
A. Yasukawa and Charles Sisung et. al. (2006) Studied on the effects of kinesio taping in an Acute Pediatric Rehabilitation Setting. In their study they found improvement from pre to post taping was statistically significant,F(1, 14) = 18.9;p.02. These results suggest that Kinesio Taping may be associated with improvement in upper-extremity control and function in the acute pediatric rehabilitation setting.16
Jaime P. Cepeda and Aliza Fishweicher et. al. (2008) Studied to determine if applying Kinesio Tape to the abdominal muscles would affect the performance of the supine-to-sit transition in children with hypotonia. In their study they found that the use of Kinesio Taping on the abdominal muscles proved to be an effective therapeutic intervention for improving the transition of supine-sit in children with hypotonia. They also found that children had less compensatory movements during the transition, increased attention and decreased protruding abdomen.17
Fotter CB et. al. (2006) Studied on the effects of therapeutic taping on gross motor function in children with cerebral palsy. In their study they found no significant differences for the GMFM-88 scores between groups over time. They found that therapeutic taping does not evoke a positive functional change in the seated postural control of children with quadriplegic cerebral palsy. Subjective observation, however, suggested that one child with athetosis benefited from therapeutic taping over the paraspinal region.18
Yoshida A. and Kahanov L et. al. (2007) Studied on the effect of kinesio taping on trunk flexion, extension, and lateral flexion. In their study they found no significant difference in extension (-2.9 cm; t(29)=-0.55, p>0.05) or lateral flexion (3 cm; t(29)=-1.25, p>0.05). Based on the findings, they found that kinesio tapping applied over the lower trunk may increase active lower trunk flexion range of motion.19
Preuss RA, Grenier SG and McGill SM et. al. (2005) Studied on postural control of the lumbar spine in unstable sitting. They found that external oblique, internal oblique, and thoracic erector spinae were most active and most likely to be used asymmetrically, with other muscles showing low levels of coactivation. In their study they found that successful balance was characterized by low levels of muscle coactivity, along with higher levels of asymmetric activation in the global trunk muscles, specifically external oblique, internal oblique.20
The review of literature showed that there were no studies found on effect of Kinesio tapping on abdominal muscles in improving stability and mobility of trunk in functional kneeling. Therefore, there is need to study the effect of Kinesio Taping on abdominal muscles hypotonic children with difficulty in functional kneeling.
6.3 OBJECTIVE OF THE STUDY:
The objectives of this study are:
1. To measure the functional reach during by functional kneeling in children with hypotonia in study and control group.
2. To measure gross motor function using item C of GMFM scale in children with hypotonia in study and control group.
3. To compare the functional reach and GMFM Score in both groups.
7.1 SOURCE OF DATA:
Samples for the study will be taken from :
1. KTG Hospital, Heggenahalli Cross, Bangalore.
2. ESI Hospital, Rajajinagar, Bangalore and other pediatric rehabilitation centers.
7.2 METHODS OF COLLECTION OF DATA:
Population :- Children with hypotonia
Sample design :- Random Sampling design
Sample size :- 30 (15 in study group and 15 in control group)
Type of Study :- Experimental study
Duration of the study : 6 weeks per child
Materials used:
· Kinesio tape with accessories.
· Yardstick
· Toy with bench of adjustable height
· GMFM score sheet
· Data collection sheet
· Stationary material: Paper, pen, pencil, eraser.
Inclusion Criteria:
· Children diagnosed with hypotonia by pediatric physician.
· Children with impairment in kneeling and reaching task in kneeling.
· Children who are not able to kneel unsupported.
· Children who are able to maintain their head against gravity.
· Children with cognitive ability to follow verbal commands and physical promts.
· Age 1-6 years.
Exclusion Criteria:
· Children who were unable to understand the commands or cues necessary for the procedure.
· Children with positive patch test.
· Children with any of the following contraincating to kinesio taping:
Open wounds
Fragile skin
Poor skin integrity
Abrasion
Tape allergies
Measuring tools:
· Functional Reach Test.
· Gross Motor Function Measure Scale 66 – item C (crawling and kneeling).
7.3 METHODOLOGY:
Intervention will be conducted on the participants:
Informed consent will be taken from the parents of the child. Patch test is applied to each of the subjects upper back at approximately the C7 region. Children who meet the inclusion criteria will be assigned. Study Group will receive conventional pediatric rehabilitation with Kinesio taping for abdominal muscles and Control Group will receive only conventional pediatric rehabilitation.
Before Intervention:
The pre-testing procedure was conducted in a quiet room to avoid distractions and to
increase attention to the task. A yardstick was placed on the wall and lined up with the
subjects glenohumeral joint. The yardstick was utilized in order to measure the distance the subjects reached for the object. Additionally, a line is drawn on the floor and the subjects knees were brought to the edge of the line of tape to ensure the same knee placement for each trial. In order to make sure the subjects were using a shoulder width base of support, two boxes of tape were also drawn to indicate proper knee placement. For the functional kneeling reach task subjects kneels on the line of tape and reached with their upper extremity for a toy that was held parallel to their body. A functional reach test was scored based on the distance the subject reached to obtain the toy. The distance on the yardstick was measured from where the toy lined up on the yardstick when the grasp was achieved. The high kneel task was administered for five trials with one practice trial and the number of times balance was lost during the five trials. Also GMFM 66 - item C is noted.
Kinesio Taping Intervention:
One week after the pre test is administered, the subjects will received Kinesio taping twice a week for four consecutive weeks. For the first week of taping, two inch Kinesio tapes are utilized for the taping procedure. The subjects are placed in supine with their hips flexed to approximately 45 degrees in order to place the pelvis in a more neutral position. The subjects shoulders were flexed over their head to elongate the trunk musculature. The length of the tape was measured from the subject's anterior superior iliac spine to their opposite lateral 10th rib. The tape was anchored at the anterior superior iliac spine and applied toward the subjects umbilicus with paper off tension. The same procedure is repeated to the opposite side of the body and the completed application of Kinesio Tape formed an X shape. The length of Kinesio Tape utilized for each subject is measured to the nearest inch to ensure the same length of tape for each week of taping. A note is sent home to the subjects parents/guardians after each Kinesio Taping intervention with instructions to leave the tape on for 3 days and instructions on removal of the tape if skin irritation occurred. All subjects still received their regular weekly physical therapy sessions.
After Intervention:
On the sixth week, the high kneeling and reaching task is completed as a post test measurement. The high kneeling task is administered for five trials with one practice trial and the best score out of the five trials will be recorded as the functional reach score. Similarly to the pre test, the number of times balance displaced and the amount of assistance to complete the task is also recorded. And again GMFM 66 – item C score will be taken.
Pre test and post test measurement will be taken for data analysis.
7.4 STATISTICAL ANALYSIS:
1. Statistical analysis will be analyzed by using SPSS and graphs will be made using Microsoft excel and Microsoft word.
2. The Chi Square (χ2) test will be used to analyze the basic characteristics of the subject.