Date Published: January 25, 2019
Publisher: Public Library of Science
Author(s): Gabriela Lopes dos Santos, Erika Shirley Moreira da Silva, Kaat Desloovere, Thiago Luiz Russo, Johnny Padulo.
Approximately 50 to 70% of post-stroke subjects present a reduction in the upper limb (UL) function even during the chronic phase. An adjuvant technique widely used in neurorehabilitation is elastic taping applications. However, its efficacy in UL treatment for post-stroke subjects still requires further investigation.
To verify the effects of elastic tape (ET) used on the paretic shoulder in upper limb (UL) performance during a drinking task.
A single-center randomized sham-controlled crossover trial randomized thirteen post-stroke subjects with mild to moderate UL impairment for group allocation to receive first Sham Tape (ST) or first Elastic Tape (ET), with one month of washout. Kinematic measures of a drinking task were taken before and after each intervention (elastic and sham tape), using Three-Dimensional Motion Analysis, and studied using feature analysis and Statistical Parametric Mapping. Outcome measures included spatiotemporal variables, scalar kinematic parameters (starting angles, range of motion—ROM, and endpoint angles) and time-normalized kinematic waveforms of trunk and UL joint angles (scapulothoracic, humerothoracic and elbow).
Elastic tape provided common modifications throughout the task (shoulder more towards midline, reduced scapula protraction and trunk flexion) and important alterations at specific time-instants. At the end of the reaching phase, for both groups (ET and ST), the elastic tape increased elbow extension [ET: CI = 12.57 (6.90 to 18.17), p<0.001; ST: CI: 12.89 (6.79 to 18.98), p<0.001). At the end of transporting the glass to the mouth, patients who underwent the elastic tape intervention presented more shoulder elevation [ET: CI = 16.40 (4.28 to 28.52), p = 0.007; ST: CI: 15.13 (5.79 to 24.48), p = 0.002)]. Moreover, an increase of elbow extension at the end of transporting the glass to the table was observed for both groups [ET: CI = 8.13 (1.48 to 14.79), p = 0.014; ST: CI: 8.20 (4.03 to 12.38), p<0.001)]. However, no changes in the spatiotemporal parameters were observed for both groups during all the phases of the task (p>0.05).
The ET changed UL joint motions and posture during a drinking task in chronic hemiparetic subjects, which defines its role as an adjuvant therapy.
Stroke is the most frequent cause of adult disability worldwide . Approximately 50–70% of stroke survivors in the chronic phase (more than 6 months post-stroke) have upper limb (UL) impairments, such as motor, sensory, perceptual and cognitive deficits. UL impairments may cause limitations in activities of daily living (ADL) and reduce their functional independence, social participation and quality of life [2, 3].
Although elastic tape has been widely used by physiotherapists, its effect on UL movements has been studied only recently [13–15, 19, 20, 34, 35]. To the best of our knowledge, this is the first study that evaluated its effect on movement strategies during a functional task for post-stroke patients. The results of the present study revealed that elastic tape did not immediately influence the spatiotemporal parameters of the drinking task in chronic hemiparetic subjects with mild to moderate UL impairments. However, ET intervention changed the shoulder position (more towards midline) and reduced scapula protraction and trunk flexion at the beginning, throughout, and at the end of the task, with small and medium effects. Moreover, using elastic tape increased shoulder elevation during reaching (for half the phase) and transporting the glass to the mouth increased the elbow extension near the table without and with the glass, increased the scapula lateral rotation (upward rotation) at the end of the reaching phase and decreased the scapula lateral rotation throughout the movement of bringing the glass to the mouth. Moreover, no adverse effects were observed in this study. Overall, these results demonstrated that elastic taping could alter UL movement strategies, thereby decreasing movement deviations in chronic hemiparetic individuals, taking age-gender matched healthy individuals as a reference .
Elastic tape provided small to moderate immediate changes in angular parameters during functional task in chronic post-stroke patients 10 minutes after the application in a single therapy session. For example, shoulder more toward midline, trunk less flexed and less scapula protraction were observed after elastic tape intervention. However, elastic tape did not alter spatiotemporal parameters and ROM of trunk, scapulothoracic, humerothoracic and elbow motions during functional task. Thus, these results could point to the inclusion of elastic tape as an adjuvant therapy and a ‘prime’ of the brain for subsequent motor training.