DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY ORIGINAL ARTICLE

The effects of Kinesio Taping on body functions and activity in

unilateral spastic cerebral palsy: a single-blind randomized
controlled trial
OZGUN KAYA KARA 1 | SONGUL ATASAVUN UYSAL 1 | DUYGU TURKER 1 | SEDEF KARAYAZGAN 2 |
MINTAZE KEREM GUNEL 1 | GUL BALTACI 1

1 Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara; 2 Department of Occupational Therapy, Faculty of Health
Sciences, Hacettepe University, Ankara, Turkey.
Correspondence to Ozgun Kaya Kara, Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100 Samanpazari, Ankara, Turkey.
E-mails: [email protected]; [email protected]

This article is commented on by Iosa on pages 11–12 of this issue.

PUBLICATION DATA AIM The aim of this study was to investigate the effects of Kinesio Taping (KT) on the body
Accepted for publication 10th July 2014. functions and activity of children with unilateral spastic cerebral palsy (CP).
Published online 12th September 2014. METHOD This study was designed as a single-blind, randomized, controlled trial. Thirty
children with unilateral spastic CP were randomized and split equally between the KT group
ABBREVIATIONS (eight males, seven females; mean age 9y [SD 2y 3mo] range 7–12y) and the control group
BFMF Bimanual fine motor function (seven males, eight females; mean age 9y 7mo [SD 3y 4mo] range 7–14y) receiving usual
BOTMP Bruininks–Oseretsky Test of care. All participants were evaluated with the Functional Independence Measure for Children
Motor Proficiency (WeeFIM), the Bruininks–Oseretsky Test of Motor Proficiency (BOTMP), the Gross Motor
ICF-CY International Classification of Function Measure (GMFM), short-term muscle power, agility and functional muscle strength
Functioning, Disability and tests. Wilcoxon signed-rank and Mann–Whitney U tests were used to evaluate within and
Health for Children and Youth between-group differences respectively. The level of significance was accepted as p<0.05.
MACS Manual Ability Classification RESULTS There were significant differences in muscle power sprint (p=0.003), lateral step-up
System test right (p=0.016), sit to stand (p=0.018), attain stand through half knee right (p=0.003),
PBS Paediatric Balance Scale BOTMP Gross scores (p=0.019), and WeeFIM total (p=0.003) and self-care scores (p=0.022)
SAS Sitting Assessment Scale between the groups (p<0.05).
STS Sit-to-stand INTERPRETATION Kinesio Taping is a promising additional approach to increase
TUG Timed up and go proprioceptive feedback and improve physical fitness, gross motor function, and activities of
WeeFIM Functional Independence Mea- daily living in children with CP.
sure for Children

Motor dysfunction in cerebral palsy (CP) is frequently Kinesio Taping (KT) is commonly used in sport injuries,
related to muscle weakness. Impairments in sensory inte- in neurology and oncology patients following the surgical
gration and balance, spasticity, co-activation of agonist and protocols, and for paediatric rehabilitation to reduce pain,
antagonist muscles, lack of selective motor control, and facilitate or inhibit muscle activity, prevent injuries, reposi-
decreased anaerobic muscle power and agility cause impair- tion joints, aid the lymphatic system, support postural
ment of body structures/functions and activity limitation.1,2 alignment, and improve proprioception.7–9 Although its
Common therapy approaches (including orthosis, botu- mechanism of action has not been fully understood, it is
linum toxin, constraint-induced movement therapy and believed that activation of the cutaneous receptors could
neurodevelopmental therapy) focus on enhancing postural influence neuromuscular functions.10 The cutaneous sen-
control and muscle strength, improving motor activity in sory system provides preliminary information about limb
the upper and lower limbs, and improving walking.3,4 Over positions and muscle forces to the central nervous system
the past decade, the use of evidence-based interventions in for monitoring and controlling limb movements, planning
CP treatment has gradually increased and investigators actions, and providing fluent movement.11 Common causes
have tried to develop more effective interventions to of unilateral spastic CP are middle cerebral artery infarct,
improve the quality of life of these children and their fami- hemi-brain atrophy, periventricular lesions, and brain mal-
lies. A recent review has reported that interventions based formations that disturb the integrity of the motor areas.
on motor learning increase activity levels in children with Middle cerebral artery infarctions can particularly impair
CP.5 Therefore, using taping in CP might be a promising the somatosensory system. Children with unilateral spastic
technique to ensure such improvement.6,7 CP and middle cerebral artery infarct, therefore, often

© 2014 Mac Keith Press DOI: 10.1111/dmcn.12583 81

suffer sensory impairments that could affect the develop- What this paper adds
ment of future motor skills.12 Yasukawa et al.7 stated that • Insight into the effectiveness of Kinesio Taping on body functions and activ-
the use of Kinesio Taping might influence the cutaneous ity in children with unilateral CP.
receptors of the sensory motor system, resulting in the • It shows that Kinesio Taping is effective on performance-related physical fit-
improvement of voluntary control and coordination in a ness, gross motor function, and activities of daily living.
physiotherapy programme for children with CP.
in unilateral spastic CP compared with usual care. The
There are increasing reports of the clinical use of taping
permission of the University Ethics Committee was
techniques on children with CP. A few studies focusing on
received (Project: HEK 12/176) and written informed con-
upper extremities have reported that taping application
sent was obtained from each participant and/or guardian.
recruited upper limb function, especially the preparation for
motion and the returning phases,13 and allowed a more func-
Participants
tional range of motion, improved selective finger movements
Thirty-seven children with unilateral spastic CP were
and fine motor manipulation,14 developed goal-directed
referred to the Department of Physiotherapy and Rehabili-
movement, increased stability of the shoulder and hand, and
tation by paediatric neurologists between November 2009
supported alignment during reaching and grasping.7 Other
and October 2013. The inclusion criteria were age between
studies that investigated the effects of taping applications on
7 years and 14 years; classified in levels I or II of the Gross
gross motor function and postural control showed a signifi-
Motor Function Classification System (GMFCS); and able
cant improvement on postural control in the sitting position
to follow and accept verbal instructions. The exclusion cri-
only in a child with athetoid CP,15 improvement of locomo-
teria were (1) any orthopaedic surgery or botulinum toxin
tor motion, facilitation of normal activity, support for weak
injection in the past 6 months, (2) children whose parents
muscles,6 increase of trunk stability,16 and improved agility
refused to participate and (3) children with allergic reac-
in sit-to-stand (STS) motion.17 Kinesio Taping is a relatively
tions to the adhesive compound of Kinesio tape.
new technique which uses Kinesio Tex tape. It is one of the
most widely-used taping methods because of elastic, adhe- Procedure
sive, latex-free, thin features of the material that can be The children were pre-stratified according to three vari-
stretched in the longitudinal plane. Kinesio Taping can be
ables: sex, Manual Ability Classification System (MACS)
stretched from 40 to 60% of its resting length. This is simi-
level (I, II–III), and age (youngest: 7–9y; oldest: 10–14y).
lar to the elastic qualities of human skin. This elasticity of
They were subsequently randomized to one of two groups
the tape allows more movement and feels more comfortable.
using a random number allocation table by an independent
Kinesio Taping can therefore be conveniently used in chil-
researcher. Of the 37 participants, 18 were randomized to
dren with CP.7,12 the taping group and 17 to the control group as shown in
The International Classification of Functioning, Disabil- the flow chart (Fig. 1). One participant had an allergic
ity and Health for Children and Youth (ICF-CY) describes reaction to the tape and two patients discontinued treat-
the characteristics of childhood functions, guides the selec-
ment. In the control group, two participants did not attend
tion of measurement tools, and determines meaningful out-
the last evaluation.
comes.18 From the ICF-CY perspective, Kinesio Taping in
conjunction with other therapeutic interventions could Measurements
promote integration of the rehabilitation process, increase Gross motor function was classified using the GMFCS,19
independent daily activities and social participation or the self-initiated manual hand function with MACS,20 and fine
quality of these activities, and improve gross and fine motor function with the Bimanual Fine Motor Function
motor functioning. (BFMF) scale.21
There are few studies on the effects of Kinesio Taping
in children with CP and the results are conflicting.7,16,17 Body structures
However, no randomized control trial has been performed Body composition was evaluated by body mass index
to show the effects of the procedure on both the upper (BMI) calculated with the formula as weight in kilo-
and lower extremities. The aim of this study was to inves- grammes divided by the square of the height in metres.
tigate the effects of Kinesio Taping on the ICF body Weight was measured with a standard electronic device
structures/functions and activity domains in children with and height with a stadiometer.
unilateral spastic CP. We hypothesized that Kinesio Tap-
ing might improve performance-related physical fitness, Body functions
gross and fine motor capacity, and independent function Short-term muscle power was evaluated using the mean
in daily living activities in children with unilateral spastic power and peak power obtained from the Muscle Power
CP. Sprint Test that has been found to be reliable in children
with CP. Children run 6 to 15 m at maximum pace
METHOD during this test.22 Power output was calculated for each
This study was designed as a single-blind randomized con- participant from the collected data by using the following
trolled trial of KT on both the upper and lower extremities equations:22

82 Developmental Medicine & Child Neurology 2015, 57: 81–88

 The 30 seconds Repetition Maximum test, which has
Participants asked to been found to be reliable in children with CP, was used
participate to assess functional muscle strength of the lower extremi-
n=37 ties. The three closed kinetic chain exercises of lateral
step-up test, STS and attain stand through half knee
were used. The children were instructed to perform as
many repetitions as possible in 30 seconds for each of
Participants ineligible the exercises. Lateral step-up and attain stand through
n=2 (planned for half knee were evaluated bilaterally. The repetition maxi-
botox or surgery)
mum for each side was used to calculate total scores for
the left and right side and thus five final scores were
obtained.23
Participants eligible to
participate on basis Activity functioning
of inclusion criteria Gross motor function was assessed using dimensions D
n=35
and E of the Gross Motor Function Measurement
(GMFM), which consists of standing, and walking, run-
ning, and jumping.24
The Bruininks–Oseretsky Test of Motor Proficiency-ver-
Randomized participants
sion 1 (BOTMP), which is a standardized, norm-refer-
n=35
enced measure used by physical therapists and
occupational therapists in clinical and school practice set-
tings, was used to assess motor function.25,26 This test is
currently used in paediatric rehabilitation to describe
motor problems of children aged between 4 years
Kinesio Taping group Control group 6 months and 14 years 6 months.27 The BOTMP includes
n=18 n=17
eight norm-referenced subtests containing 46 items, which
formulate a gross motor composite score and a fine motor
composite score. The test consists of three composites
including gross motor skills (running speed and agility,
Participants who dropped out
n=1 had allergic Did not come for last balance, bilateral coordination and strength), combined
reaction to the banding evaluation n=2 gross and fine motor skills (upper-limb coordination) and
n=2 discontinued fine motor skills (response speed, visual-motor control and
treatment for no reason
upper-limb speed and dexterity). Intraclass correlation
coefficient values for intrarater and interrater reliabilities in
the BOTMP were 0.998 to 0.999 and 0.987 to 0.998
Repeat outcome Repeat outcome respectively.27
measures n=15 measures n=15
ACTIVITIES OF DAILY LIVING
The Functional Independence Measure for Children (Wee-
FIM) was used to assess the level of independence in activ-
ities of daily living. The method measures functional
Figure 1: Flow chart of participants. performance in three domains: self-care, mobility, and cog-
nition.28 The lowest total score is 18 and the highest total
score 126.29 Intrarater (r=0.92) and interrater (r=0.81) reli-
ability has been demonstrated using this measure.30
Velocity ðm=sÞ ¼ 15 m=time
Outcome measures were evaluated at baseline and after
the intervention (week 12) by two experienced physiothera-
Acceleration ðm=s2 Þ ¼ velocity=time
pists blinded to group allocation of the children. All partic-
ipants were evaluated with the WeeFIM31 and
Force ðkg=s2 Þ ¼ body mass  acceleration BOTMP25,26 by a physical therapist with 14 years’ occupa-
tional therapy experience and GMFM,32 Muscle Power
Power (watts) ¼ force  velocity Sprint Test,22 1095m sprint test,22 and 30 seconds Repeti-
tion Maximum test23 by a physiotherapist with 8 years’
Agility was measured using the 1095m sprint test that experience. Oxygen saturation and heart rate were mea-
has been found to be reliable and valid in children with sured with a pulse oximeter just before and after, and
CP.22 10 minutes after the assessments.

Effects of Kinesio Taping Ozgun Kaya Kara et al. 83

Intervention Taping group (eight males, seven females; mean age 9y
The children were taped 6 days per week for a total of [SD 2y 3mo] range 7–12y) and the control group (seven
72 days extending over a period of 12 weeks. The 5cm males, eight females; mean age 9y 7mo [SD 3y 4mo] range
tape (Kinesio Tex, Gold; Kinesio UK, Newcastle upon 7–14y) receiving usual care. Descriptive statistics are shown
Tyne, UK) we used was kept in position for 3 days and in Table I. There were no statistical differences between
the region was then left to rest for 24 hours. Kinesio Tap- the groups. Baseline data showed that each group was
ing was then re-applied by the same experienced research well-matched including age, height, weight, BMI, sex,
assistants for another 3 days. One of them taped upper hemiplegic side, and functional level.
extremities and the other taped lower extremities. For
upper and lower limb application, the buttonhole wrist Body functions
extension for space correction technique, fascia correction At baseline, there were no statistically significant differ-
technique with ‘I’ taping for scapular stabilization and pos- ences between the Kinesio Taping and control groups.
tural control, the muscle technique with ‘I’ taping for fore- Median scores and comparison of baseline scores before
arm supination support, ‘I’ band to facilitate hip abduction and after treatment are presented in Table II. After
(gluteus medius muscle facilitation technique), and func- 12 weeks, the Taping group showed improvement in the
tional correction for knee hyperextension and dorsiflexion Muscle Power Sprint Test (mean 8.15, ES 0.56,
were used for all patients. The control group received rou- p=0.011), lateral step-up test right and left (mean 3.93,
tine traditional therapy twice a week over the period of ES 0.85, p=0.01; mean: 6.4, ES 1.28, p=0.008), STS
12 weeks. This routine traditional treatment consisted of (mean 2.46, ES 1.14, p=0.004), and attain stand through
neurodevelopmental treatment by the same clinical physio- half knee right and left (mean 3.13, ES 1.46, p=0.001;
therapist (stretching, weight bearing, functional reaching, mean: 1.93, ES 0.62, p=0.039). According to the change
walking, and so on). The Taping group also attended these in outcomes from baseline to 12 weeks (Table III) the
traditional treatments. Parents were informed about the Kinesio Taping group showed significant differences in
application of Kinesio Taping. the Muscle Power Sprint Test (mean 6.63, ES 0.54,
p=0.003), lateral step-up test right (mean 3.53, ES 0.89,
Statistical analysis p=0.016), STS (mean 2.06, ES 1.01, p=0.018), and attain
The Statistical Package for the Social Sciences (SPSS) ver-
sion 21 for the Macintosh (IBM SPSS Statistics; IBM Cor-
Table I: Physical characteristics of the participantsa
poration, Armonk, NY, USA) was used to analyze the
obtained data. One-sample Kolmogorov–Smirnov Tests KT group (n=15) Control group (n=15) pb
were used to evaluate distribution of variables before test Age (y) 7.5 (7–11.5) 7.2 (7–13.7) 0.83
selection. Descriptive analyses were presented using medi- Mean (SD) 9.07 (2.39) 9.76 (3.41)
ans and the interquartile ranges for the non-normally dis- Height (cm) 1.22 (1.15–1.40) 1.21 (1.18–1.55) 0.40
Weight (kg) 24 (21–33) 23 (19–48) 0.83
tributed and ordinal variables. Differences in physical BMI (kg/m2) 16.12 (14.66–17.39) 15.70 (14.36–19.91) 0.95
characteristics between the Taping and control groups
were analyzed using the v2 test for categorical variables n (%) n (%)
(sex, hemiplegic side, MACS, GMFCS E&R, and BFMF)
Sex
and the Mann–Whitney U test for continuous variables Female 7 (46.6) 8 (53.3) 0.72
(age, height, weight, BMI). Baseline, post intervention, and Male 8 (53.3) 7 (46.6)
Hemiplegic side
change scores were calculated. The Wilcoxon signed-rank
Left 9 (60) 8 (53.3) 0.71
test was used to compare the difference in dimensions D Right 6 (40) 7 (46.7)
and E of the GMFM, short-term muscle power, agility, GMFCS E&R
Level I 10 (66.7) 14 (93.3) 0.07
functional muscle strength, BOTMP, and the WeeFIM
Level II 5 (33.3) 1 (6.7)
between baseline and post intervention scores within MACS
groups. The Mann–Whitney U test was used to compare Level I 7 (46.7) 7 (46.7) 0.66
Level II 3 (20) 5 (33.3)
change scores and the improvement differences of dimen-
Level III 5 (33.3) 3 (20)
sions D and E of the GMFM, short-term muscle power, BFMF
agility, functional muscle strength, BOTMP, and WeeFIM Level I 6 (40) 7 (46.7) 0.62
Level IIA 4 (26.7) 5 (33.3)
between groups. Effect sizes (ES) were calculated by using
Level IIB 1 (6.7) 1 (6.7)
GPower V.3.1.7 (University of Kiel, Kiel, Germany). Mean Level IIIA 4 (26.7) 2 (13.3)
differences were represented with paired and independent a
Values are median (25th, 75th centile) for continuous variables,
t-tests. The level of significance was set at p<0.05. frequency for categorical variables. bMann–Whitney U-test for con-
tinuous variables and the v2 test for categorical variables. p-values
RESULTS of <0.05 were considered significant. KT, Kinesio Taping; BMI, body
mass index; GMFCS E&R, Gross Motor Function Classification Sys-
Participants comprised 30 children with unilateral spastic tem, Extended and Revised; MACS, Manual Ability Classification
CP randomized and split equally between the Kinesio System; BFMF, Bimanual Fine Motor Function Scale.

84 Developmental Medicine & Child Neurology 2015, 57: 81–88

 Table II: Before and after treatment values of the Kinesio Taping and control groupsa

Comparison of
KT group (n=15) Control group (n=15) baseline scores

Before median After median Before median After median

(25–75%) (25–75%) Z pb (25–75%) (25–75%) Z pb Z pc

Body functions
1095m sprint test 37.85 (30.0–44.97) 35.2 (30.25–39.8) 1.533 0.125 31.75 (27.45–42.00) 35.10 (28.15–37.66) 0.312 0.755 1.05 0.290
Muscle Power Sprint 5.23 (4.18–6.0) 4.58 (4.06–5.42) 2.840 0.005d 6.31 (4.64–7.38) 5.91 (4.6–7.4) 0.028 0.977 0.95 0.340
Test (s)
Mean power (watts) 24.41 (15.58–57.84) 38.12 (24.3–63.06) 2.556 0.011d 11.66 (8.16–40.37) 13.76 (8.50–35.57) 0.341 0.733 0.726 0.468
Peak power (watts) 30.86 (16.47–75.33) 49.94 (26.28–84.59) 2.953 0.003d 14.91 (10.28–55.23) 9.56 (16.18–40.65) 0.734 0.463 0.892 0.373
Lateral step-up test right 23.0 (19.0–27.0) 26 (23–32) 2.560 0.010d 25 (19–30) 27 (20–30) 0.985 0.324 0.89 0.371
Lateral step-up test left 21.0 (19–29) 23 (20–31) 2.632 0.008d 23 (19–30) 25 (18–32) 1.263 0.207 0.58 0.560
Sit to stand 8 (7–12) 11 (9–13) 2.915 0.004d 10 (7–10) 10 (8–11) 0.724 0.469 0.31 0.751
Attain stand through 17 (15–23) 20 (18–25) 3.194 0.001d 20 (15–22) 19 (10–22) 0.600 0.549 0.35 0.723
half knee right
Attain stand through 18 (16–22) 21 (17–24) 2.069 0.039d 17 (13–21) 17 (13–20) 0.275 0.784 0.85 0.394
half knee left
Activity
Functioning
GMFM D (standing) 94.87 (87.17–100) 97.43 (94.87–100) 2.201 0.028d 97.43 (89.74–100) 97.43 (94.87–100) 1.604 0.109 0.40 0.684
GMFM E (walking, 95.83 (91.66–98.61) 97.22 (97–100) 2.812 0.005d 94.44 (93.04–98.61) 95.83 (94.44–100) 2.096 0.036d 0.23 0.818
running, jumping)
BOTMP total 2 (0–3) 2 (0–4) 1.099 0.272 2 (1–4) 2 (1–5) 0.323 0.746 0.84 0.399
Gross 12 (3–16) 13 (8–21) 2.240 0.025d 12 (6–23) 11 (0–18) 1.340 0.180 0.62 0.533
Fine 11 (5–16) 11 (7–15) 0.900 0.368 9 (6–19) 11 (5–19) 0.491 0.624 0.47 0.633
WeeFIM total 113 (91–119) 116 (104–120) 3.315 0.001d 120 (117–126) 121 (117–126) 1.414 0.157 2.49 0.013d
Self-care 34 (24–38) 33 (28–40) 2.437 0.015d 40 (37–42) 40 (40–42) 1.638 0.101 2.84 0.004d
Sphincter 14 (14–14) 14 (14–14) 1.414 0.157 14 (14–14) 14 (14–14) 0.000 1000 1.79 0.073
Mobility 19 (15–21) 20 (17–21) 2.232 0.026d 21 (19–21) 21 (20–21) 1.857 0.063 1.55 0.119
Locomotion 13 (11–14) 14 (12–14) 1.841 0.066 14 (14–14) 14 (14–14) 1000 0.317 1.90 0.057
Communication 14 (11–14) 14 (14–14) 1.633 0.102 14 (12–14) 13 (12–14) 0.816 0.414 2.27 0.785
Social communication 20 (15–21) 20 (18–21) 1.841 1000 21 (18–21) 21 (18–21) 1.414 0.157 1.08 0.279
a
Values are median (25th, 75th centile). bp-value for within-group change calculated using Wilcoxon signed-rank test. cp-value for between-group difference in baseline scores calculated
using Mann–Whitney U tests. dStatistically significant at p<0.05. KT, Kinesio Taping; GMFM, Gross Motor Function Measurement; BOTMP, Bruininks–Oseretsky Test of Motor Proficiency-
version 1; WeeFIM, Functional Independence Measure for Children. Bold values statistically significant p < 0.05.

Effects of Kinesio Taping Ozgun Kaya Kara et al. 85

Table III: Comparison of change in outcomes from baseline to 12 weeks in the Kinesio Taping and control groups

Differences between baseline and 12 weeksa KT group Control group Mann–Whitney U pb

Body functions Mean (SD) Mean (SD)

Muscle Power Sprint Test (s) 0.60 (0.67) 0.0527 (0.44) 37.50 0.002c
Mean power (watts) 8.15 (14.55) 1.51 (9.49) 42.00 0.003c
Peak power (watts) 13.74 (13.97) 0.61 (14.66) 33.00 0.001c
Lateral step-up test right 3.93 (4.5) 0.4 (3.31) 55.00 0.016c
Lateral step-up test left 2.26 (2.57) 0.73 (3.57) 85.00 0.259
Sit to stand 2.46 SD 2.16 0.4 (1.88) 56.50 0.018c
Attain stand through half knee right 3.13 (2.13) 0.06 (2.76) 42.00 0.003c
Attain stand through half knee left 1.93 (3.12) 0.2 (1.85) 67.50 0.059
BOTMP Gross 3.33 (4.95) 2.33 (6.99) 56.00 0.019c
Activity functioning
GMFM D (standing) 3.23 (4.88) 1.37 (3.47) 89.50 0.239
GMFM E (walking, running, jumping) 2 (2.12) 0.94 (1.81) 84.00 0.227
WeeFIM total 4.4 (3.88) 0.93 (2.18) 42.00 0.003c
Self-care 1.46 (2.06) 0.6 (1.24) 59.00 0.022c
Mobility 0.8 (1.2) 0.4 (0.73) 94.50 0.371
a
Post-intervention change calculated by subtracting baseline value from post-session value. bp-value for between-group difference calcu-
lated using Mann–Whitney U tests. cStatistically significant at p<0.05. KT, Kinesio Taping; SD, standard deviation; GMFM, Gross Motor
Function Measurement; BOTMP, Bruininks–Oseretsky Test of Motor Proficiency-version 1; WeeFIM, Functional Independence Measure for
Children. Bold values statistically significant p < 0.05.

stand through half knee right (mean 3.06, ES 1.24, motor capacity in children with CP who were classified in
p=0.003). GMFCS levels I and II. In the current study, a 12-week
application of Kinesio Taping led to increased functional
Activity functioning muscle strength, short-term muscle power, and gross
This data is presented in the second part of Table II. The motor capacity with no statistically significant difference in
control group had statistically significantly greater Wee- agility. A possible explanation for this is that the short
FIM total and self-care scores than the Taping group at duration of 12 weeks may not have provided the task-spe-
baseline (p=0.013; p=0.004). The Taping group showed cific practice necessary to improve agility, and the ability
significant improvement in the GMFM dimension D and to change the direction of the body in an efficient and
E, BOTMP Gross, and WeeFIM total, self-care, and effective manner. Agility requires the child to possess a
mobility scores after 12 weeks (mean 3.23, ES 0.66, combination of balance, speed, and coordination. Routine
p=0.028; mean 2.00, ES 0.94, p=0.005; mean 3.33, ES physiotherapy programmes should, therefore, focus on the
0.67, p=0.025; mean 4.4, ES 1.12, p=0.001; mean 1.46, ability to change the direction of the body suddenly with-
ES 0.70, p=0.015; mean 0.8, ES 0.66, p=0.026 respec- out losing balance. There is only one recent pilot study
tively). The control group showed improvement only in that investigated the effects of Kinesio Taping on the STS
the GMFM dimension E score after 12 weeks (mean movement and kinematic changes in four children with
0.94, ES 0.52, p=0.036). A significant difference was CP.17 The authors also assessed dynamic postural control
found between the Taping group and the control group and balance with the Paediatric Balance Scale (PBS) and
(Table III) for the BOTMP Gross scores, and WeeFIM timed up and go (TUG) tests. They found significant
total and self-care scores (mean: 5.66, ES 0.16, p=0.019; improvements in the PBS dynamic score, TUG, STS per-
mean 3.46, ES 1.102, p=0.003; mean 0.86, ES 0.505, formance, peak ankle flexion, and knee extension of end
p=0.022 respectively). point of motion. These results proved that Kinesio Taping
improved STS motion. Da Costa et al.17 clarified the rea-
DISCUSSION son for this improvement as better postural orientation
This is the first single-randomized controlled study on the leading to development of postural control, greater knee
effects of Kinesio Taping on performance-related physical extension and less ankle flexion at the end of the STS
fitness, gross and fine motor capacity, and functional inde- movement, and better stabilization in the gravity centre.
pendence in daily living activities in children with unilat- Similarly, our results indicate that Kinesio Taping
eral spastic CP. Our primary findings indicate that Kinesio improved STS performance. We agree with da Costa et al.
Taping improves short-term muscle power, functional regarding the reasons for this improvement. Furthermore,
muscle strength, gross motor function, and independent we think that other possible reasons for the improvement
activities in the daily life of children with unilateral CP. are increasing the stability and weight bearing of the
Performance-related physical fitness is associated with affected side by facilitation of the gluteus medius, tibialis
balance, agility, short-term muscle power (anaerobic anterior, and quadriceps muscles.
performance), and functional muscle strength in CP. The gross motor capacity increased according to the
Verschuren et al.2 found a moderate to high correlation BOTMP Gross scores and GMFM dimensions D and E
between performance-related physical fitness and gross results in the Taping group in our study. However, GMFM

86 Developmental Medicine & Child Neurology 2015, 57: 81–88

dimension E scores were also enhanced in the control Physical fitness is often poor and affects daily living
group. When the groups were compared regarding the activities in children with spastic CP. Almost all daily
effectiveness of Kinesio Taping after 12 weeks, there was no activities in the childhood period are short-burst and high
statistically significant difference between the groups for intensity. Therefore, increasing short-term muscle power
GMFM dimensions D and E but the BOTMP Gross score and functional muscle strength could be a sign of improved
was improved in the Taping group. GMFM scores tend to performance of daily living activities in children with CP.
reach their highest levels in children with CP with high Other studies related to taping have commonly focused on
motor ability, and especially in those at GMFCS level I. the upper extremities. Although we found no significant dif-
BOTMP is a well-validated measure of motor coordina- ference regarding fine motor functions according to BOT-
tion.27 BOTMP includes more functional parameters and MP, the WeeFIM total and self-care scores improved
can, therefore, be another option for assessing gross motor significantly with Kinesio Taping. Improvement of daily life
function in children with CP. Improvement of functional activities and self-care may be associated with fine motor
muscle strength and short-term muscle power might also skills but we were unable to show this association using the
positively affect gross motor capacity. Only a few studies BOTMP and we believe that it is not easy to identify the
have previously investigated the effect of taping techniques quality of fine motor movements. Mazzone et al.14 explored
on gross motor function. Footer focused on the effects of the effects of functional taping on the upper extremity of chil-
therapeutic taping on gross motor function in children with dren with CP and assessed motor performance using the
CP.15 The author divided 18 children with quadriplegia into Upper Limb Assessment. They reported a significant
taping and control groups and found no significant improve- improvement in the 5-month period of functional taping,
ment on postural control in the sitting position according to while the gains were not preserved in the physiotherapy-only
the GMFM-88 with a decrease in involuntary movement period. They indicated that functional taping could allow a
and increase in trunk stability in only one child with athe- more functional range of motion, and improve selective finger
toid CP.15 Our study showed an increase in GMFM dimen- movements and fine motor manipulation.14 Yasukawa et al.7
sion E in both groups and GMFM dimension D in only the investigated the effects of Kinesio Taping in acute paediatric
Kinesio Taping group. Footer included children at GMFCS rehabilitation settings as assessed with the Upper Limb
levels IV and V who had severe limitations while our study Assessment before and just after taping and after 3 days of
included children at GMFCS levels I and II. Iosa et al.6 wearing the tape. They showed that Kinesio Taping enabled
applied functional taping (6d/wks for 6mo) to the ankles of goal-directed movement, increased stability of the shoulder
eight unilateral spastic children. Nevertheless, using taping and hand, and supported alignment during reaching and
in children for 6 days may cause allergic reactions and diffi- grasping.7 However, we chose the BOTMP to demonstrate
culties in the clinic. As a precaution, we used Kinesio Tap- the effects of taping on fine motor activities. The BOTMP
ing twice a week for 12 weeks and removed it for 72 hours, fine motor subtest consists of visual motor, upper-limb speed,
had the child rest 1 day, then applied it again to the neces- and dexterity parameters. Participants often perform test
sary muscles and joints. The functional and mechanical parameters using a pencil. Children with hemiplegia have to
effect of taping could therefore be seen more clearly and the use their non-dominant hand for such tests if their dominant
procedure was more tolerable for the children and parents. side is affected and we believe that this is the primary reason
To our knowledge, there is only one study with a con- we could not show improvement. In a case study, Camerota
trol group that investigated the effect of Kinesio Taping et al. assessed a 17-year-old female with left hemiplegia with
on sitting posture, gross motor function, and functional 3D motion analysis before and after neuromuscular taping.
independence as assessed with GMFM, the WeeFIM, and Their results have proved that Kinesio Taping recruited
the Sitting Assessment Scale (SAS).16 GMFM and SAS upper limb function, especially the preparation of motion and
scores improved in both groups after treatment but the returning phases.13 Future randomized controlled studies
WeeFIM scores increased significantly only in the Taping with instrumented 3D movement analysis might ensure
group.16 This improvement of WeeFIM scores was objective measurement of fine motor movements.
because of increased trunk stability and better postural The main strength of the current study is that it is the
alignment.16 Simsek et al. assessed independence of daily first single-blind randomized controlled trial. Previous
living activities using WeeFIM total scores. However, they studies have also shown that the facilitating effect of
did not provide the section scores, making it impossible to Kinesio Taping on cutaneous mechanoreceptors results in
determine where the improvement they noticed origi- physiological changes in the taping area and improves
nated.16 Although our control group’s WeeFIM total and muscle excitability.33 We think that Kinesio Taping could
self-care baseline scores were better than in the Taping stimulate cutaneous mechanoreceptors in children with
group, the WeeFIM total and self-care scores improved unilateral spastic CP and thus improve proprioceptive
significantly after 12 weeks in the Taping group. WeeFIM inputs for muscles to perform task-specific functions.
mobility scores also improved after 12 weeks in the Taping These positive effects of mechanoreceptors could cause
group. The Kinesio Taping group therefore had more improvement in performance-based physical fitness, gross
improvement regarding independence in activities of daily motor capacity, and independent function in daily activi-
living. ties. Clinically, our results could help physiotherapists to

Effects of Kinesio Taping Ozgun Kaya Kara et al. 87

enhance their rehabilitation programme as well as contrib- fitness, gross motor function, and activities of daily living.
ute to the growing evidence on Kinesio Taping. Future randomized controlled studies are needed to inves-
tigate the effects of taping with instrumented 3D move-
Limitations ment analysis in both the upper and lower extremities of
The limitation of this study was that the effects of Kinesio children with unilateral CP.
Taping on the social participation section of ICF-CY
parameters were not evaluated. Future studies should focus A CK N O W L E D G E M E N T S
on investigating the effects of taping techniques on the We thank Associate Professor Akmer Mutlu PT PhD from Fac-
social participation of children with CP and long-term fol- ulty of Health Sciences at Hacettepe University and Associate
low up of Kinesio Taping. Professor Cengizhan Acikel MD from Department of Biostatistics
at Gulhane Military Medical Academy for their great support in
CONCLUSION all the steps of the study process.
Kinesio Taping is a promising additional approach to The authors have stated that they had no interests that might
increasing proprioceptive feedback and improving physical be perceived as posing a conflict or bias.

REFERENCES
1. Rosenbaum P, Paneth N, Leviton A, et al. A report: the in a patient with hemiplegia. Dev Neurorehabil 2014; 17: extremity in children with cerebral palsy. Disabil Rehabil
definition and classification of cerebral palsy April 2006. 384–7. 2008; 30: 1358–66.
Dev Med Child Neurol Suppl 2007; 109: 8–14. 14. Mazzone S, Serafini A, Iosa M, et al. Functional taping 24. Russell D, Rosenbaum P, Gowland C. Gross Motor
2. Verschuren O, Ketelaar M, Gorter JW, Helders PJ, applied to upper limb of children with hemiplegic cere- Function Manual. Hamilton, ON: McMaster University,
Takken T. Relation between physical fitness and gross bral palsy: a pilot study. Neuropediatrics 2011; 42: 249–53. 1993.
motor capacity in children and adolescents with cerebral 15. Footer CB. The effects of therapeutic taping on gross 25. Bruininks R. Bruininks–Oseretsky Test of Motor Profi-
palsy. Dev Med Child Neurol 2009; 51: 866–71. motor function in children with cerebral palsy. Pediatr ciency: Examiner’s Manual. Circle Pines, MN: American
3. Berker AN, Yalcin MS. Cerebral palsy: orthopedic Phys Ther 2006; 18: 245–52. Guidance Service Inc., 1978.
aspects and rehabilitation. Pediatr Clin North Am 2008; 16. Simsek TT, Turkucuoglu B, Cokal N, Ustunbas G, 26. Duger T, Bumin G, Uyanik M, Aki E, Kayihan H. The
55: 1209–25. Simsek IE. The effects of Kinesio(R) taping on sitting assessment of Bruininks-Oseretsky test of motor profi-
4. Krageloh-Mann I, Cans C. Cerebral palsy update. Brain posture, functional independence and gross motor func- ciency in children. Pediatr Rehabil 1999; 3: 125–31.
Dev 2009; 31: 537–44. tion in children with cerebral palsy. Disabil Rehabil 2011; 27. Chen CL, Chen CY, Chen HC, Liu WY, Shen IH, Lin
5. Novak I, McIntyre S, Morgan C, et al. A systematic 33: 2058–63. KC. Potential predictors of changes in gross motor func-
review of interventions for children with cerebral palsy: 17. da Costa CS, Rodrigues FS, Leal FM, Rocha NA. Pilot tion during various tasks for children with cerebral palsy:
state of the evidence. Dev Med Child Neurol 2013; 55: study: investigating the effects of Kinesio Taping(R) on a follow-up study. Res Dev Disabil 2013; 34: 721–8.
885–910. functional activities in children with cerebral palsy. Dev 28. Schiariti V, Klassen AF, Cieza A, et al. Comparing con-
6. Iosa M, Morelli D, Nanni MV, et al. Functional taping: Neurorehabil 2013; 16: 121–8. tents of outcome measures in cerebral palsy using the
a promising technique for children with cerebral palsy. 18. Lee AM. Using the ICF-CY to organise characteristics of international classification of functioning (ICF-CY): a
Dev Med Child Neurol 2010; 52: 587–9. children’s functioning. Disabil Rehabil 2011; 33: 605–16. systematic review. Eur J Paediatr Neurol 2014; 18: 1–12.
7. Yasukawa A, Patel P, Sisung C. Pilot study: investigating 19. Rosenbaum PL, Palisano RJ, Bartlett DJ, Galuppi BE, 29. Sanders JO, McConnell SL, King R, et al. A prospective
the effects of Kinesio Taping in an acute pediatric reha- Russell DJ. Development of the Gross Motor Function evaluation of the WeeFIM in patients with cerebral
bilitation setting. Am J Occup Ther 2006; 60: 104–10. Classification System for cerebral palsy. Dev Med Child palsy undergoing orthopaedic surgery. J Pediatr Orthop
8. Morris D, Jones D, Ryan H, Ryan CG. The clinical Neurol 2008; 50: 249–53. 2006; 26: 542–6.
effects of Kinesio(R) Tex taping: a systematic review. 20. Akpinar P, Tezel CG, Eliasson AC, Icagasioglu A. Reli- 30. Ottenbacher KJ, Msall ME, Lyon NR, Duffy LC, Gran-
Physiother Theory Pract 2013; 29: 259–70. ability and cross-cultural validation of the Turkish ver- ger CV, Braun S. Interrater agreement and stability of
9. Kase K, Martin P, Yasukawa A. Kinesiotaping in Pediat- sion of Manual Ability Classification System (MACS) for the Functional Independence Measure for Children
rics. Fundamentals and Whole Body Taping. Albuquer- children with cerebral palsy. Disabil Rehabil 2010; 32: (WeeFIM): use in children with developmental disabili-
que, NM: Kinesio Taping Association, 2006. 1910–6. ties. Arch Phys Med Rehabil 1997; 78: 1309–15.
10. Paoloni M, Bernetti A, Fratocchi G, et al. Kinesio Tap- 21. Beckung E, Hagberg G. Neuroimpairments, activity 31. Aybay C, Erkin G, Elhan AH, Sirzai H, Ozel S. ADL
ing applied to lumbar muscles influences clinical and limitations, and participation restrictions in children assessment of nondisabled Turkish children with the Wee-
electromyographic characteristics in chronic low back with cerebral palsy. Dev Med Child Neurol 2002; 44: FIM instrument. Am J Phys Med Rehabil 2007; 86: 176–82.
pain patients. Eur J Phys Rehabil Med 2011; 47: 237–44. 309–16. 32. Rosenbaum PL, Walter SD, Hanna SE, et al. Prognosis
11. McGlone F, Reilly D. The cutaneous sensory system. 22. Verschuren O, Takken T, Ketelaar M, Gorter JW, for gross motor function in cerebral palsy: creation of
Neurosci Biobehav Rev 2010; 34: 148–59. Helders PJ. Reliability for running tests for measuring motor development curves. JAMA 2002; 288: 1357–63.
12. Gordon AM, Bleyenheuft Y, Steenbergen B. Pathophysi- agility and anaerobic muscle power in children and 33. Yoshida A, Kahanov L. The effect of kinesio taping on
ology of impaired hand function in children with adolescents with cerebral palsy. Pediatr Phys Ther 2007; lower trunk range of motions. Res Sports Med 2007; 15:
unilateral cerebral palsy. Dev Med Child Neurol 2013; 55: 19: 108–15. 103–12.
32–7. 23. Verschuren O, Ketelaar M, Takken T, Van Brussel M,
13. Camerota F, Galli M, Cimolin V, et al. Neuromuscular Helders PJ, Gorter JW. Reliability of hand-held dyna-
taping for the upper limb in cerebral palsy: a case study mometry and functional strength tests for the lower

88 Developmental Medicine & Child Neurology 2015, 57: 81–88