Functional taping: a promising technique for children with cerebral palsy

SIR–Limitations in the motor activity of children with cerebral palsy (CP) are the consequence of a failure to acquire appropriate motor schemas, caused by arrested normal brain maturation. Nevertheless, some of these children, exploiting their few available resources,¹ manage to walk, thanks to the emergence of atypical but still functional locomotor patterns.^2,3 However, these patterns can lead to long-term instability, contractures, and deformities.⁴

Common treatments for children with CP include botulinum toxin, serial casting, orthopaedic surgery, and orthoses.⁵ These somewhat invasive interventions are designed to act at the peripheral level, without particularly aiming at promoting more normal motor development at the central level. Functional taping may be a slightly less invasive solution in trying to reach this objective. This technique, commonly used in sports traumatology and lately proposed for patients with stroke,⁶ aims at supporting an injured joint, protecting weak structures, and enhancing sensory feedback.^7,8 This much less invasive intervention could favour the integration of therapy and daily activities and increase participation in social life. Nevertheless, it has been only applied infrequently in these children^9,10 and only at upper-body level. A pilot study was performed to test the effects of lower limb taping on the locomotor function of a group of children with spastic unilateral CP.¹¹ These children were already being treated with conventional physical therapy consisting of 1-hour treatment, repeated two times a week and based on neurodevelopmental treatment (derived from the Bobath concept).¹² It included stretching, weak muscle strengthening, and postural and walking training. However, in the months preceding the study, the above therapy alone was judged to be no longer effective for the children because expected improvements¹³ in gross motor function were not being achieved.

After the approval of the ethical committee of Fondazione Santa Lucia and the informed consent of both parents, eight children (initial mean age of 4y and 8m, SD 3y, all diagnosed with spastic unilateral CP; Table SI, supporting information published online, who were able to walk independently, were treated for 12 months adding functional taping to the previously described physiotherapy in the first 6 months. The taping was applied in order to: (1) limit the movements that can cause instability, contractures, and deformities; (2) facilitate the emergence of safer and more symmetrical and efficient locomotor schemas; and (3) reduce the social participation restriction by allowing the use of the children usual clothing and shoes.

Different types of bandages (band of polyurethane foam in contact with the skin, adhesive elastic bandage, memory foam band), resistant anelastic tape, and silk and paper patches were used to restrain pathological movements and simultaneously favor functional movements (Figure SI, supporting information published online). Ankle taping was applied weekly, kept in site for 6 days, and then removed by the patient’s parents, leaving the child without taping 1 day a week. The taping was repeated for 6 months, and was adjusted by the physiotherapist in accordance with possible functional changes, evaluated through visual assessment of the child walking without taping. If necessary, the taping was extended to the knee and the hip joint.

The motor ability of the children was assessed using clinical measures (ankle passive range of motion [ROM_p], ankle Ashworth scale, and Gross Motor Function Measure-88, [GMFM]) and instrumented gait analysis. The assessment was repeated, without taping, before the treatment (T0), at the end of the 6-month of taping (T6), and 6 months later (T12).

Results showed the acquisition of more functional (incremented GMFM and walking speed), stable (reduced step width and recurvatum knee) and symmetric (more similar step length and ankle ab/adduction and internal/external rotation between the two limbs) locomotor patterns (Table I, Fig. 1). Interestingly, the increment of the GMFM scores was higher than that associated with natural gross motor development.^13,14 However, the equinus foot was not corrected by the taping.

Observed functional improvements were not accompanied by evident changes in the ankle ROM_p and Ashworth values. This result could represent a specific difference between functional taping and serial casting. Serial casting, in fact, typically leads to short-term improvements on ROM_p, but does not always improve active functioning^15,16 since it may lead to muscle wasting, weakening spastic and non-spastic muscles.⁵ Functional taping, conversely, provides support to the weak muscles, facilitating their normal activity. The only patient that did not show any improvement (patient 6) was a child who also had dyspraxia with sensory integration dysfunction and hence was less likely to be able to properly exploit the enhanced sensory feedback provided by the taping intervention.^8,17

Further randomized controlled investigations on wider samples are certainly needed to assess effectively the effects of the taping treatment. Nevertheless, the fact that observed gait improvements occurred during the treatment period and were then maintained, without further changes, in the following 6 months suggests that they are a consequence of the taping intervention. These results should be read in conjunction with the level of satisfaction reported by the children and parents in a short questionnaire purposely administered to them at the end of the study. Parents reported positive feedback about the effects of the functional taping on children’s participation in social activities, locomotor ability, and compliance and tolerability to the treatment.

In conclusion, functional taping seems to be a promising intervention for improving locomotor function in children with CP.