Accepted Manuscript

The effect of kinesiotaping on hand function in stroke patients: A pilot study

Fathollah Qafarizadeh, Minoo Kalantari, Noureddin Nakhostin Ansari, Alireza

Akbarzadeh Baghban, Aliasqar Jamebozorgi

PII: S1360-8592(17)30239-5
DOI: 10.1016/j.jbmt.2017.09.015
Reference: YJBMT 1602

To appear in: Journal of Bodywork & Movement Therapies

Received Date: 17 October 2016

Revised Date: 26 July 2017
Accepted Date: 29 July 2017

Please cite this article as: Qafarizadeh, F., Kalantari, M., Ansari, N.N., Baghban, A.A., Jamebozorgi,
A., The effect of kinesiotaping on hand function in stroke patients: A pilot study, Journal of Bodywork &
Movement Therapies (2017), doi: 10.1016/j.jbmt.2017.09.015.

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 ACCEPTED MANUSCRIPT
The Effect of kinesiotaping on hand function in stroke patients:
a pilot study
Authors
Fathollah Qafarizadeh, MSc, OT, Department of Occupational therapy, School of
Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Minoo Kalantari, PhD, OT, Assistant Professor, Department of Occupational therapy,

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School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Noureddin Nakhostin Ansari, PhD, PT, Professor, Department of Physiotherapy, School of

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Rehabilitation, Tehran University of Medical Sciences, Sports Medicine Research Center,
Tehran University of Medical Sciences, Neuromusculoskeletal Research Center, Iran
University of Medical Sciences, Tehran, Iran

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Alireza Akbarzadeh Baghban, PhD, Biostatistics, Professor, Department of Occupational
therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran,
Iran

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Aliasqar Jamebozorgi, MSc, OT, Department of Occupational therapy, School of
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Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Corresponding Author:
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Aliasqar Jamebozorgi, MSc, OT

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Department of Occupational therapy

Physiotherapy Research Centre, School of Rehabilitation, Shahid Beheshti University of
Medical Sciences
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Damavand Ave, Imam Hossein Sq, Opposite of Booali Hospital

Postal code: 1616913111
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Tehran - Iran
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Phone (Office): +98 2177548496 – +98 2177542057

Email: aas.bozorgi@yahoo.com
Fax: +98 2177591807
Article code: YJBMT1022

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Abstract

Upper extremity motor impairment is one of the most prevalent problems following stroke.
Considering the functional importance of the upper extremity in the daily life, the purpose of
this study was to investigate the effect of kinesiotaping (KT) on hand function and spasticity
in individuals following a stroke. Eight individuals who had experienced a stroke, with their

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age ranging from 47 to 66, participated in this pretest-posttest clinical study. An I- strip of
tape was placed on the extensor muscles of the forearm. Primary outcome measures were the

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Modified Modified Ashwoth Scale, Box and Block test, and Nine Hole Peg test. At the
immediate assessment, there were significant differences between two hand function tests

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scores. Secondary assessment was done after one week and the results showed significant
differences between two hand function test scores. There was no significant change in flexor
muscles spasticity after the intervention. This pilot study indicated that KT in the direction of

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the extensor muscles could result in better hand function in stroke patients.
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Keywords: Stroke, Kinesiotaping, Hand function, extensor muscles, spasticity
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Introduction
Stroke is a common disease worldwide, with an estimated incidence of 150 per
100000 in the developing countries (Bogousslavsky, 1999). A great number of patients have
activity limitations caused by motor, cognitive, lingual and psychological impairments after
stroke(Paul et al., 2007; Feigin et al., 2008). Living with the consequences can enormously
impact daily life, resulting in the diminished health-related quality of life (HRQOL) in most

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patients(Visser et al., 2015). Motor impairment is the main cause of disability after stroke,
leading to major health problems (Boggio et al., 2007; Clarke et al., 1999). Research has

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shown that the most common consequence of stroke is the paresis of limbs; about 60-70%
of stroke survivors suffer from the paresis of their upper limbs (Rathore et al., 2002). The

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ability to live independently after a stroke depends on the recovery of motor functions,
particularly those of the upper limb (Veerbeek et al., 2011).

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Kinesiotaping (KT) is widely used in the field of rehabilitation, both for the treatment
and prevention of sports-related injuries (Jaraczewska and Long, 2006). Its intended use as a
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therapeutic modality in the clinical setting involves the application of elastic adhesive tape
on the skin for pain reduction, joint approximation, and improvement in the range of motion
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(ROM), strength and activity(van de Water and Speksnijder, 2010; Paci et al., 2005; Reiter et
al., 1998; Williams et al., 2012; Appel et al., 2011). Numerous clinical studies have examined
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the use of adhesive taping as a therapeutic modality in individuals with post-stroke, showing
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mixed results. Some studies have reported that the use of KT for upper extremity may
improve function and spasticity (Appel et al., 2011;Carda and Molteni, 2005; Hayner, 2012).
Some other studies have shown no significant benefit after KT in this population (Hanger et
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al., 2000; Pandian et al., 2013). To the best of our knowledge, there are only two studies
investigating the effect of KT on hand function. One study reported that home application of
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KT for hemiplegic stroke patients resulted in significant improvements in the activities of

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daily living, joint range of motion (ROM) and hand motions (Kim et al., 2002); another study
has reported that adhesive taping combined with botulinum toxin could have a better
impact on the reduction of spasticity (Carda and Molteni, 2005). The available evidence
supporting KT use after stroke is not sufficient; therefore, the present study was designed to
investigate the effects of KT on hand function in stroke patients.

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Methods

Participants

A total of 8 individuals with hemiparesis post-stroke were recruited for this pilot
clinical study. Stroke participants were recruited from Tabasom Outpatient Therapeutic
Center in Tehran, Iran. Inclusion criteria were as follows: 1) considering a minimum of 6

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months after their last stroke occurrence, 2) ensuring the absence of upper extremity joint
contracture, 3) having the ability to maintain a seated position in a chair, 4) considering the
absence of cognitive deficits, 5) not being under treatment for spasticity, 6) not suffering

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from other neurological pathologies, and 7) stage 4 of Brunnstrom recovery stages of hand
function.

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Procedure

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This study was approved by “Shahid Beheshti University of Medical Sciences” Ethics
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Committee. All assessments were administered individually by an Occupational therapist
(OT) in a single session that lasted about 1 hour. Participants were informed in writing about
the objectives, benefits, and possible inconveniences associated with the research protocol;
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they were assured that their participation in the research was voluntary and they could
withdraw from the study whenever they wished. We considered three times assessments to
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collect data: 1- initial assessment before KT, 2- immediate assessment after KT, 3- secondary
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assessment one week after KT. After obtaining signed consent forms and initial assessment,
Taping was performed by the OT. The subjects were taped in accordance with Kenzo Kase’s
Kinesiotaping Manual (Kase, 2016). We use a piece of the TEM TEX brand tape that has five
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Centimeter width and fifteen Centimeter length. Taping was applied in the sitting position in
which wrist muscles were in resting position and forearm was in natural pronated. A I- strip
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of tape was placed on the extensor muscles of the forearm from proximal to distal (origin of
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extensor muscles to distal of metacarpals) and stretched approximately to 50% of its

maximum length. Tape was changed each three days or in necessary situation.

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Outcome measures

There were four tools for collecting data:

Demographic questionnaire: containing general and medical information such as sex, age,
and duration of stroke.

Modified Modified Ashworth Scale (MMAS): The MMAS was developed for the

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assessment of muscle spasticity (Ansari et al., 2006). The MMAS measures spasticity
according to the following scale: 0= No increase in muscle tone; 1= Slight increase in

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muscle tone, manifested by a catch and release, or by minimal resistance at the end of the
range of motion when the affected part(s) is/are moved in flexion or extension; 2= Marked

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increase in muscle tone, manifested by a catch in the middle range and resistance throughout
the remainder of the range of motion, but affected part(s) is/are easily moved; 3=
Considerable increase in muscle tone, passive movement difficult; and 4= Affected part(s)

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rigid in flexion or extension. Studies have shown that MMAS is a reliable and valid measure
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of spasticity after stroke (Naghdi et al., 2008a; Naghdi et al., 2008b). In this study, the
Persian version of MMAS was used for assessing wrist flexors spasticity (Nakhostin Ansari
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et al., 2012).
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Box and Block Test (BBT): BBT measures gross manual dexterity(Desrosiers et al.,
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1994).The Box and block test consisted of a wooden box 53.7 cm by 25.4 cm. It was divided
into two equal compartments by a 15.2 cm high partition. The subject was instructed to
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transfer as many 2.5 cm cubes as possible from one compartment to the other in one minute;
the subject's score was the number of cubes transferred in one minute (Mathiowetz et al.,
1985a). The results showed that the test-retest reliability of BBT was high (intraclass
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correlations coefficients of 0.89 to 0.97), and the validity of the test was shown by the
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significant correlations between the BBT, an upper limb performance measurement and a
functional independence measurement(Desrosiers et al., 1994).

Nine Hole Peg Test: Nine Hole Peg Test is commonly used by occupational therapists as a
simple and quick measure of finger dexterity (Grice et al., 2003).The patient was asked to
pick up nine dowels from a tray at table height and place them as quickly as possible into
nine holes in a neighbouring horizontal board(Mathiowetz et al., 1985b). A very high
interrater reliability was obtained for both the right and left hands (r = 0.984 and r = 0.993,

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respectively). The test-retest reliability coefficient was low enough to moderate for both the
right and left hand (r = 0.459 and r = 0.442, respectively)(Grice et al., 2003).

Statistical analysis

For data analysis, SPSS, V 18.0, was used. Data normality was tested using

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Kolmogorov-Smirnov test; a paired T-test was used to compare the outcomes before and after
treatment. The Wilcoxon signed rank test (WSRT) was used to test the effects of KT on the

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spasticity MMAS scores. Significance level was set at 0.05 for all analyses.

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Results

Eight persons (4 men and 4 women), with the mean age of 57 (SD=±8.28) and the

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mean of 21.37 (SD=±13.85) month post stroke participated in the study. 3 and 5 patients had
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right and left hemiplegia, respectively. The Paired T-test analysis revealed statistically
significant differences for BBT and NHPT outcome measures at the follow-up. At the
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immediate assessment after KT, there were significant differences (mean±SD scores): Box
and Block Test (12.00 ±11.26 vs 14.87±13.80, p<0.05), and Nine Hole Peg Test (2.75±2.81
vs 3.37 ±2.87, p<0.05). The secondary assessment was done after one week and like the
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immediate assessment, the results showed significant differences (mean±SD scores): Box and
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Block Test (12.00 ±11.26 vs 17.12±14.63, p<0.05), and Nine Hole Peg Test (2.75±2.81 vs
4.00 ±2.50, p<0.05). There were no significant changes in wrist flexors spasticity after the
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intervention (WSRT, p>0.05).

Discussion
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The aim of this study was to investigate the immediate and one week effects of KT on
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hand function (gross and fine motor) and spasticity. Although spasticity did not differ
significantly after KT, the results of this study showed improvement in the gross and fine
motor (hand function) after KT, as reflected by the increase in the carry number of blocks or
pegs. Many studies have provided evidence showing the favorable effects of taping. One
previous study showed that KT resulted in better dexterity and hand function. This study
concluded that KT technique could positively influence the course of treatment in the patient
with hemiplegia; it could also improve manual dexterity obtained with the help of OT
(Chunga González, 2013). Another study evaluating the effects of KT indicated that applying

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tape to the affected upper limbs of post-stroke patients reduced spasms, resulting in the
improved range of motion, strength and function (Sun et al., 2006). Although flexor muscle
spasticity did not change in this study, based on assessment, the results showed better
extensor muscle function. This finding was supported by another study using EEG, showing
that repeated taping up to two times could be useful in improving the muscle activity and the
maximum peak of the extensor muscle (Cho et al., 2014). The findings suggested that KT

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could facilitate extensor muscle function by exerting passive, low intensity and fulltime
stretch in the flexor muscles. In addition, previous studies have demonstrated that applying

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KT in the same direction as the muscle fibers can facilitate muscle function and muscle
recruitment patterns can be altered because of better proprioception by stimulating

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mechanoreceptors (Semple et al., 2012; Morrissey, 2000). It can be concluded that KT in the
direction of the extensor muscle may result in the better muscle function.

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Limitations AN
There were a number of potential limitations in the present study. There was a small
sample size and was not a control group to compare the results. The dominant hand paresis
might affect the outcome of rehabilitation; it could be a limitation of our study we did not
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determine the effects of hand dominancy on the outcome.

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Conclusion

The results of this pilot study showed that the hand gross and fine motor function
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improved after KT protocol in this sample of patients with chronic stroke. The KT protocol
did not improve the wrist flexors spasticity level. Further rigorous investigations with a large
sample size using a sham-controlled design, and a longer term follow up are needed.
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Acknowledgments

The authors thank the Research Deputy, Shahid Beheshti University of Medical Sciences for
the financial support. We also thank the patients for participating in the study and the Stroke
rehabilitation center Tabassom for their support. The authors would like to thank Majid
Farhadian, MSc, OT., for help in this study.

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