J Acupunct Meridian Stud 2018;11(2):67e73

Available online at www.sciencedirect.com

Journal of Acupuncture and Meridian Studies

journal homepage: www.jams-kpi.com

Research Article

Kinesio Taping Associated with Acupuncture

in the Treatment of the Paretic Upper Limb
After Stroke
Moisés S. Dall’Agnol 1, Fernanda Cechetti 1,2,*

1
Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde
de Porto Alegre (UFCSPA), Brazil
2
Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre
(UFCSPA), Brazil
Available online 4 January 2018

Received: Aug 31, 2017 Abstract

Revised: Dec 21, 2017 The leading cause of disability in adults, leads to different consequences, such as hemi-
Accepted: Dec 26, 2017 paresis and loss of function in the upper limb which can impair the performance of activ-
ities of daily living. Different techniques, such as like acupuncture and Kinesio Taping
KEYWORDS (KT), have been used to ameliorate this condition. However, there is no consensus on
acupuncture; their concomitant effect on neurological patients. This study aimed to analyze the ef-
athletic tape; fects of acupuncture associated with KT on the upper limb of patients with chronic hemi-
muscle spasticity; paresis after stroke. In this clinical study, 16 subjects were divided into two intervention
stroke groups: acupuncture (ACP)d12 sessions of acupuncturedand acupuncture þ Kinesio Tap-
ing (ACP-KT)d12 sessions of acupuncture plus KT. The Modified Ashworth Scale (spas-
ticity), active goniometry [range of motion (ROM)], and the Wolf Motor Function Test
(speed of movement) were used to assess the function of the affected upper limb. As a
main result, both groups reduced spasticity in some studied musculature and increased
ROM (p < 0.05), without intergroup difference. Moreover, there was no significant
improvement concerning speed of movement in either group. Acupuncture was effective
in reducing spasticity and increasing ROM of paretic upper limb after stroke, but did not
contribute significantly to speed and quality of movement. KT did not show significant
benefits concerning the analyzed variables.

* Corresponding author. Departamento de Fisioterapia, Universidade Federal de Ciências da Saúde de Porto Alegre e UFCSPA, Rua
Sarmento Leite, 245, 90050-170, Porto Alegre, RS, Brazil. CEP UFCSPA: 935.288.
E-mail: nandacechetti@gmail.com (F. Cechetti).
pISSN 2005-2901 eISSN 2093-8152
https://doi.org/10.1016/j.jams.2017.12.003
ª 2018 Medical Association of Pharmacopuncture Institute, Publishing services by Elsevier B.V. This is an open access article under the CC
BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
68 M.S. Dall’Agnol, F. Cechetti

1. Introduction The inclusion criteria were as follows: (1) diagnosis of

stroke for at least 6 months; (2) hemiparesis in upper limb;
According to the World Health Organization, stroke is (3) age over 18 years, no gender specification; and (4)
the sudden development of clinical signs of focal or global ability to comprehend simple instruction [Mini-Mental State
disturbance of cerebral function, with symptoms lasting for Examination(MMSE)]. It evaluates seven specific cognitive
more than 24 hours or leading to death, with no apparent functions and its total score ranges from zero to 30 points.
cause other than of vascular origin [1]. It is estimated that The cut-off for diagnosis of dementia in individuals with no
50e70% of victims regain their functional independence. education is 18/19, and in the ones with education, it is 24/
Despite the high rate of survival, stroke generates some 25 [20]). Participants were excluded if they (1) presented
kind of disability in approximately 90% of cases, being subluxation or dislocation of shoulder, painful shoulder
considered the leading cause of disability in adults [2e4]. syndrome or amputations; (2) presented allergy or any re-
Motor disorders after stroke occur because of damage to action to elastic bandage, or (3) had an averse reaction to
the upper motor neurons, which control distal and proximal treatment with needles.
muscles [4], leading to hemiplegia or hemiparesis [5]. Participants were randomized (simple randomization
However, 70% of individuals with paresis of the upper limb through black envelopes) into two groups: acupuncture
will show some residual sequelae, hindering the perfor- (ACP) group and acupuncture þ Kinesio Taping (ACP-KT)
mance of daily activities [6]. The sequelae can range from group. Group ACP received 12 acupuncture sessions by an
sensory to motor disorders to change in muscle tone, like acupuncturist, three times a weekdevery Monday,
spasticity [7]. In this way, as a determining factor in Wednesday and Fridaydat the same time of the day. They
hemiplegia, spasticity is a motor disorder resulting from were in the sitting position with arms supported by the
hyperexcitability of the stretch reflex, characterized by chair when possible or in the flex-adduction pattern in the
exaggerated tendon spasms and a speed-dependent in- case that the affected arm would not be able to stay
crease of such reflex [8]. naturally on the chair-arm. Sterilized needles (Dongbang,
Currently, however, there are several treatments for 0.25 mm  40 mm) were used for 30 minutes in Baihui
stroke [9]. Among them, some more recent techniques and (DU20), Sishencong, and “Wrist 4, 5 and 6” (wristeankle
approaches, like acupuncture and Kinesio Taping (KT) acupuncture) bilaterally. Needles were inserted until
[10,11]. As a key component of Traditional Chinese Medi- “TeQi” sensation was achieved, and no further manipula-
cine and an effective remedy for stroke [12], a considerable tion of needles was performed.
number of clinical and experimental studies have demon- Group ACP-KT received the application of taping to the
strated that acupuncture relieves poststroke symptoms and segments corresponding to triceps-brachial and wrist and
complications such dysphagia, depression, and cognitive finger extensors of the paretic upper limb (fixed points on
dysfunction [13e15]. elbow and lateral epicondyle, respectively, in “I” and “Y”
Another therapeutic possibility is KinesioKT, developed techniques) with 100% tension, right after the acupuncture
by Kenzo Kase in 1996, which is the application of an elastic session, which followed the same procedures as the ACP
bandage to the skin, promoting a mechanism of pressure/ group (Fig. 1). For the tape application, patients were in
force on it while pulling up hard, differing from a common the sitting position. Elastic bandages (Dongbang Acu-Tape)
bandage [16]. So, the constant afferent mechanical and were used, and were retained on the patient’s arm until
somatosensory stimuli are perceived at the cortical level, the next session.
producing motor unit recruitment and contributing to the Spasticity was assessed through the Modified Ashworth
neuroplasticity [17,18]. Therefore, muscle function can be Scale (MAS) [21]. It is rated on an ordinal numeric scale,
facilitated or inhibited by the use of elastic bandages. In ranging from zero (normal muscle tone) to 4 (extreme
this way, the bandages effect joint position [19]. spasticity) [21,22]. For mathematical calculation purposes,
For this, it is important to identify new therapies in the 1þ rating was replaced by 1.5 [23].
stroke sequelae treatment and to provide functionality and Evaluations took place before the first and after the last
a better quality of life for patients. Hence, this research intervention session to verify joint active range of motion
aims to analyze the effects of acupuncture associated with (ROM) through goniometry (flexion, extension, and abduc-
KT on the upper limb of patients with chronic hemiparesis tion of the shoulder; elbow and wrist extension; and radial
after stroke. deviation and third finger extension). One single measure-
ment was performed for each ROM/movement for each
evaluation. The median difference between the pre-
2. Materials and methods intervention and postintervention values was analyzed. An
acrylic goniometer of the brand Profisiomed with a length
This prospective, randomized trial was registered on of 35 cm and a width of 4.5 cm was used, while the patient
ClinicalTrials.gov (NCT02690493). Participants provided was sitting on a chair, keeping the spine straight.
informed written consent to a protocol approved by the The Wolf Motor Function Test (WMFT) was applied to
Universidade Federal de Ciências da Saúde de Porto these individuals to evaluate the time spent performing 17
Alegre Human Research Ethics Committee (protocol #935. activities of daily living. It is a test currently used for
288), and all evaluations and treatment sessions were analyzing the agility of upper limb movements, and this
conducted in the Functional and Nutritional Evaluation result provides the mean completion time of all tasks [24].
Laboratory of Universidade Federal de Ciências da Saúde Descriptive statistical analysis was used. Intragroup
de Porto Alegre. comparisons were made by the Wilcoxon test and the
Kinesio Taping and Acupuncture of the paretic upper limb 69

Figure 1 Image of the application. (A) The functional taping. (B) The acupuncture needles.

intergroup differences by the ManneWhitney test for range

Table 1 Characteristics of the participants.
of motion, MAS, and FAS. The analysis of time in WMFT was
made through parametric tests: paired t test in intragroup Group Acupuncture Acupuncture pa
and t test (independent) in intergroup comparison. The þ KT
sample characterization was given from Fisher’s exact test. Total n 8 8 1.0
For all of these, the significance level was set at 5%. The Gender, n (%)
statistical treatment of the data was performed using IBM Male 4 (50%) 4 (50%) 1.0
SPSS (Statistic Package for the Social Sciences, Chicago, Female 4 (50%) 4 (50%)
IL, USA), version 20, for Windows. Age 56.0 (13.1) 59.5 (10.8) 0.62
(yearsdmean  SD)
3. Results Stroke, n (%)
Ischemia 8 (100%) 6 (83.3%) 1.0
Hemorrhage 2 (16.7%)
3.1. Study sample
Time since onset 114.1 (114.1) 115.0 (73.1) 0.69
(monthsdmean  SD)
A total of 25 patients were screened, of whom 16 met Paretic side, 4 (50%) 4 (50%) 1.0
the study criteria. These patients were randomly divided n (%) right
into the two experimental groups as follows: 8 to ACP and 8 MMSE 28.5 (1.5) 28.3 (1.9) 0.87
to ACP-KT. All of the ACP and ACP-KT participants (scoredmean  SD)
completed the proposed protocol and were recommended
for revaluation. n Z number of participants, MMSE Z Mini-Mental State Exam-
ination; SD Z standard deviation; KT Z Kinesio Taping.
a
Fisher’s exact test for proportions; t test for continuous
3.2. Participants’ characteristics variables.

The participants’ characteristics are shown in Table 1.

As it can be seen, there was no difference between groups
ACP (p 0.097), and 1172.78 (576.13) and 1171.22
in terms of age, gender, time since onset, type of stroke,
(579.64) seconds for ACP-KT (p 0.702). The result showed
paretic side, or MMSE score.
no intergroup or intragroup difference.
Regarding the evaluation of spasticity, there was no
significant intergroup difference in MAS. However, it can be
noted that there was an intragroup reduction of spasticity 4. Discussion
in both groups; the major changes of which can be seen in
Table 2. In ACP, there was significant improvement in This study aimed to determine the effects of acupunc-
muscle tone in seven of the 11 muscle groups assessed, ture associated with KT on the upper limb of patients with
whereas in ACP-KT, the tone of eight muscle groups chronic hemiparesis after stroke. Acupuncture was effec-
improved. tive in treating stroke sequelae in the paretic upper limb
Goniometry showed significant intragroup difference in concerned with a decrease in muscle tone and increase in
flexion, extension, and adduction of the shoulder, flexion of active ROM, despite not having significantly improved
the elbow and wrist, and radial deviation and extension of speed of movement in WMFT tasks. In turn, the concomi-
the third finger, whose values are shown in Table 3. tant use of KT did not bring significant benefits to
Conversely, no significant intergroup difference was found. treatment.
Regarding WMFT, the mean time to perform the tasks at Concerning the studied sample, all items evaluated be-
preintervention and postintervention moments were 784.93 tween the two groups were homogeneous. Thus, homoge-
(756.83) and 762.68 (774.26) seconds, respectively, for neous distribution of gender was found, as well as a higher
70 M.S. Dall’Agnol, F. Cechetti

Table 2 Modified Ashworth Scale outcomes.

Muscle group Variables Acupuncture Acupuncture þ Kinesio Taping p intergroup
Shoulder adductor Variation 0.7 (1.5;-0.5) 1.2 (1.5;-0.3) 0.73
Pre 1.5 (1.5;2.13) 2.5 (1.5;3.1)
Post 1.0 (0.0;1.5) 1.2 (0.7;2.1)
p intragroup 0.026* 0.039*
Shoulder extensor Variation 1.0 (1.25;-0.88) 1.0 (1.2;0.0) 0.53
Pre 1.5 (1.0;2.5) 2.5 (1.7;4.0)
Post 0.5 (0.0;1.6) 1.5 (1.0;2.5)
p intragroup 0.024* 0.059
Shoulder internal rotators Variation 1.2 (1.6;-0.7) 0.5 (1,2;0,0) 0.24
Pre 2.0 (1.3;3.0) 2.5 (1.5;4.0)
Post 0.5 (0.0;1.8) 1.7 (1.3;3.0)
p intragroup 0.041* 0.102
Elbow flexor Variation 1.0 (1.1;0.0) 1.25 (2.0;-0.3) 0.32
Pre 1.7 (0.7;3.0) 3.0 (2.0;3.7)
Post 1.2 (0.0;1.6) 1.5 (0.7;2.5)
p intragroup 0.059 0.042*
Pronator Variation 0.2 (1.1;0.0) 1.0 (1.6;-0.7) 0.15
Pre 2.2 (1.1;3.2) 3.0 (1.8;4.0)
Post 1.5 (0.0;3.2) 2.5 (0.0;3.0)
p intragroup 0.109 0.039*
Wrist flexor Variation 1.2 (1.6;-0.7) 1.0 (1.2;0.0) 0.35
Pre 2.5 (1.1;3.0) 3.0 (2.0;4.0)
Post 0.7 (0.0;2.0) 2.5 (1.5;3.0)
p intragroup 0.041* 0.059
Thumb flexor Variation 1.2 (1.6;-0.5) 1.5 (2.2;-1.13) 0.35
Pre 1.5 (1.3;1.8) 2.5 (1,5;3.0)
Post 0.5 (0.0;1.0) 0.5 (0.0;1.6)
p intragroup 0.027* 0.039*
2nd finger flexor Variation 1.1 (1.5;-0.7) 0.7 (1.6;-0.3) 0.62
Pre 1.5 (0.7;2.2) 2.0 (1.5;2.2)
Post 0.0 (0.0;1.1) 1.0 (0.7;1.6)
p intragroup 0.038* 0.042*
3rd finger flexor Variation 1.2 (1.5;-0,7) 0.7 (1.8;-0,3) 0.62
Pre 1.5 (0.7;2.2) 2.0 (1.5;2.2)
Post 0.0 (0.0;1.1) 1.0 (0.0;1.6)
p intragroup 0.038* 0.042*
4th finger flexor Variation 1.2 (1.5;0.0) 1.5 (2.2;-0.7) 0.27
Pre 1.5 (0.0;2.2) 2.0 (1.5;2.2)
Post 0.0 (0.0;1.1) 0.0 (0.0;1.2)
p intragroup 0.059 0.042*
5th finger flexor Variation 1.5 (2.0;0.0) 1.75 (2.2;-0,7) 0.50
Pre 1.5 (0.0;2.2) 2.0 (1.3;2.2)
Post 0.0 (0.0;0.2) 0.0 (0.0;0.5)
p intragroup 0.063 0.042*
Values are median (min/max). Wilcoxon and ManneWhitney tests were used for intragroup and intergroup comparisons, respectively.
*p < 0.05. Variation means difference between pretreatment and posttreatment.

incidence of ischemic stroke and mean age. Similarly, the with this finding, Plavsic et al. conducted a study to eval-
study conducted by Kuster et al., in which 341 patients uate the long-term effects of acupuncture and therapeutic
admitted to a Brazilian hospital were evaluated, found that exercises on the frozen shoulder of patients with stroke.
59.2% had ischemic stroke, 29.6% suffered transient They found that the group receiving acupuncture and ex-
ischemic attack, and only 11.1% had hemorrhagic stroke. ercise therapy achieved better results on the reduction of
Moreover, there was no difference in gender and the mean spasticity [26]. Likewise, in a study involving three children
age [25]. with cerebral palsy, it was found that the concomitant use
Regarding spasticity, after intervention it was possible to of acupuncture and neurological physical therapy twice a
verify that both ACP and ACP-KT groups showed a signifi- week for 9 months decreased the muscle tone of the lower
cant decrease in intragroup muscle tone. Corroborating limbs and trunk in all participants [27].
Kinesio Taping and Acupuncture of the paretic upper limb 71

Table 3 Active goniometry outcomes.

Muscle group Variables Acupuncture Acupuncture þ Kinesio Taping p intergroup
Shoulder flexion Variation 5.5 (3.5;10.5) 9.0 (2.5;25.5) 0.57
Pre 93.5 (36.0;116.5) 56.0 (35.5;82.5)
Post 97.0 (46.5;122.0) 70.0 (43.0;88.5)
p intragroup 0.027* 0.17
Shoulder extension Variation 17 (9.3;21) 9.0 (3.0;19.5) 0.37
Pre 20 (10.5;31.3) 18.0 (0.0;43)
Post 35 (21.5;52) 29.0 (18.0;47.5)
p intragroup 0.028* 0.043*
Shoulder abduction variation 4 (0.0;7.8) 4 (1.5;17) 0.62
Pre 10.0 (2.5;14.3) 6 (1.5;16.5)
Post 14.0 (0.0;19.5) 15.0 (8.0;2)
p intragroup 0.066 0.042*
Elbow extension Variation 3 (0.0;14.5) 9 (3;16.5) 0.46
Pre 116 (98.5;138) 102 (94;120)
Post 124 (109.5;139) 112 (101;133)
p intragroup 0.068 0.043*
Wrist extension variation 1 (0.5;24) 7 (1.5;17) 0.46
Pre 43 (28.5;52.5) 43 (29.5;65.5)
Post 54 (30;68.5) 58 (39;67.5)
p intragroup 0.197 0.043*
Radial deviation variation 5 (1.5;11.5) 3 (0.0;4.0) 0.18
Pre 5 (0.0;19) 10 (1;19.5)
Post 16 (6;24) 11 (3;20.5)
p intragroup 0.043* 0.059
3rd finger extension variation 4 (1.5;14.5) 2 (3.5;9) 0.46
Pre 12 (-66;11) 35 (-55.5;0.0)
Post 11 (51.5;14) 29 (66;3)
p intragroup 0.042* 0.71
Values are median (min/max). Wilcoxon and ManneWhitney tests were used for intragroup and intergroup comparisons, respectively.
*p < 0.05. Variation means difference between pretreatment and posttreatment.

In this way, acupuncture is able to create many biolog- motor responses. However, neuroplasticity becomes slower
ical responses, distant or close to the site of application, the more chronic the disorder is. Therefore, stimuli pro-
such as circulatory and biochemical effects, considering the duced by taping on the integumentary system, which can
release of peptides and transmitters in both the brain and help nervous system plastic response, have diminished ac-
the spinal cord. Mainly, these responses are mediated by tion [32]. This may be a reason for the lack of significant
sensory neurons to various structures in the central nervous additional benefit from KT, as found in this study, since
system [28,29]. The sensory stimulation can modify cortical most patients had chronic stroke sequelae.
sensorimotor representation areas which may also be Regarding active goniometry, there was significant in-
altered by loss of sensory input, like amputation, as well as crease in ROM for flexion and extension of shoulder and
in response to focal brain lesions, including stroke. At any radial deviation and metacarpophalangeal extension of third
rate, many types of training, sensory stimulation, and finger for ACP group, along with extension and abduction of
activation may influence plasticity and, hence, rehabilita- shoulder and the extension of the elbow and wrist for ACP-
tion [28]. In addition, acupuncture may influence cortical KT. Although they are different muscle groups, both ACP and
circuits in the damaged area of the brain. The brain tissue, ACP-KT showed improvement in all four of them. Conse-
on its turn, attempts to modify itself at cellular level, quently, it can be inferred that KT did not significantly in-
comprising neuronal and glial cell extensions and synapses. fluence the treatment regarding the increase in ROM of the
Moreover, this reorganization happens in both cortical and paretic upper limb. So far, there has not been a specific
subcortical areas as well as in the spinal cord, justifying, at clinical trial on the treatment of the paretic upper limb
least partially, the results observed in this study [28,30]. through acupuncture and evaluation of active ROM. How-
On the other hand, even though Ludwig noted a ever, Alegre et al. state that spasticity directly influences
decrease in spasticity from stroke by KT treatment, it was the range of motion and causes changes in the soft tissues
not statistically significant [31]. Furthermore, it was also [33]. Accordingly, gains in ROM and the decrease in muscle
found that KT associated with kinesiotherapy had no effi- tone can be correlated. This perspective was confirmed by
cacy in reducing spasticity in patients with chronic hemi- Silva and Chiumento, who found that three patients with
plegia [32]. In addition, KT allows afferent sensorimotor spinal cord injury, undergoing aquatic physical therapy,
stimulation, taking information to cortex and then creating improved ROM of the knees and hips in that spasticity
72 M.S. Dall’Agnol, F. Cechetti

decreased [34]. In addition, a study examined the effect of Financial support

KT in dorsiflexion movement of patients with chronic
sequelae of stroke after 4 weeks of treatment. All of them None.
presented an increase in active ROM, although it was not
significant [35]. Likewise, improvement in wrist and elbow Disclosure statement
ROM was reported in four out of five patients with stroke
sequelae, with KT treatment, as in our study. Nevertheless,
None.
participants underwent 20 sessions of concomitant kinesi-
otherapy plus taping, with no control group [36].
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