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Test–retest reliability of ankle joint sense is affected by the tension of kinesio taping application to the tibialis anterior
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1643–eS1721
Methods: There are 178 LDH patients randomized into the trial. The patients were randomly allocated to a study group with 89 cases and a control group with 87 cases. There were 3 patients lost at the follow up in the study group and 15 in the control group because of changing mind or turned to surgery. All patients must have clinical and radiological evidence of LDH with pain in the lumbar region and radiating down to lower limbs in a radical distribution. Each patient received conservative treatments basically including NSADS, dehydration agents, bed rest, etc. The study group received additional VM called Feng’s Spinal Manipulation (FSM), a very popular spinal manipulative treatment in China. FSM is focused only on releasing capture of involved joint caused by protruded nucleus pulposus (PNP) with gentle mobilization. The patients in the placebo group received a sham VM mimicking Feng’s Spinal Manipulation given by the same doctor. Oswestry deficiency index (ODI) and quantified physical exam for regional and radical irritation (PS and RS) were collected before and 20 days after the therapy. The size of PNP and its relation with the affected nerve root were also assessed by MRI image before and after the observation. Results: All patients have released their pain to some extent with obvious improvement of ODI, RS and PS scores 20 days after the observation. But the patients in study group scores significantly more compared with the controls in ODI (t = −3.51, p = 0.00) and RS (t = −2.89, p = 0.02); and shows significant greater changes of scores from their baseline in ODI (t = 2.45, p = 0.02), RS (t = 2.54, p = 0.01) and PS (t = 2.59, p = 0.01). On the other hand, the PNP inside spinal canal showed no significant changes in the recheck in all patients after the observation. Conclusion(s): Vertebral mobilization is really helpful in LDH patient with acute episode of radiculoapthy according to this short term study. Implications: Vertebral mobilization is definitely a effective treatment for LDH patient with acute radiculoapthy according to the study, but we have to take great care to avoid its adverse effects. The assessment of MRI with no regression of PNP further confirms that conservative therapy should changed its focus from the PNP inside spinal canal to the functional and compensative balance rebuilt of spinal column. Keywords: Lumbar disc herniation; Vertebral manipulation; Magnetic resonance imaging Funding acknowledgements: This research work financially supported by Beijing Municipal Government Health Care Foundation. Ethics approval: ChiCTR-TRC-13003496. http://dx.doi.org/10.1016/j.physio.2015.03.129
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Research Report Poster Presentation Number: RR-PO-06-19-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 TEST–RETEST RELIABILITY OF ANKLE JOINT SENSE IS AFFECTED BY THE TENSION OF KINESIO TAPING APPLICATION TO THE TIBIALIS ANTERIOR T.-R. Zhou, Y.-S. Chen, K.-W. Tseng University of Taipei, Exercise and Health Sciences, Taipei, Taiwan Background: The tibialis anterior is a major muscle in controlling dorsiflexion during movements. The function role of the tibialis anterior muscle is to maintain ankle activities during walking, balance control and daily live activities. In clinical application, Kinesio tape is a common therapeutic method to improve the neuromuscular function of dorsiflexors in specific population with foot drop or tibialis anterior dysfunction. However, inconsistence of tensions applied to kinesio tape may lead to misinterpretation of therapeutic evaluation during treatment. Purpose: The purpose of this study was to examine the test–retest reliability of on ankle joint sense when different kinesiotaping tensions applied to the tibialis anterior. Methods: Five health college students voluntarily participated the study in two separate occasions . The Kinesio tape was applied to the tibialis anterior. The tension of Kinesio tape was controlled in 0%, 50% and 100% of maximal length of tape (SKT-X-050BK, Nitto, Japan). A single strip was placed on the target muscle. A Biodex dynamometer was used to assess the ankle proprioception. Active and passive production of joint position was involved in the ankle joint sense test. Target angles were set at dorsiflexion (DF) of 5◦ , 10◦ and 15◦ . The angular velocity during passive movement was set at 10◦ per second. Intraclass correlation coefficients (ICC2,1 ) was used to determined test–retest reliability over the two testing sessions. Results: The results showed that test–retest reliability of maximal range of motion was poor when tape tension was applied to 50% (ICC: 0.23) and 100% (ICC: 0.23) conditions. The ICC values were inconsistent during active test (range from 0.20 to 0.82). Poor ICC values were found at the DF 5◦ during active test despite the tensions of kinesiotaping. Although there was a wide range of the ICC levels during passive tests (range from 0.29 to 0.84), optimal test–retest reliability was found at all testing ankle joint positions when the tape tension was applied to 50% of maximal stretch (DF 5◦ : 0.64; DF 10◦ : 0.84; DF 15◦ : 0.77). Conclusion(s): In conclusion, a variability of ICC levels was found during different conditions of dorsiflexors proprioceptive test. A high level of test–retest of ankle joint sense was observed during passive movement at dorsiflexion position
eS1716
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1643–eS1721
when the kinesio tape was applied with 50% of maximal stretch. Implications: Application of the kinesio tape on the tibialis anterior to assess the functional movement involved in ankle activities may result in less reliable evaluation of training or therapeutic outcome. Considerations should be addressed in selection of testing condition and functional activities when the kinesio tape is used. Keywords: Kinesiotaping; Proprioception; Tibalis anterior Funding acknowledgements: There is no conflict of interest. Ethics approval: The study was approved by institutional review board of Fu Jen Catholic University, Taiwan. http://dx.doi.org/10.1016/j.physio.2015.03.130 Special Interest Report Poster Presentation Number: SI-PO-12-09-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 COMPREHENSIVE REHABILITATION ON PACHYGYRIA: A CASE REPORT X. Zhou, S. Peng, W. Wang, X. Wang, X. Zhu, X. Wang, Y. Wang The Sixth Affiliated Hospital of Sun Yat-sen University, Rehabilitation, Guangzhou, China Background: Pachygyria is a malformation of the cerebral cortex caused by neuron migration and layering abnormality in embryonic period. Children with this disease often showed developmental delays in motor function, language and cognition, and they sometimes experience epilepsy during their growth. Pachygyria is harmful to the well-being of these children and add great burden to their families. Most clinical researches about this disease focus on the etiology and diagnosis but not the rehabilitation treatment, which however is more important to the patients themselves. Purpose: We carried out a comprehensive rehabilitation program for a 32-month-old pachygyria patient, and received a good curative effect. We want to share the whole experience and draw more attention to this particular disease and to the life quality of children who are fortunately born with it. Methods: First, assess motor function, language and overall neurological development of the patient using GM gross motor scale, sign-significant scale and Gesell developmental scale. Second, design and perform a comprehensive rehabilitation program: Physical and occupational training – pelvis control with Bobath ball, foot orthoses wearing, sit-to-stand transfer, assisted standing, balance bar, cart walking training, hand function training by fetching things and building blocks, comprehensive occupational training using the FlexTable digital system. Swallowing and speech training - vocal organ movement including mouth opening, lip shrinking and tongue
extending; pronunciation training started from simple syllable. Cognitive training – exercise ability of Identification, selection and imitation. Acupuncture – choose acupoints including linggu, dabai, zusanli, shiyin, shenmen, baihui, biyi, qianhui, and zhouyuan. We used a rewarding feedback method to encourage the patient to finish all the tasks. The whole training lasted for 2 months, and most importantly, an electroencephalogram examination was necessarily done to exclude seizures before starting any training. Results: The patient could almost not stand or speak at the beginning, GM gross motor scale showed 84.31% scoring rate in Lying and Rolling, 68.33% in Sitting, 47.62% in Crawling and kneeling, and 7.7% in walking, running and jumping. Sign-significant scale showed a developmental stage of 2-1, Gesell developmental scale showed a development quotient (DQ) of 20.13 in Adaptability, 17.73 in gross motor movement, 23.33 in fine movement, 23.33 in language, 18.96 in social contact. Great improvements have been observed at the end of the training such as a longer standing time, more spontaneous standing, better hand function, clearer pronunciation, a larger vocabulary and better understanding. GM gross motor scale rose to 98.04%, 90.00%, 71.43%, 25.64%, 22.20% accordingly. Sign-significant scale rose to the developmental stage of 3-1, Gesell developmental scale showed a DQ raise to 35.86, 32.94, 45.16, 27.45, 36.54 accordingly. Conclusion(s): Through a well-designed comprehensive rehabilitation treatment, children with pachygyria can make great progress in different aspects. Implications: Although pachygyria is a congenital dysplasia of the central nervous system, we can still greatly improve patients’ function through active rehabilitation training. We speculated that rehabilitation training can help neurons to re-develop and to re-differentiate, which may be confirmed by imageological examination in a long term. Keywords: Pachygyria; Comprehensive rehabilitation; Case report Funding acknowledgements: All fund needed in this research is kindly provided by the Sixth Affiliated Hospital of Sun Yat-sen University. Ethics approval: All the work we did was kindly approved by the parents of our patient. http://dx.doi.org/10.1016/j.physio.2015.03.131
Methods: There are 178 LDH patients randomized into the trial. The patients were randomly allocated to a study group with 89 cases and a control group with 87 cases. There were 3 patients lost at the follow up in the study group and 15 in the control group because of changing mind or turned to surgery. All patients must have clinical and radiological evidence of LDH with pain in the lumbar region and radiating down to lower limbs in a radical distribution. Each patient received conservative treatments basically including NSADS, dehydration agents, bed rest, etc. The study group received additional VM called Feng’s Spinal Manipulation (FSM), a very popular spinal manipulative treatment in China. FSM is focused only on releasing capture of involved joint caused by protruded nucleus pulposus (PNP) with gentle mobilization. The patients in the placebo group received a sham VM mimicking Feng’s Spinal Manipulation given by the same doctor. Oswestry deficiency index (ODI) and quantified physical exam for regional and radical irritation (PS and RS) were collected before and 20 days after the therapy. The size of PNP and its relation with the affected nerve root were also assessed by MRI image before and after the observation. Results: All patients have released their pain to some extent with obvious improvement of ODI, RS and PS scores 20 days after the observation. But the patients in study group scores significantly more compared with the controls in ODI (t = −3.51, p = 0.00) and RS (t = −2.89, p = 0.02); and shows significant greater changes of scores from their baseline in ODI (t = 2.45, p = 0.02), RS (t = 2.54, p = 0.01) and PS (t = 2.59, p = 0.01). On the other hand, the PNP inside spinal canal showed no significant changes in the recheck in all patients after the observation. Conclusion(s): Vertebral mobilization is really helpful in LDH patient with acute episode of radiculoapthy according to this short term study. Implications: Vertebral mobilization is definitely a effective treatment for LDH patient with acute radiculoapthy according to the study, but we have to take great care to avoid its adverse effects. The assessment of MRI with no regression of PNP further confirms that conservative therapy should changed its focus from the PNP inside spinal canal to the functional and compensative balance rebuilt of spinal column. Keywords: Lumbar disc herniation; Vertebral manipulation; Magnetic resonance imaging Funding acknowledgements: This research work financially supported by Beijing Municipal Government Health Care Foundation. Ethics approval: ChiCTR-TRC-13003496. http://dx.doi.org/10.1016/j.physio.2015.03.129
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Research Report Poster Presentation Number: RR-PO-06-19-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 TEST–RETEST RELIABILITY OF ANKLE JOINT SENSE IS AFFECTED BY THE TENSION OF KINESIO TAPING APPLICATION TO THE TIBIALIS ANTERIOR T.-R. Zhou, Y.-S. Chen, K.-W. Tseng University of Taipei, Exercise and Health Sciences, Taipei, Taiwan Background: The tibialis anterior is a major muscle in controlling dorsiflexion during movements. The function role of the tibialis anterior muscle is to maintain ankle activities during walking, balance control and daily live activities. In clinical application, Kinesio tape is a common therapeutic method to improve the neuromuscular function of dorsiflexors in specific population with foot drop or tibialis anterior dysfunction. However, inconsistence of tensions applied to kinesio tape may lead to misinterpretation of therapeutic evaluation during treatment. Purpose: The purpose of this study was to examine the test–retest reliability of on ankle joint sense when different kinesiotaping tensions applied to the tibialis anterior. Methods: Five health college students voluntarily participated the study in two separate occasions . The Kinesio tape was applied to the tibialis anterior. The tension of Kinesio tape was controlled in 0%, 50% and 100% of maximal length of tape (SKT-X-050BK, Nitto, Japan). A single strip was placed on the target muscle. A Biodex dynamometer was used to assess the ankle proprioception. Active and passive production of joint position was involved in the ankle joint sense test. Target angles were set at dorsiflexion (DF) of 5◦ , 10◦ and 15◦ . The angular velocity during passive movement was set at 10◦ per second. Intraclass correlation coefficients (ICC2,1 ) was used to determined test–retest reliability over the two testing sessions. Results: The results showed that test–retest reliability of maximal range of motion was poor when tape tension was applied to 50% (ICC: 0.23) and 100% (ICC: 0.23) conditions. The ICC values were inconsistent during active test (range from 0.20 to 0.82). Poor ICC values were found at the DF 5◦ during active test despite the tensions of kinesiotaping. Although there was a wide range of the ICC levels during passive tests (range from 0.29 to 0.84), optimal test–retest reliability was found at all testing ankle joint positions when the tape tension was applied to 50% of maximal stretch (DF 5◦ : 0.64; DF 10◦ : 0.84; DF 15◦ : 0.77). Conclusion(s): In conclusion, a variability of ICC levels was found during different conditions of dorsiflexors proprioceptive test. A high level of test–retest of ankle joint sense was observed during passive movement at dorsiflexion position
eS1716
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1643–eS1721
when the kinesio tape was applied with 50% of maximal stretch. Implications: Application of the kinesio tape on the tibialis anterior to assess the functional movement involved in ankle activities may result in less reliable evaluation of training or therapeutic outcome. Considerations should be addressed in selection of testing condition and functional activities when the kinesio tape is used. Keywords: Kinesiotaping; Proprioception; Tibalis anterior Funding acknowledgements: There is no conflict of interest. Ethics approval: The study was approved by institutional review board of Fu Jen Catholic University, Taiwan. http://dx.doi.org/10.1016/j.physio.2015.03.130 Special Interest Report Poster Presentation Number: SI-PO-12-09-Sun Sunday 3 May 2015 12:15 Exhibit halls 401–403 COMPREHENSIVE REHABILITATION ON PACHYGYRIA: A CASE REPORT X. Zhou, S. Peng, W. Wang, X. Wang, X. Zhu, X. Wang, Y. Wang The Sixth Affiliated Hospital of Sun Yat-sen University, Rehabilitation, Guangzhou, China Background: Pachygyria is a malformation of the cerebral cortex caused by neuron migration and layering abnormality in embryonic period. Children with this disease often showed developmental delays in motor function, language and cognition, and they sometimes experience epilepsy during their growth. Pachygyria is harmful to the well-being of these children and add great burden to their families. Most clinical researches about this disease focus on the etiology and diagnosis but not the rehabilitation treatment, which however is more important to the patients themselves. Purpose: We carried out a comprehensive rehabilitation program for a 32-month-old pachygyria patient, and received a good curative effect. We want to share the whole experience and draw more attention to this particular disease and to the life quality of children who are fortunately born with it. Methods: First, assess motor function, language and overall neurological development of the patient using GM gross motor scale, sign-significant scale and Gesell developmental scale. Second, design and perform a comprehensive rehabilitation program: Physical and occupational training – pelvis control with Bobath ball, foot orthoses wearing, sit-to-stand transfer, assisted standing, balance bar, cart walking training, hand function training by fetching things and building blocks, comprehensive occupational training using the FlexTable digital system. Swallowing and speech training - vocal organ movement including mouth opening, lip shrinking and tongue
extending; pronunciation training started from simple syllable. Cognitive training – exercise ability of Identification, selection and imitation. Acupuncture – choose acupoints including linggu, dabai, zusanli, shiyin, shenmen, baihui, biyi, qianhui, and zhouyuan. We used a rewarding feedback method to encourage the patient to finish all the tasks. The whole training lasted for 2 months, and most importantly, an electroencephalogram examination was necessarily done to exclude seizures before starting any training. Results: The patient could almost not stand or speak at the beginning, GM gross motor scale showed 84.31% scoring rate in Lying and Rolling, 68.33% in Sitting, 47.62% in Crawling and kneeling, and 7.7% in walking, running and jumping. Sign-significant scale showed a developmental stage of 2-1, Gesell developmental scale showed a development quotient (DQ) of 20.13 in Adaptability, 17.73 in gross motor movement, 23.33 in fine movement, 23.33 in language, 18.96 in social contact. Great improvements have been observed at the end of the training such as a longer standing time, more spontaneous standing, better hand function, clearer pronunciation, a larger vocabulary and better understanding. GM gross motor scale rose to 98.04%, 90.00%, 71.43%, 25.64%, 22.20% accordingly. Sign-significant scale rose to the developmental stage of 3-1, Gesell developmental scale showed a DQ raise to 35.86, 32.94, 45.16, 27.45, 36.54 accordingly. Conclusion(s): Through a well-designed comprehensive rehabilitation treatment, children with pachygyria can make great progress in different aspects. Implications: Although pachygyria is a congenital dysplasia of the central nervous system, we can still greatly improve patients’ function through active rehabilitation training. We speculated that rehabilitation training can help neurons to re-develop and to re-differentiate, which may be confirmed by imageological examination in a long term. Keywords: Pachygyria; Comprehensive rehabilitation; Case report Funding acknowledgements: All fund needed in this research is kindly provided by the Sixth Affiliated Hospital of Sun Yat-sen University. Ethics approval: All the work we did was kindly approved by the parents of our patient. http://dx.doi.org/10.1016/j.physio.2015.03.131