Stroke Recovery Essay

How Effective Is Kinesiotape (KT) at Restoring Balance, Stability, and Gait in Post-stroke Patients with Motor Impairments?

When it comes to developing a disability, there are not many predicaments to which in just a matter of minutes, someone can go from being apparently “normal” to being severely neurologically compromised. However, a stroke is a common disorder to which this very issue can occur. Approximately “2 people per 1000 in the world have a stroke, people affected are mostly over the age of 60, and stroke is the 3rd leading cause of death over the age of 65 years” (Csapo & Hosp, 2016). As well as having a direct impact to the brain, both short and long term changes to the muscles and nerves of the body can be observed post-stroke. These changes can occur in isolation (hemiparesis), or as part of complex physical and cognitive impairments (spasticity, muscle weakness, etc). With that being said, a large percentage of those who survived a stroke will typically form some type of physical or cognitive disability with various forms of therapy as a treatment/recovery option. The recovery of walking is arguably a key objective for many patients post-stroke. Reports may vary, but approximately “50–80% of patients will regain some degree of walking ability following stroke” (Pons et al, 2011). Walking, as simple as it may seem, is actually rather difficult when there have been impairments to your balance and gait via stroke. This is where a product called “Kinesiotape (KT)” comes into play. It has been proven to be effective in motor control as well as enhancing performance, so how effective will it be when it comes to restoring a post-stroke patient’s walking ability?

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Stroke is a major complication that is mainly caused by a sudden disruption of blood flow to certain parts of the brain. There are two different types of strokes: ischemic stroke is mainly caused by a blockage in the blood vessels, while a bleed in the brain is called a hemorrhagic stroke. Out of the two, Ischaemic strokes are the most prevalent, occurring in roughly “85% of all stroke related cases” (Csapo & Hosp, 2016), while hemorrhagic strokes have proven to be more fatal with poorer rates of recovery regarding functions. During a stroke, blood supply to the brain is interrupted or a blood vessel in the brain managed to burst itself, either way, this leads to certain areas of the brain to not be able to receive blood for a period of time. Brain cells tend to die when they are no longer receive oxygen. Which ultimately results negatively regarding neuropathlogical effects. The consequences of strokes are mostly sensorimotor: ranging from being paralyzed in one or more muscle groups, spasticity, muscle weakness, both hypoesthesia and hyperesthesia, etc.

 Only “10% of all stroke patients recover completely…Nearly 1 in 4 strokes occur in someone who has had a previous stroke.” (Bayraktar et al, 2015), this means that the majority of the stroke victims suffer from a complication of some sort for the duration of their life.

The consequences of stroke are mainly related to the damages caused to the motor fibers, which is why physical impairments are more prevalent. Typically, when a stroke damages one side of the brain, it impacts the opposite side of the body. The loss of sensation makes it especially difficult to find a sense of balance or even walk. Complications to the motor region of the brain as well as the cerebellum – region of brain that is responsible for equilibrium – can ultimately diminish muscle control and strength, another obstacle in walking by directly impacting balance and gait. This issue is prevalent in the elderly, which can potentially lead to more falls and injuries.

Recovering from a stroke can be a rather long process that requires a lot of dedication, hard work, and patience. It may take years to recover, and not that is not even fully recovering. According to the National Stroke Association, “25 percent of people who have a stroke recover with little to minor impairments… With another 40 percent experiencing some type of moderate to severe impairment that requires special attention.” (Baer & Smith, 2015) The initial recovery process begins after physicians have stabilized your conditions: restoring blood flow and reducing pressure to regions of the brain. Doing so also reduces any risk factors that may cause the patient to have another stroke in the future. It is also recommended to start the initial recovery process as early as possible to increase the likelihood of regaining affected brain and body function. Many clinics offer special care specialties from physical, occupation, and speech therapy to help the patient regain as much as possible.

If you have witnessed everyday people and athletes with some type of colorful tape stuck to their skin. Then you have seen Kinesio Tape (KT) in action. The overall objective of this rehabilitative tape is to shorten the healing process while simultaneously providing support and stability to muscles and joints without ultimately restricting the patient’s full range of motion. By being able to lift the skin, the utilization of KT would improve blood circulation and essentially reduce pain. By using this brightly colored tape next to conventional rehabilitation methods can be proven effective in “restoring the walking ability in post stroke patients” (Henriksen et al, 2014).

According to this study conducted by a group of researchers, by effectively applying the tape to the the tibialis anterior muscle for four weeks on 20 individuals who experienced a stroke within the past year, they were able to minimize the “foot stop”: a gait abnormality in which the front of the foot drops due to muscle weakness. KT showed potential when it came to “stabilizing the ankle to keep your foot off the ground when taking steps” (Koseoglu et al, 2017). Their results from this study support this as well with the only weakness being the small sample size, since larger samples are more ideal when it comes to approximating the population. According to another study conducted at St. Francis Memorial Hospital Rehabilitation Center, many post-stroke patients are left with distorted perceptions about where their body ends which ultimately leads to imbalance as well as poor form, “They don’t have an idea that the affected part of their body exists anymore” (Park & Lee, 2016).

Balance problems and falls are recurrent, especially in stroke patients, more particularly, the elderly. This is mainly due to the asymmetry in body weight: 60-80% of body weight bears on unaffected side. In order to combat this, KT stimulates mechanoreceptors and improves stability, overall effectively improving proprioception for both dynamic and static balance.

 Post stroke patients also demonstrate abnormal gait patterns due to muscular weakness and/or loss of sensation. In a recent study, researchers concluded that KT helps “identify the right position of the joint even in a comfortable posture with no weight loaded” (Woo et al, 2017). This study involved 30 participants who presented difficulty in walking due to cognitive impairments. The overall aim of this study was to test effectiveness of KT on balance and gait.  The results showed a significant difference between the experimental and control groups. Furthermore, it can be inferred that the application of kinesiotape “facilitated muscle activation in non-paralyzed parts of the body, induced gait symmetry, decreased weight bearing, and increasing gait speed” (Woo et al, 2017). Another study that demonstrated similar results took place at the Parker Institute. A total of 32 participants receiving rehabilitation after stroke (~ 50 days) who showed difficulty walking were recruited. A 10 meter walking test was authorized with primary outcomes in speed and secondary outcomes steps taken. The results were significant between the two groups. After applying the tape, the maximal walking speed increased “by 0.08 m/s (95% CI, 0.04 to 0.12; P < .0001)… The number of steps taken during the test was significantly decreased by 1.4 steps” (Boeskov et al, 2015). Not much, if any, weaknesses were found in both studies. The main strengths were the findings. These studies both displayed positive impacts on motor function regarding KT, could be proven valuable in rehabilitation of patients with stroke.

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A stroke is classified as a devastating and distressing experience with deleterious consequences to both the individual and the people around them. All it takes is a clot and just a matter of minutes to completely flip your whole life around. On the bright side, those who have a stroke tend to survive but the recovery process is a long and tedious journey that all depends on the person, and how severe their impairments are. There is a wide range of specialists that will care for a stroke patient from the medical, nursing, and therapeutic professionals. In today’s society, advancements in medical technology are made everyday. New diseases are being cured, and better treatments are being developed for the diseases that are not. As a result, products like Kinesiotape are being invented with the overall aim of allowing our bodies to reach our maximum potential.

Citations:

• Bayraktar, D., Yazici, G., Guclu-Gunduz, A., Aksoy, S., Kilinc, M., Yildirim, S., & Irkec, C. (2015). Does correcting position and increasing sensorial input of the foot and ankle with Kinesio Taping improve balance in stroke patients? NeuroRehabilitation,36(3), 345-353. doi:10.3233/NRE-151223
• Couto, H., Kiefer, K., & Roberto, P. (2017). Effects of the Kinesio® Taping on the gait of stroke subjects: A systematic review with meta-analysis. Fisioterapia E Pesquisa, 24(2). doi:10.1590/1809-2950/17387024022017
• Csapo, R., Hosp, S., & Hasler, M. (2016). Eccentric Exercise, Kinesiology Tape, and Balance in Healthy Men. Journal of Athletic Training,52(7), 636-642. doi:10.4085/1062-6050-52.3.11
• Ekiz, T., Aslen, M., & Özgirgin, N. (2015). Effects of Kinesio Tape application to quadriceps muscles on isokinetic muscle strength, gait, and functional parameters in patients with stroke. Journal of Rehabilitation Research & Development,52(3), 223-231. doi:10.1682/JRRD.2014.10.0243
• Henriksen, M., Boeskov, B., Essen, A., & Carver, L. (2014). Kinesthetic Taping Improves Walking Function in Patients with Stroke: A Pilot Cohort Study. Topics in Stroke Rehabilitation, 21(6), 495-501. doi:10.1310/tsr2106-495
• Koseoglu, B., Tatli, H., Dogan, A., & Polat, C. (2017). Can kinesio tape be used as an ankle training method in the rehabilitation of the stroke patients? Complementary Therapies in Clinical Practice, 27(46), 51st ser. doi:10.1016/j.ctcp.2017.03.002
• Park, Y., & Lee, J. (2016). Effects of proprioceptive sense-based Kinesio taping on walking imbalance. Journal of Physical Therapy Science,4(11), 3060-3062. doi:10.1589/jpts.28.3060
• Pons, J., Farina, D., Molinari, M., Ramos, A., & Bruner, C. (2011). Rehabilitation of gait after stroke: A review towards a top-down approach. Journal of NeuroEngineering and Rehabilitation, 8(66). doi:10.1186/1743-0003-8-66
• Smith, M., & Baer, G. (2011). The recovery of walking ability and subclassification of stroke. Journal of Physiotherapy, 6(3), 134-144. doi:10.1002/pri.222
• Woo, K., Yong, C., Jung-Ho, L., & Young-Park, H. (2014). The Effect of Muscle Facilitation Using Kinesio Taping on Walking and Balance of Stroke Patients. Journal of Physical Therapy Science, 1831-1844. doi:10.1589/jpts.26.1831
• Youn-Bum, S., Cheol, J., & Kyoung, K. (2017). Effects of taping and proprioceptive neuromuscular facilitation for stance phase duration of stroke patients. Journal of Physical Therapy Science, 2031-2043. doi:10.1589/jpts.29.2031