KINESIO ARM TAPING AS PROPHYLAXIS AGAINST THE DEVELOPMENT OF ERB S ENGRAM

Transcription

1 KINESIO ARM TAPING AS PROPHYLAXIS AGAINST THE DEVELOPMENT OF ERB S ENGRAM Thesis Submitted in Partial Fulfillment of the Requirements for a Master Degree in Physical Therapy, Department of Growth and Developmental Disorders in Children and Its Surgery By: RADWA SAID SHAHAT AHMED B.Sc., Physical Therapy (2004) Supervisors: PROF. DR. EMAM HASSAN EL- NEGMY Professor, Department of Physical Therapy for Growth and Developmental Disorders in Children and Its Surgery, Faculty of Physical Therapy Cairo University PROF. DR. AMINA HENDAWY SALEM Professor of Pediatrics, Faculty of Medicine Cairo University DR. ABD EL AZIZ ALI SHERIEF Lecturer, Department of Physical Therapy for Growth and Developmental Disorders in Children and Its Surgery, Faculty of Physical Therapy Cairo University Faculty of Physical Therapy Cairo University 2012

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3 AKNOWLEDGMENT I praise ALLAH, the most Gracious, the most Merciful, for what He had bestowed upon me throughout my life, and mostly for the guidance, energy and patience He granted me during the past two years of working on this research. Prof. Dr. Emam Hassan ElNegmy - Professor of Physical Therapy, Department of Physical Therapy for Growth and Developmental Disorders in Children and Its Surgery, Faculty of Physical Therapy, Cairo University thank you for devoting your time, expert guidance and unique perspectives to this project and making this endeavor a rich and gratifying learning experience. I was fortunate enough to have you as my supervisor. Prof. Dr. Amina Hendawy Salem - Professor of Pediatrics, Faculty of Medicine, Cairo University was especially supportive of this project and her care is dearly appreciated. I thank Dr. Abd ElAziz Ali Sherief - Lecturer of Physical Therapy, Department of Physical Therapy for Growth and Developmental Disorders in Children and Its Surgery, Faculty of Physical Therapy, Cairo University for his interest and support of my work. His insights and friendship are appreciated. My gratitude is extended to the Kinesio Taping Association, Albuquerque, New Mexico, for kindly supplying the Kinesio tape applied in this project. Their consideration and commitment is deeply treasured. Acknowledgment is given to Rahul K. Nath MD, Texas Nerve and Paralysis Institute, Houston, Texas and Agnes F. Hoeksema - MD, Department of Rehabilitation Medicine, Academic Medical Centre, Amsterdam for their valuable counsel. I would like to express my heartfelt appreciation to all my friends and colleagues from the Department of Physical Therapy for Growth and Developmental Disorders in Children and Its Surgery, Faculty of Physical Therapy, Cairo University, for being at the end of a phone or whenever I needed advice. I am indebted to the families of children with Erb s Palsy who gave their time to participate in this study. Without their interest and commitment this research would not have been possible.

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5 To my father, Said, and my mother, Asma; thank you for raising me to be who I am and accepting nothing from me less than perfect. I look up to you always seek your advices, though shocking they seem at first, but they always did the trick. Thank you for your encouragement, inspiration and love. I m proud to be your daughter. To my sister and brothers, Mona, Yahya and Mohamad; thank you for being my wall to lean and depend on, anywhere and anytime. I will be forever grateful for the encouragement you offered throughout this work and always. Last, but never least, my beloved husband, Ahmed, I m afraid you had to witness my dark side but you nevertheless stood by me and encouraged me to go forward. You never doubted me and always trusted my work, bearing with my late nights and very early mornings. This never would have been possible without you. And to my sons, Abd ElRahman and Omar, you are ALLAH s reward to me, I cherish every minute we spend together, and from now on more play time for us! I pray for your future to be full of love and be as prosperous as could be. Enjoy your adventure! Radwa Said, 2012

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7 Kinesio Arm Taping As Prophylaxis Against The Development Of Erb s Engram, By: Radwa Said Shahat Ahmed, Supervisors: Prof. Dr. Emam Hassan ElNegmy - Professor of Physical Therapy, Department of Physical Therapy for Growth and Developmental Disorders in Children and Its Surgery, Faculty of Physical Therapy, Cairo University, Prof. Dr. Amina Hendawy Salem - Professor of Pediatrics, Faculty of Medicine, Cairo University, Dr. Abd El Aziz Ali Sherief Lecturer of Physical Therapy, Department of Physical Therapy for Growth and Developmental Disorders in Children and Its Surgery, Faculty of Physical Therapy, Cairo University. Master thesis, 2012 Abstract Aim The purpose of this study was to investigate the effect of Kinesio taping over the deltoid and the forearm on the development of proper upper extremity function in recovering Erb s palsied children. Methods Thirty patients with Erb s Palsy (age ranges from 1 to 5 months) were equally divided into two groups; control group (A) and study group (B). Group (A) received a designed physical therapy program for the treatment of Erb s Palsy, while group (B) received the same designed treatment program in addition to Kinesio taping over the deltoid and the forearm. The subjects were evaluated and scored functionally, using the Toronto Active Motion Scale, and objectively, using an EMG device utilized to obtain the percentages of degeneration of the deltoid and the biceps muscles, at different time intervals; pretreatment and three months later during which they underwent the treatment program. Results The results revealed statistically significant improvement in the measuring variables of both groups when comparing their pre and posttreatment mean values. Comparing the two groups post-treatment variables, significant difference is revealed in favor of the study group (B). Conclusion The obtained results strongly support the introduction of Kinesio taping of the deltoid and the forearm as an additional procedure to the treatment program of Erb s palsied children. Key words: Erb s Palsy, Erb s Engram, Toronto Active Motion Scale, ENoG, Percentage of Degeneration, Kinesio Taping.

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9 CONTENTS List of Abbreviations. List of Tables List of Figures. CHAPTER I Introduction. Statement of the problem.... Purpose of the study.... Significance of the study. Limitations. Delimitation. Basic assumption. Null hypothesis Venue.. iii iv viii CHAPTER II: Review of Literature 1. The structural and functional basis of: I. The Brachial Pexus... II. Obstetric Brachial Plexus Palsy. III. The Deltoid Muscle.... IV. Forearm Supinators. i)biceps Brachii.. ii)supinator Erb s Engram.. 3. Taping.. 4. Electroneurography. 5. Toronto Active Motion Scale i

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11 CHAPTER III: Subjects, Materials and Procedures 1. Subjects.. 2. Materials. I- For evaluation II- For treatment Procedures I- For evaluation II- For treatment Statistical Design CHAPTER IV: Results 1. General characteristics of the subjects Percentage of Degeneration... A. Deltoid Muscle B. Biceps Brachii Muscle 3. Toronto Active Motion Scale. A. Shoulder Flexion... B. Shoulder Extension.... C. Shoulder Abduction... D. Shoulder External Rotation E. Elbow Flexion... F. Radioulnar Supination... G. Wrist Extension.. CHAPTER V: Discussion CHAPTER VI: Summary, Conclusion and Recommendations References Appendices Arabic Summary ii

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13 LIST OF ABBREVIATIONS Ach Acetylcholine AROM Active Range Of Motion BTX A Botulinum Toxin A C 4-8 Cervical nerve roots 4 8 CMAP Compound Muscle Action Potential EMG Electromyography ENoG Electroneurography KT Kinesio Tape OBP Obstetric Brachial Plexus OBPI Obstetric Brachial Plexus Injury ROM Range Of Motion SHEAR Scapular Hypoplasia, Elevation And Rotation T 1, 2 Thoracic nerve roots 1, 2 TAMS Toronto Active Motion Scale iii

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15 No. Table (1) Table (2) Table (3) Table (4) Table (5) Table (6) Table (7) Table (8) Table (9) Table (10) Table (11) LIST OF TABLES Classification of Obstetrical Brachial Plexus Palsy Motor, sensory and reflex testing The Toronto Grading System Mean ±SD, t and P values of the age of patients in groups (A)&(B) Mean ±SD, t and P values of the pre-treatment percentages of degeneration of the deltoid muscle for groups (A) and (B) percentages of degeneration of the deltoid muscle for group (A) percentages of degeneration of the deltoid muscle for group (B) Mean ±SD, t and P values of post treatment percentages of degeneration of the deltoid muscle for groups (A) and (B) Mean ±SD, t and P values of pre-treatment percentages of degeneration of the biceps brachii muscle for groups (A) and (B) percentages of degeneration of the biceps brachii muscle for group (A) percentages of degeneration of the biceps brachii muscle for group (B) Page iv

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17 Table (12) Table (13) Table (14) Table (15) Table (16) Table (17) Table (18) Table (19) Table (20) Table (21) Table (22) Table (23) Table (24) Mean ±SD, t and P values of post treatment percentages of degeneration of the biceps brachii muscle for groups (A) and(b) Mean ±SD, t and P values of pre-treatment TAMS grades in shoulder flexion for groups (A) and (B) TAMS grades in shoulder flexion for group (A) TAMS grades in shoulder flexion for group (B) Mean ±SD, t and P values of post treatment TAMS grades in shoulder flexion for groups (A) and (B) Mean ±SD, t and P values of pre-treatment TAMS grades in shoulder extension for groups (A) and (B) TAMS grades in shoulder extension for group (A) TAMS grades in shoulder extension for group (B) Mean ±SD, t and P values of post treatment TAMS grades in shoulder extension for groups (A) and (B) Mean ±SD, t and P values of pre-treatment TAMS grades in shoulder abduction for groups (A) and (B) TAMS grades in shoulder abduction for group (A) Mean ±SD,t and P values of pre and post treatment TAMS grades in shoulder abduction for group (B) Mean ±SD, t and P values of post treatment TAMS grades in shoulder abduction for groups (A) and (B) v

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19 Table (25) Table (26) Table (27) Table (28) Table (29) Table (30) Table (31) Table (32) Table (33) Table (34) Table (35) Table (36) Table (37) Table (38) Mean ±SD, t and P values of pre-treatment TAMS grades in shoulder external rotation for groups (A) & (B) TAMSgrades in shoulder external rotation for group (A) TAMS grades in shoulder external rotation for group (B) Mean ±SD, t and P values of post treatment TAMS grades in shoulder external rotation for groups (A) & (B) Mean ±SD, t and P values of pre-treatment TAMS grades in elbow flexion for groups (A) and (B) TAMS grades in elbow flexion for group (A) TAMS grades in elbow flexion for group (B) Mean ±SD, t and P values of post treatment TAMS grades in elbow flexion for groups (A) and (B) Mean ±SD, t and P values of pre-treatment TAMS grades in radioulnar supination for groups (A) and (B) TAMS grades in radioulnar supination for group (A) TAMS grades in radioulnar supination for group (B) Mean ±SD, t and P values of post treatment TAMS grades in radioulnar supination for groups (A) and (B) Mean ±SD, t and P values of pre-treatment TAMS grades in wrist extension for groups (A) and (B) TAMS grades in wrist extension for group (A) vi

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