Developmental Neurorehabilitation, April 2013; 16(2): 121–128

Pilot study: Investigating the effects of Kinesio TapingÕ on

functional activities in children with cerebral palsy

CAROLINA SOUZA NEVES DA COSTA1, FERNANDA SIMIONI RODRIGUES2,

FERNANDA MUSTAFE LEAL2, & NELCI ADRIANA CICUTO FERREIRA ROCHA1
1
Department of Physiotherapy, Neuropediatric Research Unit, Federal University of São Carlos, Rodovia Washington
Luis, São Carlos 13565-010, Brazil and 2Department of Physiotherapy, Centro Universitário UNIFAFIBE,
Bebedouro, Brazil
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(Received 24 July 2012; revised 29 August 2012; accepted 1 September 2012)

Abstract
Objective: To investigate the immediate effects of Kinesio TapingÕ (KT) on sit-to-stand (STS) movement, balance and
dynamic postural control in children with cerebral palsy (CP).
Methods: Four children diagnosed with left hemiplegic CP level I by the Gross Motor Function Classification System were
evaluated under conditions without taping as control condition (CC); and with KT as kinesio condition. A motion analysis
system was used to measure total duration of STS movement and angular movements of each joint. Clinical instruments
such as Pediatric Balance Scale (PBS) and Timed up and Go (TUG) were also applied.
Results: Compared to CC, decreased total duration of STS, lower peak ankle flexion, higher knee extension at the end of
STS, and decreased total time in TUG; but no differences were obtained on PBS score in KT.
For personal use only.

Conclusion: Neuromuscular taping seems to be beneficial on dynamic activities, but not have the same performance in
predominantly static activities studied.

Keywords: Postural control, standing, kinematics, motor abilities

Introduction response to higher loads, representing decreases in

Children with cerebral palsy (CP) manifest several
developmental disorders of movement and posture
[1]. The motor dysfunction of CP is often
accompanied by muscle weakness, impairments in
integrating the sensory information received from
various receptors throughout the body, lack of
muscle coordination [2], and limitations in balance
and postural control [3]. These impairments are
generally associated with restrictions in functional
activities such as transfer from sitting to standing.
The sit-to-stand (STS) transfer activity, which is
among the most commonly executed movements
and a fundamental activity for upright mobility and
daily living, is a mechanically demanding task [4, 5].
According to Park et al. [6], children with CP took
longer time to perform STS movement, demonstrat-
ing increased final pelvic tilting, greater peak flexion
of hip, ankle, and trunk angles. Furthermore, chil-
dren with CP used higher cocontraction of vastus
lateralis/hamstrings muscles and did not increase
vastus lateralis contraction as typical children in
agonist recruitment function during rising from
chair [7, 8].
Although children with CP have neuromotor
limitations, therapeutic interventions are directed at
improving the quality of information feedback,
stabilizing the body for functional control. Recently
proposed for children with CP, functional taping
method supports joint function by exerting an effect 13
on muscle function, improving proprioception by
20
normalization of muscle tone, correction of inap-
propriate position and stimulating effect on skin
receptors [9–11].
Iosa et al. [12] treated eight unilateral CP
children, including different types of bandages for
6 months in 12 months of physiotherapy treatment.
The authors found acquisition of more
functional, stable and symmetric walking and
higher increment of gross motor activities in bandage
period. However, these functional improvements
were not accompanied by changes in range of
motion.

Correspondence: C. S. N. da Costa, Department of Physiotherapy, Neuropediatric Research Unit, Federal University of São Carlos, Rodovia Washington
Luis, São Carlos 13565-010, Brazil. Tel: 55 313 4914489. Fax: (55) 33518647. E-mail: costa.csn@gmail.com
ISSN 1751–8423 print/ISSN 1751–8431 online/13/020121–8 ß 2013 Informa UK Ltd.
DOI: 10.3109/17518423.2012.727106
 122 C. S. N. da Costa et al.
In another hand, Footer [13] stated that 12 weeks
of paraspinal taping did not have a positive effect on
postural control in sitting, however, one of the
children in the study, diagnosed as athetoid, had
decreased involuntary motor movements and
increased trunk stability.
Among neuromuscular taping methods, Kinesio
TapingÕ (KT) is a new application of adhesive and
elastic taping. KT can be stretched 40–60% form
resting length [14, 15]. This degree of stretch
approximates the elastic qualities of human skin,
resulting in less mechanism constrains compared
with conventional tape [16], which was applied in
the above cited studies with children. Furthermore,
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the better efficacy of the support for the muscle has
been explained in terms of KT effect on the skin, by
means of moving and raising it in appropriate
direction [14–16].
Few studies have identified positive influences of
the KT in children with disabilities. S¸ims¸ek et al.
[17] verified no direct effects of 12 weeks of KT
application on gross motor function and functional
independence; however, sitting posture seems to be
affected positively. Furthermore, the authors
For personal use only.
suggested that future studies should investigate the
immediate effect of KT on postural alignment in
functional activities in children with CP. In this
sense, Yasukawa et al. [18] found improvements in
functional use of upper extremities function of
infants with risk for brain lesions in
evaluations performed immediately after application
of the tape, and 3 days later. Furthermore,
Ohman [19] found better muscular balance in
infants with congenital muscular torticollis under
KT application.
However, to our knowledge, no study exists
discussing the immediate effect of neuromuscular
taping on STS movement in children with CP.
Therefore, the aim of this preliminary study was to
investigate the immediate effects of KT on STS
movement in children with CP. As a complement,
we also investigate the effect of KT on changes in
dynamical postural control and functional balance in
children with CP, through score of Timed up and Go
(TUG) test and Pediatric Balance Scale (PBS),
respectively. We believe that KT can increase
proprioceptive and tactile information [20], restore
optimal muscle length and provide a foundation for
normal firing and recruitment patterns [21, 22]. For
that, our hypothesis is that KT will allow positive
influences on kinematics characteristics in STS
movement, resulting in better performance with
lower peak flexion of hip, ankle, and trunk
angles, decreases in time to rise from chair, and
also higher score of PBS and lower time obtained in
TUG test.
Methods
Participants
Initially, we had a sample of convenience of 12
children diagnosed with CP levels I and II by the
GMFCS (Gross Motor Function Classification
System) to participate of the study; however, three
children (one girl and two boys) with shortening of
muscles of lower limbs which were identified by
compromising the task were excluded, one boy had
athetoid CP type, one child had bilateral CP type
and three children could not STS without support.
For that, we opted for evaluating a small sample size,
but a homogeneous sample with four children (two
boys and two girls) diagnosed with left hemiplegic
CP level I by the GMFCS participated of the study.
The age of participants was 9–11 years with mean
age of 10 years and 4 months (1 year and 3
months). Patients who were in physiotherapeutic
treatment (mean ¼ 4 years; 2.6 years), and they did
not undergo surgery or have made application of
botulinum toxin for at least 6 months before assess-
ment date. Children also were able to understand the
examiner’s command. Children with shortening of
muscles of lower limbs, which were identified by the
decreased range of motion for the hip, knee and
ankle joints according to Hoppenfeld [23] were not
included.
The study was done with four children approved
by the Ethics Committee on Human Research
(process no. 0302/2011), and the parents or guard-
ians previously signed the free and clear consent
form.
Procedures
On arrival at the laboratory, children were given time
to acclimate by playing with toys and the research
team members. Subsequently, we removed all cloth-
ing and children wore only a Lycra shorts to allow
for accurate marker placement. Reflective markers
(2.5 cm diameter) were attached using double-sided
hypo-allergenic tape over the following body land-
marks, according to Helen Hayes Marker Placement
Protocol [24], on the child’s affected side: base of
the 1st and 5th metatarsal, calcaneous, lateral
malleolus, medial malleolus, and the femoral lateral
and medial epicondyles. Bilateral marker locations
were placed onto the anterior superior iliac marker
set, greater trochanter and inferior to the lateral
aspect of the acromion process. Markers were also
placed to the back at the level of the first sacral spine,
and to the front on the manubrium sternal.
The initial seating position was controlled care-
fully, since each child was placed in a standardized
position for each trial. Children were barefoot and
seated in an adjustable chair, for positioning the knee

joints as close to 90 as possible [25]. The first two
STS movement was allowed for the child to get used
to this position, and after that three first trials were
recorded for the analysis. The participants rose to
stand at their preferred speed for three trials, while
watching a standing eye level target. A quiet sitting
reference trial with arms by the side was recorded.
Rising to stand commenced with arms by the side,
however, arms were free to move during rising.
Start of movement was the time at which the
horizontal velocity of the marker on the acromion
was greater than or equal to 10 mm s1 [26] and the
marker had not begun to move in a vertical direction.
Movement end was when knee extension was max-
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imal [27], and the vertical displacement of the
acromium marker was maximal [28]. Each trial
was time normalized with start in 0% and movement
end 100%.
The whole experiment phase was recorded using
two-camera motion capture system. Two cameras
were positioned 45 from sagittal plane of child’s
body, on the left side, shuttered (1/500 s), genlocked
to synchronize their scans (60 fields per second), and
adequately calibrated to determine the 3-D scaling
factors. The average mean square error for the
For personal use only.
calibration was 3.88 mm.
Motion data were processed using Kwon 3-D
version 3.0 using a cut off frequency of 6 Hz (fourth-
order zero phase shift Butterworth filter).
Although we believed there are compensatory
strategies in frontal and transversal planes, there is
no other research in STS movement in children that
evaluated transverse and frontal plane for compar-
isons. For that, this preliminary study focused on the
sagittal plane, for being also considered the main
plane of movement. Therefore, we calculated:
(a) Time of execution: the total duration of STS
motion, i.e., the difference between initial and
final point in seconds [6, 29].
(b) Joint angles: The kinematic (ankle, knee, and
trunk joint angles) were computed based on a
3-D model including five segments (feet, shank,
thigh, pelvis, and trunk). Accordingly,
initial, maximal, and final values of these
joint angles were obtained for the trials analyzed.
[6, 29]
After the STS task, assessments about dynamic
postural control and balance were done through PBS
and TUG tests.
Pediatric Balance Scale. PBS has 14 items of
increasing difficulty. These items are used to test
functional skills relevant to everyday tasks, such as
moving from sitting to standing, and reaching,
beyond one’s base of support. Items were designed
Pilot study 123
to test a client’s ability to maintain a position within
a decreasing base of support and to change positions.
The items are performed within a specified time
frame, or the positions are held for a specified
amount of time. The items are scored on a five-point
ordinal scale from 0 to 4 [30]. A higher score
indicates better balance abilities. Inter-rater reliabil-
ity using the PBS is reported to be extremely high,
with an intraclass correlation coefficient of 0.98.
Similarly, intra-rater reliability is high with a
reported correlation coefficient of 0.99. The intra-
rater agreement was 92%. In this way, we divided
the PBS in PBS-static and PBS-dynamic. PBS-
dynamic part presents eight dynamical activities,
allowing for a maximum score of 32 points, and
PBS-static, which include six static balance
activities, allowing for a maximum score of 24
points [30].
Timed up and go. The child sat in a height-
adjustable chair. The height of the seat was such
that the subject’s knees and hips were flexed to 90
when sitting with the feet plantigrade on the floor.
The child was informed that he would perform one
practice trial and three recorded trials. The child was
given a signal ‘ready, 1, 2, 3, and go.’ On the go cue,
the child stood up, walked 3 m, turned around a
mark on the floor, walked back, and sat down.
Following one practice trial, each child performed
three recorded trials with a 30 s break between trials.
The time in seconds was recorded from the ‘go’ cue
to when the child sat down in the chair. In this sense,
the shorter the time of execution, better dynamic
balance control obtained by the child [31]. The
intra-rater agreement was 88%.
Children then rested for 3 min before taping the
quadriceps muscles and anterior tibial with elastic
tape. The elastic tape for these muscles was a 8–
20 cm piece of KT (Kinesio TexÕ , KT-X-050,
Tokyo, Japan), cut into an Y shape (quadriceps)
and I shape (tibial anterior), and the elastic applied
with minimal tension from origin to insertion mus-
cles according to muscle activation technique of
Kase et al. [15]. The tape was applied by an expert
with technical course of KT in pediatrics. After the
taping application, the subject received the first or
second measurement of STS movement and func-
tional tests (PBS and TUG tests).
We named the condition without taping as control
condition (CC) and the condition after the taping
application as KT condition. The order of
conditions was randomized for each child excluding
the effect of practice.
Data were analyzed in the SPSS statistical package
(version 16.0). To view the differences between CC
and KT conditions, the paired t-test test was used for
 124 C. S. N. da Costa et al.

the analysis of variables related to the angles, time of

the STS activity, and the TUG test, since that
sample is normally distributed. Non-parametric
Wilcoxon test was used for analyzing the score of
the PBS-static and PBS-dynamic scale, being
qualitative variables. The significance level adopted
was 5%.

Results
A total of 24 attempts on the STS movement were
collected. The average time executed in STS move-
ment under CC was 2.41 (0.27) s and decreased
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significantly (p ¼ 0.022) to average time of 1.61

(0.21) under KT condition.
It was found that children under CC and KT
conditions started (p ¼ 0.332) and ended
(p ¼ 0.385), the STS movement with very similar
ankle flexion values. Moreover, children under the
CC condition reached peak ankle flexion values
significantly higher (p ¼ 0.012) than those under the
KT condition, as illustrated in Figure 1(A).
Although the mean peak knee flexion value has
For personal use only.

decreased in the KC condition, this difference was

not significant (p ¼ 0.066). The values at the end of
the STS movement decreased in the KT condition
(p ¼ 0.041), for that children in the KT condition
showed higher knee extension values at the end of
the movement (Figure 1B).
However, it was found that children started
(p ¼ 0.066) and ended (p ¼ 0.053), the STS
movement with lower values for trunk flexion on
both conditions, these differences were not
significant (Figure 1C). Furthermore, although
children under KT condition reached smaller
peak values, this difference was not significant
(p ¼ 0.155).
The average value obtained in the TUG test
results was also significant (p ¼ 0.048), with an
average value of 20.09 (4.4) s in the CC condition,
decreasing to 12.36 (3.4) s in the KT condition.
More specifically, Figure 2 shows the average time
Figure 1 Averaged curves of the relevant kinematic data of STS in
achieved by each child in the TUG test in both CC CC and kinesio condition (KT) for: (A) ankle dorsiflexion; (B)
and KT conditions. knee flexion; and (C) trunk flexion. The horizontal axis represents
In the analysis of the PBS scale, an increase in the percentage of cycle of STS.
mean PBS-static score from 16.6 (1.4) in the CC
to 17.7(1.3) in the KT condition was found.
However, this difference was not significant
(p ¼ 0.102). For dynamic activities, we found an Discussion
increase in the mean PBS-dynamic score from 24.0 The aim of this study was to investigate the imme-
(1) in the CC to 28.5(1.5) in the KT, presenting diate effects of using the neuromuscular taping
significant difference (p ¼ 0.043). Table I presents method on kinematic changes in the STS, and the
the difference in scores of the PBS-static and balance and dynamic postural control assessed by
PBS-dynamic activities in CC and KT conditions PBS and TUG test. From the results, the study
for each child. suggests the effectiveness of the neuromuscular
 Pilot study 125
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Figure 2 Mean of time of execution for TUG for each child in CC and kinesio condition (KT).
For personal use only.

Table I. Score differences between kinesio control (KT) and CC of evaluated items of PBS for dynamic and static activities for each child.

Score KT–CC

Evaluated items Child A Child B Child C Child D

PBS-static activities Standing unsupported 0 0 0 0

Sitting unsupported 0 0
Standing with eyes closed 0 0
Standing with feet together 0 0
Standing with one foot in front 0 þ1
Standing with one foot þ1 þ1
Total þ1 þ2
PBS-dynamic activities Sitting to standing 0 0
Standing to sitting 0 0
Transfers 0 0
Turning 360 0 0
Turning to look behind 0 0
Retrieving object from floor 0 0
Placing alternate foot on stool þ1 0 0
Reaching forward with outstretched arm þ1 þ1
Total þ2 þ1
0 0
0 0
0 0
0 þ1
0 þ1
0 þ2
0 0
0 0
0 0
þ2 þ1
0 0
þ2 þ1
0
0 0
þ4 þ2

taping in agility from sitting to standing and
ambulation through the results obtained in the
STS, PBS-dynamic activities and TUG test.
However, there was no significant difference in
balance and static postural control represented by
the PBS-static score.
The results of this study found that under the
condition with the taping application, there was a
significant improvement in the performance of STS,
which was reflected by the decrease in time of
execution, reduction in ankle flexion peak and
greater knee extension at the end of the movement.
The study by Park et al. [6] showed that children
with diplegia and spastic hemiplegia CP have
reduced knee extension at the end of the task and
little ability to generate contraction of the hip and
knee extensor muscles when compared to typical
children. In addition, children with spastic CP have
 126 C. S. N. da Costa et al.
difficulties in performing the STS due to inefficiency
in the control of the neuronal selection process, to
imbalances between agonist and antagonist muscles
and to tonus alterations and ineffective balance
reactions [6, 29]. Thus, it is believed that the
neuromuscular taping was effective in improving
the performance of the STS, since it changed the
knee and ankle values, bringing them closer to values
found for typical children. In addition, we believe
that KT improved children neuromuscular control,
since that postural control is mainly the result of
better postural orientation. For that the better body
alignment, i.e., lower peak angle flexion, and more
extension at the final of STS, the easier the
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stabilization of the center of mass, enabling better
equilibrium and more efficient movement.
Thus, methods such as therapy taping with KT
can help in the performance of STS activity, and
contribute to be useful in the clinical practice.
In the literature, there are studies that investigated
the effects of other contextual factors in STS
movement, such as the use of the ankle–foot orthosis
(AFO) [32]. The study by Park et al. [33] on the
applicability of AFO for children with diplegia
showed a decrease in the execution time of the
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STS activity, increased knee flexion at the beginning
of the movement and increased ankle dorsal flexion
at the end of the STS. However, the outcome joint
angle strategies obtained from use of AFO and KT
on STS seems different; both methods are effective,
since those children executed the task successfully
and more rapidly.
However, the theoretical principles of the use of
AFO are different from those of the use of taping.
The placement of AFO is based on the mechanism
of primary inhibition of hyperactive muscle, such as
gastrocnemius and soleus muscles, by the applied
elongation. According to Ross and Bowers [34],
AFO orthoses benefit the recruitment of evertor and
dorsiflexor muscles, reducing muscle tonus, improv-
ing the performance of postural transfers, walking
and jumping.
On the other hand, the fixed positioning of this
type of orthosis often generates changes in the tibia
alignment, preventing the recruitment of plantar
flexor muscles [35]. Thus, some authors consider
that the long-term use of AFO limits the child’s
sensorimotor experiences for motor learning, leads
to deformities of feet and knees, such as the
plantar arch collapse associated with hyperextension
or excessive flexion of knees [34, 36, 37].
Neuromuscular taping has the principle of primarily
activating dominated or hypoactive muscles, which
would not change the foot-shank biomechanical
alignment, allowing free range of motion of ankle
and foot [14]. Thus, we believe that the application
of the KT technique is as effective as the use of AFO,
providing similar results of improved performance in
rising from chair. Neuromuscular taping also con-
tributed to proper muscle balance with less risk of
causing future deformities. However, further studies
investigating the comparison between the long-term
use of AFO orthoses and neuromuscular taping
should be conducted to confirm these inferences.
Initial assessment showed that children participat-
ing in this study performed the TUG test in a longer
time than expected for the corresponding age group,
since the literature indicates that the average time
expected for children over 9 years of age must be
below 5.9 s [31]. Thus, these children performed the
task with lower speed than the adequate speed (total
average time of 17.58 s).
The longer time in the TUG test is associated with
high risk of falls [38], thus indicating that children
assessed in this study have deficits in dynamic
postural control; since that test requires a process
of planning, initiation, and execution of complex
activities such as rising from chair, walking, changing
direction, and sitting [31, 38]. With the taping
application, it was found that children decreased the
time of TUG test and increased the speed. Thus, it is
considered that the taping is effective in improving
the dynamic postural control, also improving the
performance of dynamic activities such as STS
movement, TUG test.
Few studies investigated the effect of KT on
dynamic activities in children. Although S¸ims¸ek
et al. [17] verified no effect of long-term physiother-
apy associated with KT on gross motor function; the
authors suggested that immediate effect also should
be investigated. The only study found in the liter-
ature on the immediate effectiveness of the KT
technique in dynamic activities for children showed
significant improvements in upper extremities func-
tion of children with risk for brain lesions [18].
Others studies in adults that verified immediate
effect of KT on joint amplitude, body alignment,
and muscles balance explained those improvements
through increases the electrical activity of the mus-
cles involved [20–22].
The literature shows other physiological and
biomechanical reasons that would explain the effec-
tiveness of the KT technique on body structures on
the performance of dynamic activities as required in
this study. Kase [14] reports that the application of
the KT technique provides a tactile–proprioceptive
stimulation, aligning muscular fascia and providing
sensory stimulation that would inhibit or facilitate
the muscles involved in the movement. Callaghan
et al. [39] found that taping can modulate brain
activity in several areas of the brains, specially,
sensory motor cortex during a proprioception knee
movement using patellar taping. For that, we
assumed that KT has positive effect on

mechanoreceptors which may be the cause of
improvements in dynamic activities. The stimulus
of cutaneous mechanoreceptors achieved thought
KT which applies pressure to the skin or even
stretches seem to result in physiological changes
such as adequate firing and recruitment pattern of
the quadriceps and tibial anterior muscles. Those
physiological changes probably are related to
improvements in postural and neuromuscular con-
trol reflected in our results.
Regarding the results on the PBS score, it was
found that there was no change between CC and KC
conditions for PBS-static scores. On the other hand,
PBS-dynamic activities score was increased under
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taping condition. Thus, based on the physiological,
biomechanical, and elastic properties of the KT
method, it has been suggested that this technique is
effective for activities that require dynamic postural
control as compared to static postural control
activities which were performed in this study. In
this sense, studies previously [14–16] reported elas-
tic properties from KT which possibly would act
more effectively during the approach and retraction
of the body segments involved, which would explain
the higher number of studies proving the effective-
For personal use only.
ness of the neuromuscular taping preferably in
dynamic activities, when compared with studies
focused on static activities, corroborating the
findings of this study.
A single study that evaluated the effectiveness of
the KT technique in the static postural control was
found. In this study by Cortesi et al. [40], the
applicability of the KT technique in the calf of
subjects with multiple sclerosis exhibited significant
reduction in oscillation and total displacement of the
center of pressure on the base of support. Although
the cited study seems to be in disagreement with the
results of this study, it is important to note that the
methodology of the study by Cortesi et al. [40]
include a high-sensitivity instrument for assessing
postural control. Therefore, it could be inferred that
the lack of difference found in PBS-static score may
be due to the reduced accuracy provided by this
instrument. However, further studies using force
plate should be conducted to verify the effectiveness
of the KT technique on static activities, standing or
sitting balance control of children with CP.
The difference of results from PBS-dynamic
activities to PBS-static activities under KT may be
explained for the fact that dynamic activities seem to
be considered more complex than static activities.
In dynamic activities, more demanding control of
the center of gravity in different bases of support and
high coordination of interdependent segments are
required. In this context, it could be inferred that the
KT technique is more effective in carrying out
dynamic activities, since these activities require
Pilot study 127
greater demand on postural control and greater
degree of difficulty shown by children with CP.
In conclusion, we believe that KT is beneficial on
dynamic activities, as evidenced in the analyses of
the STS movement, TUG test and PBS-dynamic
activities. However, the use of taping does not have
the same performance in predominantly static activ-
ities, as shown by the results obtained in the PBS-
static scores by children assessed in this study. A
methodological limitation of this study is the use of a
small sample size without using a placebo condition.
Although, it is important to note that this is a pioneer
study in evaluating the immediate effectiveness of
the KT technique in children with CP in functional
activities, which require dynamic and static postural
control.
For being a cross-sectional study, further studies
should be conducted for examining and relating the
short and long-term effects of the KT technique in
STS movement of children with CP, with more
accurate methods to prove the physiological changes
assumed by KT in taped areas.
Declaration of interest: The authors report no
conflict of interest. The authors alone are respon-
sible for the content and writing of this article.
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