NEUROMUSCULAR TAPING REHABILITATIVE APPROACH TO THE “DROPPED HEAD SYNDROME” IN AMYOTROPHIC LATERAL SCLEROSIS (ALS)
IRCCS San Camillo, Venice, Italy
The Dropped Head Syndrome (DHS) is characterized by a deficit of the cervical muscles and it has been described in isolated cases of the Amyotrophic Lateral Sclerosis (ALS). The consequences regard deglutition, respiration and the possibility to look forward. There are no suggestions for rehabilitative interventions, except the use of an orthopedic collar. Our objective was to evaluate the efficiency of the NeuroMuscular Taping rehabilitative treatment and it’s consequences on QOL.
Material and Method
4 Patients diagnosed with ALS-diagnosis through EL-Escolaris criteria and bulbar signs have been studied (see table). The angle of cervical inclination was approx. 30° with a hypotrophy and deficit condition particularly of the extensor muscles (the upper trapezius) with MRC of 1-2, the SCM with a MRC of 2-3, electromagnetic motion tracking system for ROM evaluation, biological assessment
ALS functional rating scale-revised (alsfrs-r)
This scale is a well-established scale for the functional status of ALS. It is based on 12 items, each of which is rated on a 0-4 point scale. The items are: bulbar functions (speech, swallowing and salivation), motor and functional, respiratory function. The range of total functional disability is 21-48.
Functional Independence Measure (FIM)
The FIM, the most widely accepted functional assessment measure in use in the rehabilitation community, is an 18-item ordinal scale, used for assessment of progress during inpatient rehabilitation. The FIM measures independent performance in self-care, sphincter control, transfers, locomotion, communication, and social cognition. By adding the points for each item, the possible total score ranges from 18 (lowest) to 126 (highest) level of independence.
Quality of life assessed by Italian version of ALSAQ-40. These evaluations were executed at the beginning and at the end of the study.
NeuroMuscular Taping Treatment protocol
- non convectional and non pharmacological treatment method based on application of elastic adhesive tape
- its biomechanical active principle brings the patient to improve his voluntary motility capacity for at least 3 days
- facilitates the active muscle-work in deficit areas (Upper Trapezius bilaterally, deltoid bilaterally, Rhomboid bilaterally and flexors of head. It is of vital importance during all the applications of the tape, not to create any traction or tension. The tape has to be applied without being stretched, in order to respect the concept of DECOMPRESSION, which will allow the patient to execute the exercises given to him without functional or proprioceptive limits.
At the conclusion of the study all four patients have shown:
- a reduction of the angle of cervical inclination of approx 10°
- increase of one point on MRC score of the extensor muscles
- data analysis show an increase in FIM and QOL mean scores, at admission and discharge
- the ALSFRS-R scores did show any change
Our pilot study indicates that an intensive rehabilitative treatment integrated with NMT (NeuroMuscular Taping) improves the angle of inclination of DHS, allowing an increase of QOL and an optimized motor function, respiratory and logopedic approach. All four patients had bulbar exordium that seems to include Dropped Head Syndrome; a hypothesis that is anatomy- physiology based, since the muscles involved (Upper Trapezius bilaterally, deltoid bilaterally, Rhomboid bilaterally and flexors of head) are innerved by the accessory nerve. REFERENCE: Gourie-Devi M et al., Early or late appearance of “Dropped Head Syndrome” in amyoptrophic lateral sclerosis, J Neurol Neurosur Psy. 2003 May; 74 (5): 683-6.