REHABILITATIVE APPROACH WITH NEUROMUSCULAR TAPING TO THE “DROPPED HEAD SYNDROME” IN AMYOTROPHIC LATERAL SCLEROSIS (ALS)
Physiotherapist, Ospedale San Camillo/IRCCS,
Lido di Venezia Italy
Dropped head syndrome (DHS), which is characterized by weakness of the cervical extensor muscles, has been described, in isolated cases, in the early stages of amyotrophic lateral sclerosis (ALS). We performed an intervention in DHS using the NeuroMuscular Taping technique.
NeuroMuscular Taping encourages the muscles in the weakened area to work actively, giving the patient proprioceptive inputs that allow him to correct his posture, and not just during the treatment session but throughout the day (figure 1). This method was chosen because it works on the basis of an active biomechanical principle whereby the patient is induced to increase his capacity for voluntary movement. At the same time, the thickness of the tape and its capacity to adapt to the skin mean that this is a low-invasive and well tolerated approach.
How does it work at the level of the neck muscles?
NeuroMuscular Taping is used to provide interaction between muscle and skin in the anterior-posterior or lateral-lateral direction,
Combined decompressive application to improve the posture of the head.
according to the pathological features of the single patient (figure 2). Thanks to the particular way in which it is applied, it keeps the muscles constantly subjected to a contractile stimulus, both in dynamic and static moments, acts on the circulation according to the application technique used (decompressive or compressive) and acts at the level of the exteroceptors; during movement, the particular arrangement of the collagen and the weave of the tape along its length have the effect of increasing the subcutaneous space between the muscles and the fascia. This improves the blood flow and therefore the supply of nutrients to the muscles and facilitates the removal of catabolites (figure 3).
Application to the neck muscles (sternocleidomastoid, subhyoid) and the deltoid muscle (a); trapezius, sternocleidomastoid and splenius capitis muscles (b).
How are its benefits assessed?
From the first application it is possible to note that the patient is better able to perform exercises designed to stimulate the weakened muscle areas (objective evidence); this aspect can also be evaluated through the comparison of
Application to the rhomboid muscle.
muscle strength tests performed at baseline, mid-way through, and at the end of the treatment period. By conducting electromyographic examinations at the start and end of treatment it is possible to establish physiologically the quantitative increase in contractile capacity of muscles; instead, with a dynamometer strength test it is possible to establish the improvement in force generated, while the SF-36 (self-rating scale) can be used to measure the patient’s perception of his/her own health.
Since the principle underlying NeuroMuscular Taping treatment is biomechanical – i.e. based on the method of application and cutting and on the elasticity of the tape – it is possible to combine shortening of the muscles that need to be strengthened, achieved by placing a tape anchor beyond the muscle origin or insertion, with variable stretching of the tape (this is its peculiarity), which can vary from 0 to 25 to 50%, i.e. with lengthening of the muscles that need to be relaxed. This also makes it possible to obtain different working loads.