Journal 2013

NMTCONCEPT JOURNAL, JANUARY 2013, ISSUE 2

Content

  1. Editorial – David Blow
  2. Editorial – Sonja Mains
  3. Mission Statement
  4. Case 1: NeuroMuscular Taping and Treatment of De Quervain Syndrome
  5. Case 2: Assessment of the Efficacy of NeuroMuscular Taping in Rehabilitation Following Knee Replacement Surgery
  6. Case 3: NeuroMuscular Taping in Ankle Sprain Rehabilitation
  7. Case 4: NeuroMuscular Taping Rehabilitative Approach to the “Dropped Head Syndrome” in Amyotrophic Lateral Sclerosis (ALS)
  8. Applicable Billing Codes for NMT
  9. ————–

  10. NMT 2013 Course Schedule
  11. Our Book: NeuroMuscular Taping: from Theory to Practice
  12. ————–

  13. Download PDF version of this journal

NeuroMuscular Taping: A Therapeutic System or Just a Trend?

NeuroMuscular Taping is a methodical rehabilitation system utilized in broad healthcare settings offering significant results. To improve and en- hance ongoing rehabilitation in a medical area which is rapidly changing we offer many varied training courses on leading health issues that will help every hospital and healthcare service meet their treatment goals. In the sporting area last year we witnessed many major events such as the European Football Championships and the long and exciting 2012 Olympics in London, where the use of NeuroMuscular Taping was taken to levels nev- er before seen. The obvious congratulations go to the athletes who participated in these events. It is clear that with correct and continuous training and competition, the fatigue and sometimes injuries associ- ated with such training makes up a complex scenario of what it takes to be an athlete. The unique charm that distinguishes the Olympic games and its historical magic from other events empha- sizes the beauty of some disciplines poorly known. Behind each of these sporting events there is not only commitment, sacrifice and dedication of the athlete but also the essential support of families, staff organizations and teams of individual medical and rehabilitation professionals who follow the athletes over years. All assist in providing the means and strategies, whether physical, mental or emotional, to achieve optimal and appropriate athletic performance keeping their goals in sight.

The principle of NeuroMuscular Taping is based on biomechanics – correct and accurate appli- cation on the body is fundamental to its success. If you are in the presence of pain, inflammatory syndromes, traumatic injuries, post surgical pain, postural defects or need the fastest possible muscle recovery; NeuroMuscular Taping will be useful to you as a rehabilitation specialist. Any athlete or patient that is in step with the times knows that they will benefit from the NeuroMuscular Taping rehabilitation system that significantly improves every healing process.

To Tape or Not to Tape?

The following is an outline of the various terminologies used to differentiate and classify the various techniques:

  • Taping – A form of strapping with an application of an elastic tape on the body surface, applied with pressure, to keep in place muscle or joint in a certain position.
  • NeuroMuscular Taping – Specific applications of an elastic tape to the skin surface specifically following the bodies longitudinal anatomy with techniques that offer eccentric stimuli resulting in decompression and dilation action on the area covered – used for therapeutic purposes.
  • Strap taping – Application of non-elastic or an elastic tape for purposes of limiting movement in a joint, muscle, vascular and lymphatic area.
  • Bandage and compression bandage – Application of a specific material to support a dressing of a damaged area or wound or to limit movement.
  • Dressing – Application of a dressing over a wound, which is going to promote healing and prevent further harm to the area treated.
  • Wraps and braces – Applications used help stabilize an affected area.
  • Sticking patch or plaster – Application of a non-elastic tape with aims to cover a wound and/or facilitate the assimilation of medications (medicated plaster).

Blue, Red or Orange?

The colors have no therapeutic implication – they are only aesthetic. The different colors do not indicate different characteristics of the tape. The results of correct application of NeuroMuscular Taping depends only on a correct diagnosis and correct fo- cused clinical reasoning allowing the professional to perform the proper application. As with all rehabilitation techniques it is highly recommended that only qualified professionals perform treatment.

NeuroMuscular Taping Institute

The NeuroMuscular Taping Institute assures the quality of its teaching staff through a qualifi- cation and training process done by the Institute itself. The aim is to place particular attention on the student/teacher relationship to enhance learning skills during the course. This course allows participants to have direct contact with the teachers and to develop knowledge by working in small groups to enhance the practical aspects of the methodology. During these sessions in small groups, students are able to practice the techniques, be assessed and im- prove manual treatment skills during the course. In these sessions, the teacher assists par- ticipants in their manual practice while introducing a self-evaluation process. This allows for linking into intensive learning skills during the training course and serves to optimize learning.

David Blow
NeuroMuscular Taping Institute

Neuromuscular Taping in a Hospital Setting

Neuromuscular taping was a new concept for the staff at St. Luke’s Roosevelt Hospital. We had been given an in service on this new taping technique from David Blow, the founder of this technique. We were told that this concept was used all over Europe and has also become recognized in the United States. As therapists, we are always looking for ways to improve patient function and decrease pain. We were also skeptical and wanted to see studies on this topic, but it intrigued us, so the staff here decided to learn more about Neuromuscular taping. Many of the patients were familiar with seeing taping, since they had seen a form of taping on the athletes in the recent Olympics. We learned Neuromuscular taping is a form of taping that uses decompressive and compressive stimuli to relieve pain, increase lymph flow and assist musculosketal movement. We are now using it at St. Luke’s / Roosevelt Hospital New York, in the Rehabilitation Inpatient and Outpatient Departments with positive results. The therapists that were trained in NeuroMuscular Taping by David Blow were able to start using these techniques immediately when they returned to work after the classes. They were very surprised and happy with the results they saw with their patients.

Some of the most significant cases that we have seen were with stroke patients. Patient H. was a woman in her 30’s with a right-sided hemiparesis. She had no active shoulder AROM, but had increased pain with PROM of this shoulder. On the right arm we applied two fan cuts on the anterior shoulder and posterior shoulder, a fan cut on the posterior elbow, two I cuts on the anterior elbow, and anterior and posterior taping of the hand with the extensor and flexor digitorm fan cut. Then the therapist performed PROM several times on the right shoulder, elbow, wrist and fingers. A little while later the therapist returned and performed PROM of the right shoulder and the patient no longer had pain with PROM. The patient was then re-taped every three days. It worked so well, the physiatrists on the rehabilitation floor asked if there was lidocaine or pain medication in the tape. The patient had a positive response with NeuroMuscular taping – it helped reduce her pain and improve PROM to allow for ADL care to be improved.

Another patient, Mr. L. had a stroke, which resulted in right hemiparesis and as a consequence was unable to clasp a cup and bring it to his mouth. He had active shoulder flexion and elbow flexion but his grasp was poor. We used a fan cut and taped the extensor digitorum and flexor digitorum of his right arm after which he performed AAROM of the right hand. After taping, he attempted to pick up the cup again and was able to bring the cup to his mouth and drink independently for the first time since the stroke.

Another patient had a dark purple hematoma on the thigh from a fall. The therapists used a fan cut over the area and within three days the area was covered with a waveform of white patches where the tape had decompressed the area. Where the tape was applied most of the discoloration was gone. The NeuroMuscular tape on the hematomas have diminished them in size and color within a week or less.

The staff now use NeuroMuscular Taping on patients with low back pain, status post knee surgery for edema, stroke, status post ankle surgery and have had excellent results. The doctors here are very interested in reviewing case studies on their patients who have had NeuroMuscular Taping. I am a Physical Therapist myself, and I have seen what Neuromuscular taping can do. It can provide pain relief, increase range of motion, and decrease edema without using medications. It is an excellent tool for therapists to use in conjunction with exercise and education.

Sonja Mains, PT
Manager, Rehabilitation Medicine
St. Luke’s Roosevelt

Mission Statement

The NeuroMuscular Taping Institute is a result of a continuing passion for providing medical professionals working in rehabilitation with innovative and effective treatment protocols and skills that improve patients’ overall treatment results and quality of life. The institute was founded in 2003 in Italy and its headquarters are in Rome. It currently provides many ongoing courses in continuing education in rehabilitation a year. Teaching over 1,400 physiotherapists and MDs just in 2011 in courses at hospitals, clinics, universities, and private clinics. Because the NeuroMuscular Taping Concept (NMTConcept) is widely accepted and applied by hospitals as well as private practices, I have decided to establish a US branch in 2012 to introduce the NMTConcept to medical professionals in the US to meet the needs of patients undergoing rehabilitation. This journal is the first issue of a three monthly edition covering case studies and clinical trials of the NeuroMuscular Taping concept.

MISSION STATEMENT

At the NeuroMuscular Taping institute, we are committed to creating innovative continuing education programs to help medical treatment rehabilitation services offer the best ther- apy possible. Our goal is to improve patients’ overall treatment results and quality of life by using our treatment protocols to maximize patients’ rehabilitation time, reduce pain, and enable patients to achieve active and healthy lifestyles. Our primary objective is to provide medical education to maintain high quality standards and to improve short- and long-term rehabilitative care. Our varied education program together in combination with our teaching professionals will guide medical staff in gaining new treatment skills. The programs are designed to ensure that professional therapists acquire the best skills possible.

PHILOSOPHY

Our philosophy is to use clear and comprehensive educational programs to offer NeuroMuscular Taping as a flexible technique that can be integrated with many other neurological and physical therapies, such as PNF, osteopathy, chiropractic, occupational therapies, and all types of therapeutic exercise and manual therapies. NeuroMuscular Taping is a method of treatment developed in Europe that has successfully been used in hospitals and clinics by doctors and therapists specializing in post-operative, orthopedic, oncological, and neurological care of patients as well as in sports medicine.

NeuroMuscular Taping and Treatment of De Quervain Syndrome

Alessandro Moccia
Physiotherapist, Osteopath
Physiotherapist of the Italian National Fencing Association
Rome, Italy – 05.31.2011

De Quervain Syndrome is a stenosing tenosynovitis of the tendons of the long abductor and of the short extensor of the thumb as they pass through the radial styloid process at the level of the first dorsal extensor compartment.

The two affected tendons run very close to each other and form one of the margins of the fossa visible at the root of the thumb, known as the ‘anatomical snuffbox’ as it once served snuff users. The condition is more common among women than men; it appears between the ages of 30 and 50 and the dominant hand is often affected, as this is the one most frequently used in work and play in movements or positions that pro- mote onset of the condition.It is encountered among people who carry out repeated pin- cer movements with the thumb or who spend long periods with their wrist in a flexed posi- tion. This is also an occupational syndrome often seen with overuse of digital hardware as changes in wrist direction – especially if the elbow is unsupported – inducing inflam- mation in the abductor pollicis longus and the extensor pollicis brevis within their shared synovial sheath. The pathology also occurs frequently among sports enthusiasts.

Tennis players, golfers, and fencers expose this tendinous area to repeated stress over time. These movements stretch the tendons concerned causing inflammation, which if permitted to persist leads to a reduction in sliding space available promoting the thick- ening and stenosis of the synovial sheath of the first extensor retinaculum compartment. This leads to onset of pain above the styloid process of the radius, which in a worst-case scenario radiates proximally to the forearm and distally to the thumb. The pain, exac- erbated by use of the hand, intensifies and may sometimes lead to considerable dis- ability (e.g. difficulty in carrying out simple movements such as turning a key in a stiff lock).

Treatment consists first and foremost in sus- pending activities that might promote inflam- mation and in the application of ice several times a day. Effective rehabilitation measures are manual therapies and lower intensity diathermy. However, the use of Neuromus- cular Taping is essential. In the acute phase of treatment application consists in a small double fan on the affected tendons, which cross at the point of the anatomical snuffbox. This has the purpose of vascularization and drainage of the phlogistic process.

Assessment of the Efficacy of NeuroMuscular Taping in Rehabilitation Following Knee ReplacementSurgery

ianmarco Lazzarini
University of Parma, Italy Faculty of Medicine and Surgery
Parma, Italy – 05.31.2011

Objectives

Gonarthrosis is an evolving chronic arthropathy whose effects are severely disabling and limiting on the patient’s life during normal daily, social and work activities. Over the years many therapeutic techniques have been developed to limit damage from this pathology. Not least among these has been the option of surgically implanting a prosthesis to substitute the affected joint (TKR).

Carrying out the surgical procedure for implantation of a knee prosthesis means replacing the joint-covering surfaces comprised of the femoral condyles, the tibial condyles and the posterior surface of the kneecap. This makes the surgery extremely invasive. Along with the possible risks and complications that may arise from any surgical procedure, issues emerge following a TKR implant and subsequent enforced immobility, which may influence the effectiveness and duration of rehabilitation procedures. Pain, bruising and limited ROM may delay or even limit recovery of proper knee function. Often in a hospital environment these aspects are overlooked during the post-acute phase of knee arthoprosthesis with concentration being placed on the recovery of the ability to walk. Once this objective has been achieved, the patient may be discharged. The principle aim of this study is to show how proper application of an elastic bandage during post-acute reha- bilitation following TKR can contribute to improved joint articulation, diminished bruising and reduced knee pain.

For this study no special category of patients was chosen on which to apply the rehabilitation technique in question. In spite of this, there was an attempt to create experimental and control groups that were evenly matched for certain specific parameters. This was done to optimize each individual evaluation and physical examination and in order to make the rehabilitative program fully applicable to each patient involved. Of thirty patients selected, fifteen were treated according to traditional rehabilitation procedures, (specifically the protocols laid down by Cameron, Brotzman and Wilk), making up the control group. The other fifteen patients received the same treatment with the addition of NeuroMuscular Taping. The patients involved in this research received rehabilitation treatment lasting approximately three weeks, a period coinciding with their postacute hospitalization.

Methodology

Application of NeuroMuscular Taping Phase 1 (from taking charge of the patient up to the removal of the stitches) During this initial period, the patient still had stitches and dressing on their surgical wound, which prevented any direct action on the knee. Our objective was to drain the quadriceps muscle and the popliteal fossa.

Tape on Quadriceps

Cut: the tape was cut in half lengthways, giving it a width of 2.5 cm.
Taping Length: from the dressing to the inguinal area.
Application: four strips of tape were applied to the patient. The first laterally wrapped around the vastus lateralis. The second was positioned laterally on the rectus femoris and medially to the vastus lateralis. The third was located between the rectus and the vastus medialis. The fourth wrapped medially around the vastus medialis.
Joint Position: the tape was applied with the knee held in a position of maximum flexion.
Method: decompressive

Fig. 2.1 Quadriceps Tape: Front view

Popliteal Fossa Tape

Cut: fan shaped
Taping Length: 20 cm
Application: the tape was applied to the popliteal fossa. The anchor point was proximal and half of the tape followed the line of the popliteal fossa. The five strips comprising the fan covered the space behind the knee evenly. Indicatively, the first and fifth strips followed the gastrocnemius laterally and medially. The third strip descended straight toward the Achilles tendon. The last two filled the remaining space.
Joint Position: The tape was positioned with the joint extended.
Method: Decompressive

Fig. 2.2 Popliteal Fossa Tape, posterior viewFig. 2.3 Quadriceps Tape and Popliteal Fossa, lateral view

Anterior Tape #1

Cut: fan shaped
Taping Length: 30 cm
Application: the middle of the tape was located in a position corresponding to the center of the kneecap and the anchor point was 1 cm to the left of the locating position for the femur. The first, third and fifth rays passed along the tibial ridge, the center of the kneecap and the head of the fibula respectively. The other two were positioned in such a way as to fill the remaining spaces evenly.
Joint Position: the tape was applied with the knee flexed as far as possible.
Method: decompressive

Anterior Tape #2

Cut: fan shaped
Taping Length: 30 cm
Application: the middle of the taping was located in a position corresponding to the center of the kneecap and the anchorage was 1 cm left of the indicative position of the femur. The first, third and fifth rays passed along the tibial crest, the center of the kneecap and the head of the fibula respectively. The other two filled the remaining spaces evenly
Joint Position: The tape was positioned with the joint flexed as far as possible.
Method: decompressive

Posterior Tape

Cut: fan shaped
Taping Length: 20 cm
Application: he tape was applied to the popliteal fossa. The anchor point was proximal and the middle of the tape coincided with the line of the popliteal fossa. The five strips of the fan covered the space behind the knee evenly. Indicatively, the first and fifth strips followed the gastrocnemius laterally and medially; the third strip descended straight toward the Achilles tendon and the other two strips filled in the remaining space.
Joint Position: the tape was positioned with the joint extended.
Method: decompressive

Fig. 2.4 Fan-shaped tape on the knee, anteriorviewFig. 2.4 Fan-shaped tape on the knee, anterior view

Fig. 2.5 Popliteal Fossa Tape, posterior viewFig. 2.5 Popliteal Fossa Tape, posterior view

Fig. 2.6 Fan-shaped tape and popliteal fossa, side viewFig. 2.6 Fan-shaped tape and popliteal fossa, side view

Assessment

The assessment parameters for the patients were: joint ROM, circumference of thigh and pain.Degree of articulation was taken into consideration because hospital policy and reference texts maintain that the achieve- ment of a 90° flexion is normally considered the minimum for a normal return to daily life and therefore usually leads to the patient’s discharge from the hospital. Thigh circum- ference, on the other hand, is important as it directly affects the other two parameters as well as the quality of the patient’s recov- ery. Pain is without doubt the one factor that most influences the patient’s approach to rehabilitation and to the post-operative peri- od. Objective measurement of this parame- ter has always been problematic. Hence, for this study I opted to use the Visual Analogue Scale (VAS). The term ‘VAS’ usually refers to the quantitative logging of a qualitative clinical measure by means of asking the pa- tient to indicate a point on a line with its ends corresponding to two extreme and opposite conditions. There are different kinds of VAS tests, ranging from analogue scales to verbal and numerical scales. A numerical scale was chosen for this study in that it is perhaps the easiest to understand for the patient, while it is the most practical for this kind of research. For the numerical scale (NRS), the patient was asked to gage the pain experienced over the previous week. The pain was given a numerical value between 0 and 10, where 0 represented absence of pain and 10 was the highest possible level of pain that the pa- tient could experience.

Results

Reduction of Swelling
The two tables (Table 1 and Table 2) contain the thigh circumference measurements (measured at 15 cm above the upper margin of the patella) of patients in two groups that were upon admission and discharge from the Rehabilitation Unit. Separate calculations were then made of the average reduction in swelling of the lower extremity for the patients in each group, which are compared schematically in the Graph 1 below.

Improvement in Knee Articulation
The two tables below (Table 3 and 4) contain values for joint ROM of the operated knee of patients in the two groups, taken upon admission and discharge from the Rehabilitation Unit. Separate calculations were then made of the average improvement in joint articulation (flexion-extension, passive-active) of the knee for patients in each group, which are compared in the graph below (Graph 2.1).

Pain Improvement (VAS)
The two tables below contain values for pain experienced by patients in the two groups, taken upon admission and discharge from the Rehabilitation Unit. Pain was measured using a numerical Visual Analogue Scale (VAS), whose values range from 0 to 10. Separate calculations were then made of mean improvement in pain levels, which are shown in the diagram below (graph 3), where differences found are highlighted.

Table 2.1 Control Group Thigh CircumferenceTable 2.1 Control Group Thigh Circumference

Graph 2.1 Control Group Thigh CircumferenceGraph 2.1 Control Group Thigh Circumference

Table 2.2 Experimental Group Thigh CircumferenceTable 2.2 Experimental Group Thigh Circumference

Graph 2.2 Experimental Group Thigh CircumferenceGraph 2.2 Experimental Group Thigh Circumference

Final Assessment

Comparing the results obtained from the two research groups over the period under consideration, it can be seen how the use of elastic bandaging without departing from traditional rehabilitation procedures aimed at recovery of joint articulation and the reduction of swelling and pain, accelerates and optimizes the achievement of these aims. All the while this treatment avoids the establishment of compensatory processes, motor schemas and incorrect posture in the patient, which over the long term usually lead to certain secondary problems. In comparing the results obtained, it is important not to overlook certain factors that may bear on their veracity. Specifically, the value of the use of the difficult to compare and assess the variable of pain as a subjective parameter is to be considered. Pain may be evaluated differently by different patients depending on their emotional state, their individual pain threshold and on the way in which pathologies associated with the surgical procedure are confronted. Therefore, comparison of this parameter measured in the two research groups appears to be of limited value, as it is an expression of different factors independent of the rehabilitation procedures applied. Nevertheless, the large difference in values between the two groups, with the experimental group favored strongly, may in any case indicate how using taping can help hospitalized patients during the post-operative period.

Reduction in Pain

Of much greater experimental significance, however, are the differences found in reduction of swelling and improvement in joint ROM. Regarding the first of these parameters, despite the interaction among various factors such as inflammation, the resulting stasis of liquids rich in catabolites and inflammation mediators and the trophic tone of each individual patient’s thigh, there was a remarkable difference between the experimental and control groups. In the literature there are articles in which the use of bandaging is indicated as an effective method for reducing post-operative edema and swelling. The counter-indication for this technique is the invasive nature of the bandaging, especially with patients who have just undergone surgery. NeuroMuscu- lar Taping overcomes this objection through its being only slightly invasive, easy to apply and to remove as well as improved patient compliance and motivation. Improvements in ROM, were significantly greater in the experimental group than in the control patients. This difference was mainly found in active and passive flexion.

n conclusion, it may be affirmed that the application of elastic bandaging, using NeuroMuscular Taping during the postacute phase after an FKR implant, provides undeniable advantages when used, together with traditional rehabilitation therapy. The method offers improvement in the overall condition of the patient and positively affects the specific parameters that are usually considered and measured for purposes of discharge from the Intensive Rehabilitation Unit. Along with these quantifiable data, increased patient compliance and motivation was also noted. The use of NeuroMuscular taping appeared to be much appreciated by patients from the outset and following initial measurements and corroboration of positive outcomes, they seemed to expect its application.

Graph 2.3 Reduction of Pain (VAS)Graph 2.3 Reduction of Pain (VAS)

NeuroMuscular Taping in Ankle Sprain Rehabilitation

David Blow
NeuroMuscular Taping Institute
Rome, Italy – 05.31.2011

An injured, unstable ankle creates susceptibility to recurrent sprains. The importance of effective reeducation following a sprain is therefore easily appreciated. Once the trauma has been treated, between 10% and 30% of patients complain of chronic symptoms characterised by:

  • Synovitis
  • Tendinopathy
  • Stiffness
  • Increase in dimensions due to edema
  • Pain
  • Muscle failure.

These symptoms may or may not be associated with instability of the instep, difficulty in walking on uneven ground and recurrent sprains. All of these may occur irrespective of the kind of treatment given to the acute event.

An Overview of Ankle Sprains

  • 20% from sport injuries
  • 30% of cases represent chronic dysfunction
  • Frequent recurrence
  • High social costs

Recovery therapy for ankle sprain involves complex treatment of the ligament, nerve, muscle/tendon and fascia tissue of the entire tibiotarsal astragalus joint. Whatever treatment is provided for the patient – whether surgical or conservative – the time required for complete functional recovery can vary between 3 and 5 weeks. The time needed before a return to work can vary between 4 and 7 weeks. 10 weeks are required before it is possible to return to competitive sports. Usually, recovery times are shorter among professional athletes because much more time is spent on rehabilitation than is the case for amateurs.

Sprains may be acute in nature (following impacts, tackles, collisions or sudden changes in direction) or chronic (following sizeable, prolonged loads). The traumatic event can lead to pathology of the joint, which may be subdivided under two clinical schemas:

  1. Joint looseness, with capsular lesions, enlargement and laceration of the lateral and medial ligamental compartment of the tibio-tarsal and subtalar joint, causing excursion of the joint beyond its normal physiological limits.
  2. Joint instability, which is perceived by the athlete as a sign of yielding of the joint while executing a movement in sport, and which can be pathologically identified as a more or less complete rupture of the ligaments.

Classification of Sprains

Grade 0 – tilt of astragalus of less than 8°, no ligament rupture Grade 1 – tilt of astragalus of 10°- 20°, rupture of the anterior peroneal astragalus ligament Grade 2 – tilt of astragalus of 20°- 30°, rupture of the anterior peroneal astragalus and peroneal calcaneal ligament Grade 3 – tilt of astragalus of more than 30°, rupture of the three ligaments

Symptoms of Ankle Sprains

Symptoms of acute sprains are: sharp pain, localized at the level of the anterior peroneal malleolus area, provoked by palpation; moderate or conspicuous periarticular and articular swelling, sign of rupture of the small arteriole passing above the anterior peroneal astragalus ligament (Robert-Jaspert sign). Other symptoms are functional limitation caused by pain the patient feels during articulation movements and instability of the tibiotarsal joint.

Conservative Treatment

Treatment for tibiotarsal sprain follows an approach of three phases of rehabilitation:

  • Acute
  • Sub-acute
  • Functional Reeducation

Acute Phase
The most widely proven protocol for acute lesions is P.R.I.C.E. (Protection Rest Ice Compression Elevation). In the acute phase, the objectives are:

  1. Immobilization
  2. Pain reduction and facilitation of drainage of the edema or of the tissue stasis.
  3. Prevention of further mechanical stress on the injured structure.

During the acute-phase rehabilitation, supplementary treatment with NeuroMuscular taping has the following objectives:

  • Reduction of inflammation
  • Drainage of edematous congestion
  • Drainage of hematic congestion
  • Pain reduction
  • Mechanical support for the joint axis

The application of NeuoMuscular taping focuses on improving lateral drainage of the ankle. The double fan may be applied in conjunction with an ankle brace to provide support and coherence to the ligments.

Figure 1
Lateral fan and lateral double fan

Sub-acute Phase

During the sub-acute phase, the purpose of treatment is to provide the injured tissue a series of mechanical stimuli in order to promote the physiological orientation of the collagen fibres.

  1. The objectives of this phase are:
  2. Eliminatoin of pain
  3. Recovery of articulation
  4. Elimination of muscle spasm
  5. Elimination of edema
  6. Recovery of muscular strength.
Figure 2
Adding lateral stability in the final application

Supplementary therapy with NMT during the sub-acute phase has the following objectives:

  • Reduction of inflammation
  • Drainage of edematous and hematic congestion
  • Pain reduction
  • Assistance with weight-bearing

Functional Reeducation Phase

The functional reeducation phase aims at:

  1. Recovery of proprioception
  2. Recovery of strength
  3. Prevention of recurrence
  4. Prevention of relapse or recurrence on resumption of motor activity
  5. Reduction of damage from a prolonged period of immobility or of functional inactivity
  6. Reduction of recovery times
Figure 3
Application dorsal functional correction – lateral stability – stability of Achilees tendon and of the gastrocnemius

Supplementary therapy with NMT during the functional reeducation phase has the following objectives:

  • Recovery of proprioception
  • Recovery of strength
  • Prevention of recurrence
  • Lateral stability

Functional Re-education Phase

The functional reeducation phase aims at:

  1. Recovery of proprioception
  2. Recovery of strength
  3. Prevention of recurrence
  4. Prevention of relapse or recurrence on resumption of motor activity
  5. Reduction of damage from a prolonged period of immobility or of functional inactivity
  6. Reduction of recovery times
Figure 4
Recovery of proprioception

Supplementary therapy with NMT during the functional reeducation phase has the following objectives:

  • Recovery of proprioception
  • Recovery of strength
  • Prevention of recurrence
  • Lateral stability
Figure 5
Recovery of strength and of lateral stability

NeuroMuscular Taping Rehabilitative Approach to the “Dropped Head Syndrome” in Amyotrophic Lateral Sclerosis (ALS)

C.Berlingieri, F.Piccione, A.Merico
Hospital IRCCS San Camillo, tdrcarmine@gmail.com
Venice, Italy / 10.31.2011

NTRODUCTION: The Dropped Head Syndrome (DHS) is char- acterized by a deficit of the cervical muscles and it has been de- scribed in isolated cases of Amyotrophic Lateral Sclerosis (ALS).

The consequences of the Dropped Head Syndrome regard difficulty in deglutition, res- piration and the possibility of looking forward. There are no guidelines for rehabilitative in- terventions, except the use of an orthopedic collar. Our objective was to evaluate the ef- ficiency of the NeuroMuscular Taping reha- bilitative treatment and it’s consequences on Quality of Life issues (QOL).

MATERIAL AND METHOD: 4 Patients diag- nosed with ALS through EL-Escolaris criteria and bulbar signs were studied (Table 1). The angle of cervical inclination was 30° – 35° in all cases with a muscular hypotrophy and deficit condition particularly of the exten- sor muscles (the upper trapezius) with MRC of 1-2, the SCM with a MRC of 2-3, electro- magnetic motion tracking system for ROM evaluation, biological assessment (Fig.1).

Table 4.1Table 4.1

Fig. 4.1Fig. 4.1

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 func- tional 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, loco- motion, communication, and social cogni- tion. 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.

TEAM

The ALS patients were followed by a mul- tidisciplinary team composed of: neurolo- gists, nurses, physiotherapists, occupation- al therapists, respiratory therapists, speech/ language pathologists, neuropsychologists, clinical psychologists and social workers. The patients underwent a standard multidis- ciplinary neurorehabilitative treatment for 3 hours a day for 5 days a week.

NeuroMuscular Taping Treatment Protocol

  1. NMT is a non convectional and non pharmacological treatment method based on application of elastic adhesive tape creating eccentric and dilation stimulus to muscle fiber.
  2. Biomechanical NMT active principle assists the patient to improve his voluntary motility capacity for the duration of the application for at least 3 days.
  3. Facilitates the active muscle-work in deficit areas especially Upper Trapezius, deltoid, Rhomboid and flexors of head, all applications performed bilaterally. It is of vital importance during all the applications of NeuroMuscular Taping not to create any traction or tension on the tape material. The tape has to be applied without being stretched, in order to respect the application method of DECOMPRESSION, which will allow the patient to execute the exercises given to him without functional or proprioceptive limits.

Fig. 4.2, 4.3, 4.4

RESULTS

At the conclusion of the study all four pa- tients have shown: A mean reduction of the angle of cervical inclination of 10° An 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 dis- charge The ALSFRS-R scores didn’t show any change.

CONCLUSION

Our pilot study indicates that an intensive rehabilitative treatment integrated with NeuroMuscular Taping improves the angle of inclination of DHS, allowing an increase of QOL and an optimized motor function, re- spiratory and assisting in logopedic therapy. 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 Syn- drome” in amyoptrophic lateral sclerosis, J Neurol Neurosur Psy. 2003 May; 74 (5): 683-6.

97112
Neuro-Muscular Re-Education (this code can apply to any taping option)Neuro-Muscular Re-Education of movement, balance, coordination, kinesthetic sense, posture, and/or

97533
Sensory Integrative Techniques to Enhance Sensor Processing and Promote Adaptive Responses to Environmental Demands. For treatment of developmental disorders such as Autism, ADHD, brain injuries, fetal alcohol syndrome, and neurotransmitter disease. Thera- pist must be certified in Sensory Integrative Techniques.

997110
Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to de- velop strength and endurance, range of motion and flexibility

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