COMBINATION TAPING TECHNIQUE VERSUS ANKLE FOOT ORTHOSIS ON IMPROVING GAIT PARAMETERS IN SPASTIC CEREBRAL PALSY: A CONTROLLED RANDOMIZED STUDY

BackgroundOne of the important goals in the treatment of spastic cerebral palsy is to maintain efficient and effective walking in order to be independent in activities and participate in society.ObjectiveTo compare the efficacy of foot combination taping of kinesio tape and athletic tape vs ankle foot orthosis in correcting spatiotemporal gait parameters in children with spastic diplegia.MethodsThirty-six children with spastic diplegia were randomly assigned into 3 groups; control, combination taping, and ankle foot orthosis groups. Children in the control group, in addition to those in both experimental groups, continued with conventional physical therapy, 1 h, 3 times per week for 4 weeks. Spatiotemporal gait parameters were assessed with the GAITRite system before and after the application of interventions.ResultsThere were significant increases in walking velocity, step length, stride length, right single support duration, and left single support duration of the ankle foot orthosis and combination taping groups compared with pre-intervention values. Moreover, the post-intervention values of the double support duration of the ankle foot orthosis and combination taping groups were significantly lower than pre-intervention values. There were no significant differences between the post-intervention values of the ankle foot orthosis and combination taping groups for all parameters.ConclusionThe results demonstrated that combination taping is an effective alternative technique to ankle foot orthosis to improve spatiotemporal parameters in children with spastic diplegic in combination with conventional physiotherapy.LAY ABSTRACTChildren with cerebral palsy have abnormal patterns of walking secondary to spasticity, which can negatively affect their functional abilities and quality of life. Several therapeutic interventions are used, with the aim of improving gait quality in those children so that they become independent in functional activities and can participate in society. This study compared the effectiveness of ankle bracing with the application of a combination taping on gait parameters. The results showed that both interventions are equally effective. Combination taping might be considered a promising alterative to ankle joint bracing, as it is a more functional and less aggressive technique.Key words: combination taping, ankle foot orthosis, gait parameters, cerebral palsy

Cerebral palsy (CP) is a lifelong motor impairment caused by an early brain injury. Depending on the dominant neurological signs of children with CP, the condition is classified as spastic, ataxic, athetoid, or flaccid (1). More than 70% of children with CP are spastic (2). Gait in children with spastic CP is frequently associated with abnormal gait kinematics, linked to increased walking energy cost, which may lead to activity limitations (3).Plantar flexion in the ankle at the beginning of standing and in all phases of walking is one1 of the most common dynamic musculoskeletal deformities in children with spastic CP, which could be accompanied by additional abnormal joint positions of the lower extremities (4). The ability to maintain proper joint alignment of the lower extremity, and monitor the position of the foot while standing and walking, are critical prerequisites for gait in children with CP (5).Lower extremity orthosis, such as ankle foot orthosis (AFO) is widely recommended in children with spastic CP to prevent the progression of the deformity and to improve the child’s gait efficiency (6). The solid AFO maximizes control by restricting both plantarflexion and dorsiflexion movements in the stance and swing phases. Its rigid structure prevents ankle rocker function and reduces excessive plantarflexion during the stance phase, thus facilitating clearance of the toes during the swing phase (7). The benefits of wearing an AFO on gait parameters in children with spastic CP have already been documented in the literature (8).Athletic and Kinesio tapes are the 2 most common types of tape used in clinical settings. Both can be used on patients with orthopaedic or neurological dysfunctions. Athletic tape is a rigid/inelastic tape that restricts movement, while Kinesio tape is a form of flexible/elastic tape. Researchers have used them for similar purposes, such as spasticity control, muscle function facilitation, and joint stabilization (9). Furthermore, studies suggest that rigid tape is more effective than elastic tape at controlling joint mobility (10).The use of Kinesio taping in paediatric rehabilitation has become increasingly popular in recent years. Recent systematic reviews reported moderate evidence that Kinesiology taping is a valuable complement to physiotherapy treatment in better-performing children with CP (11, 12). Combination taping is a technique first introduced by Kenzo et al. (13), in which Kinesio tape is combined with rigid athletic tape to maximize the treatment benefits. This approach remains briefly addressed in the literature with no prior studies has examined the effects of combination tapings of Kinesio tape and athletic tape in the CP paediatric population. Hence, this study was conducted to compare the effectiveness of foot combined taping vs AFO in correcting spatiotemporal gait parameters in spastic CP children with equinus deformity.