III Congreso de la SEFIP Vallodolid 13,14 y 15 de

9/17/2014

Numerous children with cerebral palsy suffer from excessive drooling

III Congreso de la SEFIP Vallodolid 13,14 y 15 de mayo de 2010

Experimental study(29 children & 10 adults) of an elastic therapeutic tape application to address excessive drooling in people suffering from CNS and genetic disorders.

Musculo-skeletal disorders in Cerebral Palsy: physiotherapeutic, orthotic and surgical approaches.

Esther de Ru

Palacio de Congresos conde Ansúrez. Universidad de Valladolid ETT in PPT www.gophysio.info

paediatric physiotherapist NDT-Mueller pre-logopedia therapist

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Elastic therapeutic taping

Tape* characteristics

Kinesio taping introduced 1973 by Kenzo Kase

cotton, highly elastic lengthwise only (30-40%) protective paper back 10% stretch heat sensitive acrylic adhesive (wavepattern) +/-thick as epidermis waterproof light & comfortable, does not limit motion can only be applied once

1. support & reducing muscle fatigue, 2. stimulating weakend muscles, 3. relaxing soft tissue and improving lymphatic flow 4. reducing pain and swelling 60 different brands of elastic tape at the moment * ETT in PPT * K-taping Kumbrink B, Heidelberg:Springer Medizin Verlag 2009 www.gophysio.info

ETT in PPT www.gophysio.info

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*Curetape

Properties elastic tape

Effects of elastic tape on oral control/excessive drooling

Mechanical properties of different tape brands vary

Documents found on taping to improve oral motor function & drooling.

Mechanical properties vary per colour

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Mechanical behaviour of functional tape: implications for functional taping preparations. X. Aguado Jödar et al 13th Congress ECSS Portugal July 2008

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Vendaje neuromuscular.¿tienen todas las vendas las mismas propiedades mecánicas? J.M. Fernandez Rodroguez Apunts Med Esport 2010 doi:10:1016/j.apunts.2009.11.001 ETT in PPT www.gophysio.info

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Trish Martin & Audrey Yasukawa 2003 S. Drummond & Fox 2007 Hille Maas 2008 Esther de Ru 2009 Mariana de Liveira Ribeiro et al 2009 ETT in PPT www.gophysio.info

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Idea s-tape

Various applications

Case study Taping of 4 yr old girl with Rett Syndrome & follow-up after 7 months.

various tape applications found:

1 yr s-tape: frequency

severity bibs clothes rash wipe mouth smell

4-3 4-3 5-3 2-0 5-0 4-4 3-4

Tape is used irregularly, parents decide. ETT in PPT www.gophysio.info


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Participants

Background prospective cohort:

29 children 2.7 – 16.7 yrs old 10 adults 19 - 50 yrs old

Can positive results obtained in case study* be duplicated in a larger group? Differences in results in various disorders? GMFCS level important?

dropouts 10 children 4 adult

6 CNS.

12 CNS

Qeted A 29k-10a Qeted B 23k-10a Qeted C 18k- 6a

Groups: 1. central neurological disorders including brain trauma and/or cognitive impairement 2. genetic disorders

7 genetic

GMFCS children Level I Level II Level III Level IV Level V Unknown

* Drooling – possible new treatment method to help reduce excessive drooling & Seven months later… the further development of our case published in Newsletter ATENA & ANEID September 2009 ETT in PPT www.gophysio.info

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0 genetic

1 1 5 0 9 13


29 children:

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Participants received:

CNS: unilateral and bilateral spasticity, encephalopathy, neurodevelopmental delay, cognitive developmental delay Genetic: Rett syndrome, Otahara syndrome, agnesia corpus callosum, Angelman syndrome, Lennox G. syndrome, Trisomy 22

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General information for parents / caregivers

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S-tape instruction sheet

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Questionnaires Qeted A-E

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Example of informed consent sheet

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Tape satisfaction questionnaire

Children from Spain, Belgium and Holland. ETT in PPT www.gophysio.info

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Informed that:

Tape protocol Test patch child & parent/therapist

• this tape application was being applied in a “new” area • they could stop any time during the study • in the case of an allergic reaction they had to stop • they were part of the whole tape procedure ETT in PPT www.gophysio.info

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Response Questionnaires

1. fill in Qeted A (10 questions) 2. s-tape apply in the morning & remove in the evening for 1 month 3. fill in Qeted B 4. freedom to tape or not to tape 5. fill in Qeted C 6. End ETT in PPT www.gophysio.info

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Removing tape - be careful! strong adhesive

Qeted. A = 29 = 100% (children) Qeted. B = 23 = 79.3% (16 CNS +7 genetic) Qeted. C = 19 = 66.5% (12 CNS +7 genetic)


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stretch tape 10-20%

Do not touch tape

Tape ends 0% stretch

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Questionnaires: 90 items in 10 questions.

application s-tape cut tape lengthwise


Feel for muscle while child swallows

Q. 1 = 4 items Q. 2 = 5 items Q. 3 = 9 items (0-8 scale) Q. 4. = 6 items (0-5 scale) Q. 5- Q.10 = 11 items (0-10 scale)

Tape = not visible

The higher the score the more problems ETT in PPT www.gophysio.info

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2. Severity drooling

1. Frequency drooling CNS

CNS

genetic

genetic


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3. CNS: bibs changes per day

ETT in PPT

¿How manywww.gophysio.info bibs are needed daily?

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5. CNS: smell

ETT is in PPT ¿ How bad the smell? www.gophysio.info


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4. CNS: changes of clothes

ETT in PPT

¿How often do clothes www.gophysio.info need to be changed every day?

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6. CNS: skin problems

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ETT in PPT

www.gophysio.info ¿ Does your child suffer from skin irritation (rash or flaking) around mouth and chin?24

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7. CNS: wiping mouth

ETT in PPT

www.gophysio.info ¿ How often does your child’s mouth need to be wiped every day?

8. CNS. shame

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9. Wiping toys & objects

ETT in PPT

¿ How often do objects and www.gophysio.info toys have to be cleaned every day?

ETT in PPT

www.gophysio.info ¿ Is your child ashamed because of the saliva loss?

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10. CNS: coughing & chocking

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Preliminary results 12 children with CNS disorders

ETT in PPT

¿ Does your child have problems www.gophysio.info with chocking and coughing?

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Preliminary results 7 children genetic disorders decreased numbers Qeted-C = positive result improvement in % of total items Qeted.

decreased numbers Qeted-C = positive result improvement in % of total items Qeted.

4 improved: - 25.10.11.25 mean = -17.75 (19.72%)

7 improved: -14.6.4.29.4.13.12 mean = -11.71 (13.01%)

2 status quo + discrepancy scores and comments : - 6.3. mean = -4.5 (5%)

4 status quo + discrepancy scores/comments: - 12.1.3.2 mean = -4.5 (5%)

1 deteriorated: + 2. (2.22%)

1 deteriorated: +11 (12.22%) ETT in PPT www.gophysio.info

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Preliminary results

Problems we encountered • the number of dropouts

decreased numbers Qeted-C = positive result improvement in % of total items Qeted.

• communication difficulties

6 CNS adult cases:

• another tape used (rigid strappal)1x

5 improved: - 12.16.5.16.23 mean = -10.4 (11.56%)

• taking part in other study at the same time

1 status quo: - 4. (4.44%)

• treatment changes during tape periode ETT in PPT www.gophysio.info

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Flaws

Remarks parents/therapists •

important to round the corners when cutting tape – square doesn´t stick well

not possible to train or check all “tapers” (emails and skype)

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keep an eye on the skin, may get rash after longer use

standard application was therefore questionable

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when child is sick drooling often increases

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tape tends to peel off in the cold (snow) ETT in PPT www.gophysio.info

frequency differed (2 x week & daily) no control group (natural course drooling problems well documented) 33

What have we learned from this study so far ?


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Thanks go to: participating parents, grandparents, physiotherapists, cuidadores & our patients

Preliminary results show improvement in symptoms related to excessive drooling from this tape application. Daily applications and 2 x week both give good results. Future: More studies needed with both adults and children.

Atena Co. for suppling 24 rolls of Curetape.

Which application will prove to be the most effective?

Esther de Ru: Member SEFIP & KNGF AEVNM instructor

In further research one tape brand and one colour must be used. ETT in PPT www.gophysio.info

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