DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY

CLINICAL LETTER

Functional taping: a promising technique for children with

cerebral palsy
Marco Iosa1,2, Daniela Morelli1,
Maria Vittoria Nanni1, Chiara Veredice1,
Tiziana Marro1, Alessandra Medici1,
Stefano Paolucci1, Claudia Mazz2
1 Fondazione Santa Lucia IRCCS, Rome, Italy.
2 Department of Human Movement and Sport Sciences, Universit degli studi di
Roma 'Foro Italico', Rome, Italy.
Correspondence to: m.iosa@hsantalucia.it

T0

60

T6

T12

40
Hf

20
0

Knee
ext [deg] flex

20
60

Ankle
pl-flex [deg] do-flex

Hip
ext [deg] flex

SIRLimitations in the motor activity of children with cerebral palsy (CP) are the consequence of a failure to acquire
appropriate motor schemas, caused by arrested normal brain
maturation. Nevertheless, some of these children, exploiting
their few available resources,1 manage to walk, thanks to the
emergence of atypical but still functional locomotor patterns.2,3 However, these patterns can lead to long-term instability, contractures, and deformities.4
Common treatments for children with CP include botulinum toxin, serial casting, orthopaedic surgery, and orthoses.5
These somewhat invasive interventions are designed to act at
the peripheral level, without particularly aiming at promoting
more normal motor development at the central level. Functional taping may be a slightly less invasive solution in trying

to reach this objective. This technique, commonly used in

sports traumatology and lately proposed for patients with
stroke,6 aims at supporting an injured joint, protecting weak
structures, and enhancing sensory feedback.7,8 This much less
invasive intervention could favour the integration of therapy
and daily activities and increase participation in social life.
Nevertheless, it has been only applied infrequently in these
children9,10 and only at upper-body level. A pilot study was
performed to test the effects of lower limb taping on the locomotor function of a group of children with spastic unilateral
CP.11 These children were already being treated with conventional physical therapy consisting of 1-hour treatment,
repeated two times a week and based on neurodevelopmental
treatment (derived from the Bobath concept).12 It included
stretching, weak muscle strengthening, and postural and walking training. However, in the months preceding the study, the
above therapy alone was judged to be no longer effective for
the children because expected improvements13 in gross motor
function were not being achieved.
After the approval of the ethical committee of Fondazione
Santa Lucia and the informed consent of both parents, eight
children (initial mean age of 4y and 8m, SD 3y, all diagnosed
with spastic unilateral CP; Table SI, supporting information
published online, who were able to walk independently, were

40

Kf

40
20
Kr

20
Adf

20

25 50 75 100 0 25 50 75 100 0 25 50 75 100

Gait cycle (%)
Gait cycle (%)
Gait cycle (%)

Figure 1: Representative results of gait analysis for one participant (patient 4) before treatment taping (TO) and 6 and 12 months after taping (T6, and T12).
The curves are the sagittal joint kinematics for the paretic (black curves) and healthy (grey curves) limb. The vertical bars indicate the relevant foot off.
The kinematic parameters reported in Table I are highlighted by arrows. The intervention led to an evident improvement of knee and hip kinematics, whereas
a normal ankle dorsiplantar flexion pattern was still to be acquired.
The Authors. Journal compilation Mac Keith Press 2009

DOI: 10.1111/j.1469-8749.2009.03539.x 587

treated for 12 months adding functional taping to the previously described physiotherapy in the first 6 months. The taping was applied in order to: (1) limit the movements that can
cause instability, contractures, and deformities; (2) facilitate
the emergence of safer and more symmetrical and efficient
locomotor schemas; and (3) reduce the social participation
restriction by allowing the use of the children usual clothing
and shoes.
Different types of bandages (band of polyurethane foam in
contact with the skin, adhesive elastic bandage, memory foam
band), resistant anelastic tape, and silk and paper patches were
used to restrain pathological movements and simultaneously

favor functional movements (Figure SI, supporting information published online). Ankle taping was applied weekly, kept
in site for 6 days, and then removed by the patients parents,
leaving the child without taping 1 day a week. The taping was
repeated for 6 months, and was adjusted by the physiotherapist in accordance with possible functional changes, evaluated
through visual assessment of the child walking without taping.
If necessary, the taping was extended to the knee and the hip
joint.
The motor ability of the children was assessed using
clinical measures (ankle passive range of motion [ROMp],
ankle Ashworth scale, and Gross Motor Function Mea-

Table I: Characteristics of the eight patients (sex, age and level of Gross Motor Function Classification System [GMFCS], at the beginning of the study) and
the results of the clinical assessment and of the gait analysis (mean values computed over six strides).

Patient no.
1

Sex
Age
GMFCS
Female
1y 11mo
level I
Male
2y
|level II
Female
2y 5mo
level I
Male
2y 5mo
level I
Male
4y 6mo
level I
Male
7y 6mo
level II
Female
8y 3mo
level I
Male
8y 8mo
level I
Mean
(SD)

Session

GMFM
(%)

GMFME
(%)

SW
(%)

WS
(m s)

SI
(%)

Adf
(deg)

Kr
(deg)

Kf
(deg)

Hf
(deg)

T0
T6
T12
T0
T6
T12
T0
T6
T12
T0
T6
T12
T0
T6
T12
T0
T6
T12
T0
T6
T12
T0
T6
T12
n
at T0
at T6
at T12

81
88
93
60
77
91
84
91
91
83
93
93
96
100
100
77
75
77
92
95
100
97
98
98
8
84 (12)
90 (9)
93 (7)

50
60
100
17
42
67
56
76
100
69
82
82
93
100
100
58
53
54
90
96
99
90
93
93
8
65 (26)
75 (22)
87 (18)

53
33
27
55
31
25
33
35
27
45
26
28
37
32
35
47
45
36
31
25
24
25
24
23
8
41 (11)
31 (7)
28 (5)

0.71
0.69
0.97
0.51
0.91
0.73
1.15
0.91
1.05
0.65
1.04
0.89
0.91
1.11
1.02
0.86
1.03
1.09
0.97
1.23
1.13
0.83
0.94
1.01
8
0.82 (0.20)
0.98 (0.16)
0.98 (0.13)

)14
)19
)16
)25
)3
)16
)11
0
3
)17
0
)18
)10
5
)9
)16
6
2
)4
3
19
0
2
0
8
)12 (8)
)1 (8)
)4 (13)

4
)7
5
9
5
5
2
2
4
3
5
8
)1
0
1
8
4
4
6
3
0
)1
5
1
8
4 (4)
2 (4)
4 (3)

)4
4
2
)2
2
)1
)2
8
)2
)9
2
6
)11
)4
2
6
17
8
16
14
)3
)3
)4
)5
6
)5 (4)
1 (5)
0 (4)

8
30
31
1
6
17
36
31
33
8
30
30
6
5
13
32
33
24
26
34
20
9
23
7
5
6 (3)
19 (12)
20 (11)

37
38
38
29
30
22
46
37
38
24
32
28
17
19
29
40
45
25
37
42
34
18
32
31
3
20 (4)
28 (8)
29 (1)

Joint kinematics values are those of the paretic limb. Gross Motor Function Measure (GMFM) and its locomotion dimension (GMFME) increased
along time. Step width (SW, % of leg length) decreased between before taping (T0) and 6 months after taping (T6), when walking speed (WS) and
symmetry index (SI = (SLpareticSLhealthy) SLmean*100, with SL = step length) increased. No improvements were found at T6 and 12 months after
taping (T12) for the excessive plantar-flexion at the foot strike, as shown by the positive (or slightly negative) values of the Adf (range of ankle
dorsiflexion during the first roll phase) that were still recorded after treatment. An improvement was found for the participants having
impairments at knee level: recurvatum was reduced (increased minimum knee flexion, Kr) and load acceptance corrected (increased maximum
stance knee flexion, Kf). Also, the only patient with a crouch gait at T0 (patient 7) showed kinematic improvements in terms of Kr and Kf, especially
at T12. At T0, three patients (4, 5, 8) showed reduced hip flexion angle at foot strike (Hf around 20), which seemed to be improved after treatment
(Hf around 30 at both T6 and T12). Subgroup means and standard deviations are reported in the bottom lines of the table for the N patients with
similar pathological features (such as Adf>)5, Kr<0, Kf<20, Hf<25)

588 Developmental Medicine & Child Neurology 2010, 52: 587589

sure-88, [GMFM]) and instrumented gait analysis. The

assessment was repeated, without taping, before the treatment (T0), at the end of the 6-month of taping (T6), and
6 months later (T12).
Results showed the acquisition of more functional (incremented GMFM and walking speed), stable (reduced step
width and recurvatum knee) and symmetric (more similar step
length and ankle ab adduction and internal external rotation
between the two limbs) locomotor patterns (Table I, Fig. 1).
Interestingly, the increment of the GMFM scores was higher
than that associated with natural gross motor development.13,14 However, the equinus foot was not corrected by the
taping.
Observed functional improvements were not accompanied
by evident changes in the ankle ROMp and Ashworth values.
This result could represent a specific difference between functional taping and serial casting. Serial casting, in fact, typically
leads to short-term improvements on ROMp, but does not
always improve active functioning15,16 since it may lead to
muscle wasting, weakening spastic and non-spastic muscles.5
Functional taping, conversely, provides support to the weak
muscles, facilitating their normal activity. The only patient that
did not show any improvement (patient 6) was a child who also
had dyspraxia with sensory integration dysfunction and hence
was less likely to be able to properly exploit the enhanced sensory feedback provided by the taping intervention.8,17
Further randomized controlled investigations on wider samples are certainly needed to assess effectively the effects of the
taping treatment. Nevertheless, the fact that observed gait
improvements occurred during the treatment period and were
then maintained, without further changes, in the following
6 months suggests that they are a consequence of the taping

intervention. These results should be read in conjunction with

the level of satisfaction reported by the children and parents in
a short questionnaire purposely administered to them at the
end of the study. Parents reported positive feedback about the
effects of the functional taping on childrens participation in
social activities, locomotor ability, and compliance and tolerability to the treatment.
In conclusion, functional taping seems to be a promising
intervention for improving locomotor function in children
with CP.

ACKNOWLEDGEMENTS
This study was partially funded by the Department of Human Movement and Sports Sciences of the Universita` degli studi di Roma Foro
Italico.

SUPPORTING INFORMATION
Additional supporting information may be found in the online version
of this article:
Table SI: Side of hemiparesis and neuroimaging results reported for
the eight treated children.
Figure S1: Example of functional taping tailoring: (a) band of polyurethane foam (in contact with the skin) and adhesive elastic bandage;
(b) tape for facilitating the foot eversion; (c) tape for facilitating the
ankle dorsiflexion; (d) tailored taping. Functional taping examples: (e)
a more containing taping (for facilitating foot eversion and ankle
dorsiflexion); (f) a less invasive taping (only for facilitating foot eversion).
Please note: Wiley-Blackwell are not responsible for the content or
functionality of any supporting materials supplied by the authors. Any
queries (other than missing material) should be directed to the corresponding author for the article.

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