sign in sign up
<<
Home , Adeli suit, Cerebral palsy

International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571

Original Research Article

Effect of Therapeutic Taping on Functional Sitting Control during an Exercise Session in Children with Hypotonic

Khushboo Dureja1, Shaswat Verma2

1Physiotherapy Assistant, Sydney, Australia, 2Assistant Professor, Department of Physiotherapy, Ramaiah Medical College and Hospitals, Bangalore, India,

Corresponding Author: Shaswat Verma

ABSTRACT

Background: Cerebral palsies are a heterogeneous group of non- progressive motor disorders of developing . It results from a lesion or developmental abnormality in fetal life or early infancy. Children with hypotonic cerebral palsy often exhibit problems with impaired trunk control and display poor sitting postures against gravity due to altered co- activation of muscles of trunk and hip. Therapeutic taping over the trunk helps in orientation of muscle forces along normal vectors and increasing proprioceptive and tactile facilitation. This study aims to, determine whether therapeutic taping helps in improving the functional sitting control during an exercise session in children with Hypotonic Cerebral Palsy, using the sitting domain of Gross Motor Function Measure-88 scale. Methodology: Convenience samples of twenty subjects were taken and were screened for inclusion and exclusion criteria. Baseline scores of sitting domain of GMFM were taken and specific exercise to improve sitting balance was given. After the exercise session the scores for sitting domain of GMFM was taken again. All subjects were called after a gap of one day and baseline score for sitting domain of GMFM was recorded. Therapeutic taping was applied over the trunk and exercises were given along with it. After the session, scores of sitting domain of GMFM was recorded without removing the tape. Results: Wilcoxon signed rank test was used for statistical analysis of the scores of sitting domain of GMFM-88 scale before and after treatment session. There was a significant change observed in the scores of exercise session with and without therapeutic taping (p<0.001). Conclusion: On analyzing the results of this study, it is observed that addition of therapeutic taping to an exercise session is beneficial in improving the functional sitting control in children with hypotonic cerebral palsy.

Key words: Cerebral palsy, Functional Sitting Control, Therapeutic Taping, Gross Motor Function Measure-88.

INTRODUCTION cerebral palsy are often accompanied by “Cerebral palsy (CP) is described as a disturbances of sensation, perception, group of permanent disorders in the , communication and behavior. [2] development of movement and posture, The incidence of cerebral palsy is between 2 causing activity limitations that are to 2.5 cases per 1000 live births. attributed to non progressive disturbances Approximately 25 lakh children and people that occurred in the developing fetal or in India are estimated to be affected with infant brain.” [1] The motor disorders of cerebral palsy. This makes cerebral palsy as

International Journal of Health Sciences & Research (www.ijhsr.org) 71 Vol.8; Issue: 9; September 2018 Khushboo Dureja et.al. Effect of Therapeutic Taping on Functional Sitting Control during an Exercise Session in Children with Hypotonic Cerebral Palsy the commonest cause of in India. two functional levels of control. First level [3] involves the generation of basic, direction- Etiology of cerebral palsy is very specific adjustments. Perturbations that diverse and multifactorial. Injury to induce a forward sway of body, such as developing brain may be prenatal, perinatal reaching movements are accompanied by or postnatal. [4] Cerebral palsy can be activity of muscles on dorsal side of body classified in two ways. One way to classify and perturbations that induce backward CP is to describe the predominant motor body sway are accompanied by postural characteristics which include , activity in ventral muscles. Second level of , , and Mixed. control is involved in fine tuning of basic Another way classifies CP by, describing postural patterns on basis of multisensorial the topographical pattern of limb afferent inputs from somatosensory, visual involvement which includes , and vestibular systems. The modulation of , , Hemiplegia and postural adjustments can be achieved in Quadriplegia. CP accounts for various ways for instance by changing the nearly 70-80% of all cases of CP and non number of direction specific muscles spastic CP which includes dyskinetic and recruited and by modifying the order in ataxic forms account for 20-30% of all which the direction specific muscles are cases. [5] Children with spastic CP exhibit recruited (e.g. In caudal- cranial sequence or upper motor neuron signs, weakness, in reverse order). [11,12] , hyper-reflexia, and Children with hypotonic cerebral positive Babinski sign. Hypotonic CP is palsy show difficulty in achieving static and characterized by extreme floppiness when dynamic trunk control in sitting due to infant is picked up and by the infant’s faulty feedback mechanisms. As a result of inability to generate enough muscular force this the postural control system is unable to to move the body against gravity. [6] generate appropriate muscular forces and One of the key gross motor functions integrate sensory information received from to be achieved against gravity is sitting. It is receptors present throughout the body. Thus also an essential activity to provide postural leading to “Postural Dyscontrol”. [13] tone required for functional movements of Therapeutic interventions to address upper extremity. Maintaining an erect sitting seated postural dyscontrol in children with requires coordinated activation of flexors CP should emphasize on improving postural and extensors of trunk as well as hip. [7] alignment and gravitational forces about the Infants begin to sit independently by the age body. Thereby, allowing normalization of of 6-8 months of postnatal life. This skill recruitment and timing patterns of muscles. develops from sitting with hands propped at [13] One of the most widely used therapy 3-4 months of age to unsupported sitting in approach for treatment of children with few months. By 9-10 months the child is cerebral palsy is Neurodevelopmental able to move in and out of this position Therapy, developed by Berta Bobath in while playing. [8] 1940,s. It aims at normalizing the muscle Children with developmental motor tone and improving postural alignment by disorders often show deviant and delayed specific handling techniques. The therapist development of sitting. Thus, knowledge controls proximal “key points of control” about the typical development of postural (i.e. head, shoulder, trunk and pelvis) which control is a prerequisite for understanding of helps in controlling the abnormal patterns of deviant development of sitting. [9] movement while at the same time normal Normal Postural control involves patterns of movement can be facilitated. [14] controlling the body’s position in space for Other techniques of facilitation used in dual purposes of stability and orientation. rehabilitation of children with cerebral palsy [10] Postural adjustments are organized into include The Sensory Integration therapy,

International Journal of Health Sciences & Research (www.ijhsr.org) 72 Vol.8; Issue: 9; September 2018 Khushboo Dureja et.al. Effect of Therapeutic Taping on Functional Sitting Control during an Exercise Session in Children with Hypotonic Cerebral Palsy

Roods Approach, Conductive education, dimensions. Individual dimensions of Patterning Therapy, Constraint induced GMFM can be administered depending on movement therapy and Vojta method. [15] the client’s current level of function. This selective use of GMFM allows fewer items New adjuncts for therapy and to be administered and increases the management of children with cerebral palsy measures responsiveness to change by have been emphasized in past two decades. eliminating items that are not relevant to the Some of these interventions like Lycra therapeutic intervention or are unlikely to pressure garments and Adeli suits have change the result of intervention. GMFM is shown to improve abnormal a valid, reliable and widely used outcome and proximal stability especially in children measure used to detect changes motor with hypotonia and ataxia. However they function for children with cerebral palsy. [19] are associated with significant practical There are a few studies done on problems like difficulty to put on and off, incorporating therapeutic taping to a cost noncompliance to heat and need for intervention in children replacement with growth. [16,17] other with cerebral palsy. However, the evidence adjuncts like electrical stimulation over the on effects of incorporating therapeutic abdomen and posterior back muscles have taping over the trunk with exercises in shown to improve trunk control in children children with hypotonic cerebral palsy is with . [7] very scarce. Therefore, this study has been Therapeutic taping over the trunk undertaken to determine whether therapeutic may employ similar advantages. Taping taping helps in improving the functional employs the principle of applying prolonged sitting control during an exercise session low load corrective forces to the using the sitting domain of GMFM-88 scale, musculoskeletal system and provides a in children with Hypotonic Cerebral Palsy. foundation for normal firing and recruitment patterns of muscles. It also helps in MATERIALS & METHODS orientation of muscle forces along normal 20 children of age group 1-3 years vectors and increasing proprioceptive and diagnosed as having Hypotonic CP were tactile facilitation. [18] Thus addition of included in the study. A cross over study Therapeutic taping during an exercise design was chosen to assess the effect of session may be beneficial in facilitating therapeutic taping. The subjects were correct posture and movement patterns. recruited based on convenience sampling. Accurate measurement of motor The exclusion criteria were: change in children with cerebral palsy is 1. Children having other types of Cerebral necessary for monitoring their motor Palsy other than Hypotonia development and evaluating the outcome of 2. Children diagnosed as having treatment intervention. Gross Motor Myopathies Function Measure (GMFM) a criterion 3. Children diagnosed as having Down’s referenced assessment tool has been syndrome and other genetic disorders developed especially for evaluating changes 4. Presence of structural in gross motor function over time in 5. Children with Surgically implanted children with cerebral palsy. It consists of spinal instrumentation 88 items grouped into 5 functional dimensions i.e. lying and rolling, sitting, Procedure crawling and kneeling, standing and Twenty subjects both males and walking. Scores of each dimension are females diagnosed as having hypotonic expressed as percentage of maximum scores cerebral palsy were selected. All subjects for that dimension. Total score is obtained acted as self controls. The purpose of the by averaging percentage scores across the 5 study was explained to the parents of

International Journal of Health Sciences & Research (www.ijhsr.org) 73 Vol.8; Issue: 9; September 2018 Khushboo Dureja et.al. Effect of Therapeutic Taping on Functional Sitting Control during an Exercise Session in Children with Hypotonic Cerebral Palsy subjects and an informed consent was taken. was applied bilaterally with the patient The subjects who satisfied the inclusion sitting in supported upright position on a criteria were taken for the study. On Day 1, stool in the following manner: Baseline score for the sitting domain of Strips 1 and 2 were applied over the GMFM-88 was taken. After recording the paraspinal region in caudo-cephalic baseline data, specific exercises to improve direction from L4 to T1. Strips 3 and 4 were the sitting balance was given according to applied along the course of lower portion of the protocol. The score for sitting domain of trapezius with a medially directed force GMFM-88 was recorded after the exercise from acromion process to T 12 obliquely. session again. The rigid therapeutic tape was applied After a gap of one day the subjects directly over the cover roll stretch tape. were called again and their scores for the Exercises were given along with the tape sitting domain of GMFM-88 were taken. according to the protocol. After the therapy After recording the baseline score, skin was session, the scores for sitting domain of prepared by applying Milk of Magnesia GMFM-88 were recorded without removing over the trunk and cover roll stretch tape the therapeutic tape (Picture 1-6).

Picture 1: Posture without Taping Picture 2: Posture with Taping

Picture 3: Pectoral Elongation with Vertebral Compression without Tape

International Journal of Health Sciences & Research (www.ijhsr.org) 74 Vol.8; Issue: 9; September 2018 Khushboo Dureja et.al. Effect of Therapeutic Taping on Functional Sitting Control during an Exercise Session in Children with Hypotonic Cerebral Palsy

Picture 4: Pectoral Elongation with Vertebral Compression with Tape

Picture 5: Reach Outs in Side Sitting without Tape Picture 6: Reach Outs in Side Sitting with Tape

Statistical analysis: Excel were used to generate graphs and Descriptive statistics was used to tables. analyze gender and age. Normality of the data was checked using Shapiro- Wilk test. RESULTS All the data were not distributed under An interventional study, consisting normal distribution curve, therefore, of 20 children with hypotonic cerebral palsy Wilcoxon Signed Rank Test was used to is taken up to assess the Effects of determine the difference between the total Therapeutic Taping on functional sitting scores of GMFM-88 with and without control during an exercise session, using the therapeutic taping. The statistical software sitting domain of GMFM-88 scale. The for Social Science (SPSS) version 20 demographic data of the study sample in package was used for the computation and terms of age, gender are shown in table 1. analysis of data and Microsoft Word and

Table-1: Age and sex distribution of subjects Age (months) Male Female Total Number Percentage Number Percentage Number Percentage 11-20 8 57.1 1 16.7 9 45 21-30 4 28.6 2 33.3 6 30 31-40 2 14.3 3 50.0 5 25 Total 14 100.0 6 100.0 20 100

The above table 1 shows that, of the 20 (14.3%) and 3 females (50%) were from 31- subjects, 8 males (57.1%) and 1 female 40 months of age. (16.7%) were from 11-20 months of age, 4 The exercise session without therapeutic males (28.6%) and 2 females (33.33%) were taping, the mean  SD of pretest and from 21-30 months of age and 2 males posttest is 17.556.86 and 19.207.35 respectively. The difference in the mean

International Journal of Health Sciences & Research (www.ijhsr.org) 75 Vol.8; Issue: 9; September 2018 Khushboo Dureja et.al. Effect of Therapeutic Taping on Functional Sitting Control during an Exercise Session in Children with Hypotonic Cerebral Palsy from pre test to post test is found as seen in table 2. statistically significant (Z= 3.347, P<0.001)

Table-2: Comparison of GMFM scores before and after exercise session without taping GMFM Pre-test Post-test Z-value@ P-value*** Effect size (sitting domain) Mean SD Mean SD (2 tailed) Exercise session without taping 17.55 6.86 19.20 7.35 -3.347 0.001 0.23 (S) @ Z-value obtained by applying the Wilcoxon signed rank test, as the data is non-normal. *** Highly significant at 0.1% level

Table 3: Comparison of scores of GMFM before and after exercise session with Taping GMFM Pre-test Post-test Z-value@ P-value*** Effect size (sitting domain) Mean SD Mean SD (2 tailed) Exercise session with Taping 18.90 7.61 24.00 9.10 -3.934 0.000 0.61 (M) @ Z-value obtained by applying the Wilcoxon signed rank test, as the data is non-normal. *** Highly significant at 0.1% level

The exercise session with therapeutic noted between the mean of the two sessions taping, the meanSD of pretest and posttest (p<0.001), showing the effect of therapeutic is 18.907.61 and 249.10 respectively. The taping incorporated with exercise session. difference in means is found to be The effect size of intervention is 0.58 and statistically significant as seen in table 3. the percentage change pre and post treatment is 25%. Table-4: Comparison between the exercise session alone and exercise session with taping GMFM Pre test Post test (sitting domain) Exercise session Mean 17.55 19.20 without taping SD 6.86 7.35 Exercise session Mean 18.90 24.00 with taping SD 7.61 9.10 Z-value@ 3.342 3.392 P-value < 0.001*** < 0.001*** (2-tailed) Effect size 0.19 (S) 0.58 (M) Percentage change 7.7% 25% @ Z-value obtained by applying the Wilcoxon signed rank test, as the data is non-normal. *** Highly significant at 0.1% level

The comparison between the exercise session without taping and exercise Figure 1: The following graph shows the difference between session with taping in the pre test reveals the pre and post treatment scores of exercise alone and that, the mean  SD of exercise session exercise session with Taping without taping is 17.556.86 and in the exercise session with taping it is 18.907.61 DISCUSSION as seen in table 4 and Figure 1. There is a The baseline parameters (table 1) in statistically significant difference noted the study show that, maximum males were between the two sessions (p < 0.001), in the age group of 11-20 months and showing the carry over effect of the exercise maximum females were in the age group of session. Effect size of the intervention is 31-40 months. This could be due to 0.19 and the percentage change pre and post convenience sampling chosen for this study. treatment is 7.7%. In the post treatment, it is On analyzing the results of table 2, it is noticed that meanSD for exercise session observed that, there is a statistically significant improvement in the scores of without taping is 19.207.35 and for sitting domain of GMFM-88 scale after exercise session with taping it is 249.10. exercise session without taping. This change There is a statistically significant difference

International Journal of Health Sciences & Research (www.ijhsr.org) 76 Vol.8; Issue: 9; September 2018 Khushboo Dureja et.al. Effect of Therapeutic Taping on Functional Sitting Control during an Exercise Session in Children with Hypotonic Cerebral Palsy could be attributed to the ability of the On comparison of exercise session exercises in specifically targeting the without taping to exercise session with dynamic co-activation of trunk musculature, taping (table 4), it is observed that there is a which is an important pre requisite to significant improvement in the scores of attaining an independent sitting control. [21] sitting domain of GMFM on addition of Exercise sessions for children with cerebral therapeutic taping to an exercise session. palsy are directed towards eliciting and This immediate change seen after the establishing normal patterns of movement application of tape can be attributed to the by providing controlled sensorimotor input proprioceptive input provided by the tape. and by using specific handling techniques [24] Therapeutic taping causes an increase in which guides the movement in a functional proprioception through increase in way. [22] The exercise session in the present stimulation to cutaneous mechanoreceptors. study was directed at improving the When tape is applied, it causes stretching of functional sitting control by, facilitation of skin which is thought to provide the central active weight shifting in the frontal plane to nervous system with feedback concerning produce elongation on weight bearing side joint movement and position , thereby while maintaining the appropriate dynamic improving the proprioception. [25] In co-activation of trunk flexors and extensors addition to the above mentioned effects, and facilitation of functional trunk rotation taping applies corrective forces to the in the transverse plane. [21] Therefore, musculoskeletal system which helps in improvement in motor performance of the restoring optimal muscle length by children can be attributed to the facilitation providing foundation for normal firing and of co-activation of trunk muscles that could recruitment pattern of muscles. [19] The have helped the children in gaining better above findings are consistent with the scores post exercise session. findings of Greig et al, who observed an On analyzing the results of table 3, it immediate reduction in thoracic kyphosis is observed that there is a statistically following the application of postural taping significant improvement in the scores of over the trunk in women. [20] sitting domain of GMFM after exercise The tape acts as a passive stabilizing session with taping. It has been proved that mechanism and promotes desired children with hypotonic cerebral palsy symmetrical movement pattern. It also helps exhibit reduced strength in trunk in maximizing use of the affected muscles musculature and present with an inability to by incorporating it with functional activities. generate enough muscle forces to move the [26] In the present study, therapeutic taping body segments against gravity. [2] Taping was incorporated along with an exercise can be applied over weak muscles to protocol which was specifically directed at facilitate muscle contractions. The tape is improving the functional sitting control in applied from origin to insertion of muscle children with hypotonic cerebral palsy. and as the muscle fibers contract, the tape Therefore, the improvement in functional acts as a support by pulling and stimulating sitting control following the exercise session the muscle back to point of origin. [23] In incorporated with therapeutic taping can be addition to this, therapeutic taping provides attributed to the above mentioned fact. The the foundation for improved functional present study also shows that there is a sitting abilities by controlling trunk carryover effect of the exercise session to movements in frontal and sagittal planes, the taping session. orienting muscle forces along normal Therefore, from the present study it vectors thereby, assisting in static and can be inferred that, Therapeutic Taping dynamic balance. This in turn optimizes incorporated with exercise is beneficial in gravitational forces about the column of improving the functional sitting control in segments by improving body alignment. [14] children with Hypotonic Cerebral Palsy.

International Journal of Health Sciences & Research (www.ijhsr.org) 77 Vol.8; Issue: 9; September 2018 Khushboo Dureja et.al. Effect of Therapeutic Taping on Functional Sitting Control during an Exercise Session in Children with Hypotonic Cerebral Palsy

CONCLUSION Sitting position during the first half year of From the present study we can life. Dev Med Child Neurol. 2005; 47: 312- conclude that therapeutic taping 320. incorporated with exercise is beneficial in 9. Eva Brogren Carlberg and Mijna Hadders improving the functional sitting control in Algra. Postural dysfunction in children with Cerebral Palsy: Some implications for children with hypotonic cerebral palsy. Therapeutic Guidance. Neural Though the study was conducted on a small plasticity.2005; vol.12, No.2-3, 221-228. population and treatment was of a short 10. Anne Shumway- Cook & Manjorie H. duration, it showed statistical significance in Woolacott: Motor Control Theory and the scores of sitting domain of GMFM after Practical Application, 2nd Edition. Page no. the exercise session incorporated with 164. taping. Therefore, it can be inferred from 11. Hadders Algra M. Development of Postural the present study, that therapeutic taping can Control during First 18 months of life. be used as an effective adjunct along with Neural Plast. 2005; 12: 99-108. exercises to improve the functional sitting 12. Forsberg H, Hercgfeld H. Postural control in children with hypotonic cerebral adjustments in sitting humans following external perturbations: muscle activity and palsy. Further studies should be done to kinematics. Exp brain Res. 1994; 97: 515- evaluate the long term effects of therapeutic 527. taping in improving functional sitting 13. Cheryl B Footer. The effects of Therapeutic control in children with hypotonic cerebral Taping on Gross Motor Function in children palsy. with Cerebral Palsy. Ped Phys Ther. 2006; 18: 245-252. REFERENCES 14. Tatjana Dolenc Velickovic, Milivoj 1. Rosenbaum P, Paneth N, Leviton A, Velickovic Perat. Basic principles of The Goldstein M, Bax M. A report: the Neurodevelopmental Treatment. Medicinia. definition and classification of cerebral 2005; 42(41): 112-120. palsy April 2006. Dev Med Child Neurol 15. Dilip R Patel: Symposium on 2006, 49:8-14. Developmental and Behavioural Disorders- 2. Roberta B Shepherd. Physiotherapy in II. Therapeutic interventions in Cerebral : Third edition, Butterworth Palsy. Indian journal of Pediatrics. 2005; Heinemann. Pg no-19, 115. 72(11): 979-983. 3. http://www.deepaksharan.com/pocs cp.html 16. Simona Bar Haim, Netta Harries, Mark 4. Bo Jacobson, Gudrun Hagberg. Antenatal Belokopytov, Alexander Frank, Leonel risk factors for cerebral palsy. Best practice Copeliovitch, Jacob Kaplnski, Eli Lahat. and research clinical Obstetrics and Comparison of efficacy of and Gynecology. 2004; vol.18,No 3, 425-436. neurodevelopmental treatments in children 5. Martha Wilson Jones, Elaine Morgan, Jean with cerebral palsy. Dev Med Child E Shelton. Cerebral palsy: Introduction and Neurol.2006; 48: 325-330. Diagnosis (part I). Journal of pediatric 17. JH Nicholson, R E Morton, S Attefield, D health care.2007; vol. 21, no. 3, 146-152. Rennie. Assessment of upper limb function 6. Guidelines for Best Practices in and movement in children with cerebral Determining Eligibility Based on Children’s palsy wearing lycra pressure garments. Dev Physical Development. Med Child Neurol. 2001; 43: 384- 391. www.nlm.nih.gov/medlineplus/ency/article/ 18. Theratogs, Inc. How do Theratogs work? 003292.htm http://www.theratogs.com 7. Eun Sook Park, Chang II Park, Hong Jae 19. Dianne J Russel, Lisa M Avery, Peter L Lee, Yoon Soo Cho. The effect of Electrical Rosenbaum, Parminder S Raina, Stephen D stimulation on the Trunk control in children Walter, Robert J Pallisano. Improved with . J Korean Med scaling of Gross Motor Function Measure Sci. 2001; 16; 347-50. for children with cerebral palsy: Evidence of 8. Asa Hedberg, Eva Brogren Carlberg, Hans Reliability and Validity. Phys Ther.2000; Forssberg, Mijna Hadders Algra. vol. 80: 873-885. Development of Postural adjustments in

International Journal of Health Sciences & Research (www.ijhsr.org) 78 Vol.8; Issue: 9; September 2018 Khushboo Dureja et.al. Effect of Therapeutic Taping on Functional Sitting Control during an Exercise Session in Children with Hypotonic Cerebral Palsy

20. Russel D, Rosenbaum PL, Gowland C. 24. Audrey Yasukawa, Payal Patel, Cyrus Manual for the Gross Motor Function Valete and Charles Sisung. Functional Measure. Hamilton, Ontario, Canada: effects of Kinesiotaping in an acute McMaster University .1993 Pediatric Rehabilitation Setting. 21. Sherry W Arndt, Lynette S Chandler, Jane http://www.kinesiotaping.com/functional- K Sweeney, Mary Ann Sharkey and Jan effects-of-kt-in-an-acute-ped-rehab- Jhonson. Effects of Neurodevelopmental setting.php Treatment based Trunk Protocol for infants 25. Travis Halseth, John W Mc Chesney, Mark with Posture and Movement Dysfunction. DeBeliso, Ross Vaughan and Jeff Lien. Pediatric Physical Therapy. 2008; 20:11-22. Effect of Kinesiotaping on Proprioception at 22. Jan S Tecklin. Pediatric physical therapy, the ankle. J Of Science and fourth edition. Lipincott Williams and Medicine. 2004; 3: 1-7. Wilkins. Pg number-205. 26. Vijay Batra, Meenakshi Batra. To study the 23. Jaime P Cepeda, Aliza Fishweicher, efficacy of VM functional dynamic Taping Michael Gleeson and Susan Greenwood. protocol/ technique over conventional Does Kinesiotaping of the Abdominal treatment protocol in Bell’s palsy. The Muscles improve the Supine to sit transition Indian Journal of . in children with Hypotonia? August - November 2007; Vol.XXXIX: http://www.kinesiotaping.com/kinesio- No.2:35-40. taping-for-abdominal-muscles-to-improve- the-supine-to-sit-transition-in-children.php

How to cite this article: Dureja K, Verma S. Effect of therapeutic taping on functional sitting control during an exercise session in children with hypotonic cerebral palsy. Int J Health Sci Res. 2018; 8(9):71-79.

******

International Journal of Health Sciences & Research (www.ijhsr.org) 79 Vol.8; Issue: 9; September 2018