Elastic Therapeutic Taping with Kinesio® Tape:

An Adjunct Modality for the SLP

by Guest Bloggers for SwallowStudy.com:

Judith Macias-Harris, M.S., CCC-SLP/BSLP/CKTI
Elizabeth G Harvey, DPT, MSR, CKTP

Customary Modalities Used by Allied Healthcare Professionals:

The following table characterizes standard, but not exhaustive, modalities typically used PT’s, OT’s, and SLP’s. (Table 3).

Modalities are necessary to remove resistant forces that prevent the physiology of healing, but they only work as well as the thought process behind them. The rehabilitation occurs when three factors are taken into consideration:

1. Clinical analysis,
2. Solid diagnostic interpretative skills, and
3. Proficient understanding of anatomy/physiology (along with how the body functions as a system).

This triangulation of abilities allows the treating clinician to assess and interpret how “the hierarchy” of systems (skin, circulation, fascia, autonomic nervous system) may be affecting muscles and joint deficits wherever they are occurring in the body (Barnes, 2011; Spencer, 2015). Once this has been established, then any modality (standalone or multi-modal) can be used more effectively for rehabilitative purposes.

It is all about the jaw!

The SLP’s areas of treatment present the need to affect muscle group tensegrity in the head/cervical/thoracic/pelvic areas for one reason –> jaw alignment and stability.

Jaw stability is the foundation for speech production and feeding management (Johnson and Gray, 2008). The jaw, the temporomandibular joint (TMJ), and hyoid bone are suspended structures supported by a series of ligaments, muscles, and cartilages. In order to maintain TMJ/mandibular alignment and stability, cervical and submental muscles must be able to work synergistically with the trunk, pelvis, and extremities.

Traditionally, the focus of strengthening the muscles of the oral cavity has overshadowed the need to keep the TMJ condyle aligned and stable. The oral cavity is intimately affiliated with the temporomandibular joint. Picture a door on a hinge. Trying to strengthen the door, which has come unhinged, will not cause improved function – which is our goal. However, keep the door hinged (aligned and stable), and see the improvement in function. Muscle strength improves by 30% when the joint is stabilized (Kase, 2014). The essence of oral motor exercises (OME), specifically for muscle groups that support the mandible, is beneficial; however, until the muscles, ligaments and tendons that support the TMJ joint are addressed, everything else in the oral cavity (tongue, lips) will be limited in providing the synergistic movement and strength necessary for optimal function.

Along with TMJ joint alignment, overall postural compliance is key to the normal feeding and swallowing process (Redstone and West, 2004). The whole body, with its ascending/descending neural pathways, will impact the synergistic movements associated with swallowing and labial/lingual movement (Gisel et al., 2000; Johnson and Gray, 2008; Redstone and West, 2004).

TMJ/Mandibular Alignment and Stability: How is this related to speech, language, cognition, voice?

The brain is composed of three main structural divisions: the cerebrum, the cerebellum and the brainstem. The cerebellum lies beneath the occipital and temporal lobes; it’s functions are to maintain balance and posture, to promote muscle coordination, motor learning, sensory processing and cognitive functioning.

The reticular activating system (RAS) is a loose network of neurons and neural fibers, consisting of two systems – ascending and descending. (Read More: What is the Reticular Activating System?)

The ascending RAS connects to the cortex, the thalamus, and the hypothalamus.

The descending RAS connects to the cerebellum and to nerves responsible for the various senses.

Information from somatosensory, hearing and vision systems help activate many cortical areas associated with cognitive function (Read More for a “Mind Workout: The Power of Focus and Imagination” on CareerTuneUp.com).

In conjunction with the RAS, the mandible and TMJ joint also bring information to the temporal lobes through the cranial nerves (Schrader et al., 2011). Trigeminal nerve (CNV3 – mandibular branch) stimulation has been shown to have a neural connection to CN VII and VIII at the auditory meatus and TMJ junction thus showing the vast connectivity of the neural network at this site (Ash et al., 1991; Blum; 2008; Buraa, 2013; Faught and Tatum 2013; Finley, 2014; Schrader et al., 2011; Williams, 2015).

Cognitive scientists at Indiana University have also discovered a strong correlation between hand-eye coordination, learning abilities, and social communication skills (See this article by Bergland, C.). Using tactile stimulation techniques in the hand has been shown to stimulate cortical brain activity, possibly due to peripheral innervation through radial, medial, and ulnar nerves which connect at the brachial plexus. There is converging evidence that proprioceptive training of the upper and lower extremities can yield meaningful improvements in somatosensory and sensorimotor function (Aman et al., 2014). Also, the globulus skin of the hands and feet are rich with cutaneous receptors, which have been shown to be more important for reflexive postural responses than vestibular or vision systems (Kafa, 2015).

Modalities and the SLP

Using either non-instrument or instrument-based stimulus methods appears to help rehabilitate muscle group deficits related to speech, language, cognitive, vocal, and swallowing function (Hamdy, 1998; Kelly, 2011, McGough, 2015; Oh et al., 2007).

Body systems (e.g., endogenous analgesic, lymphatic, fascia, muscles, and joints) can be addressed effectively with the use of modalities, such as elastic therapeutic tape. Corrective techniques (e.g., mechanical, fascia, space, ligament, functional, and lymphatic) used appropriately can help with remediation of spine, upper and lower extremity dysfunction that impact jaw alignment and stability.

“Got Tape?”- Elastic therapeutic taping with Kinesio® Tape as an adjunct modality for the SLP

The unique qualities of elastic therapeutic tape, specifically Kinesio® Tape, appear to support the complex role of the SLP in many ways.

First, as a passive modality, it supports the Primum Non Nocere (“First, do no harm“) principle. It is a gentle modality, which can be used to relieve pain, normalize range of motion, improve muscle contraction, stabilize joints, assist in tissue recovery, and release fascia restrictions. Kinesio® Tape’s thickness and weight are similar to skin and act as a stimulus effect to create a cortical response through the RAS. Also, the tape is tolerable for most patient populations, geriatric to pediatric, and can be used at any stage of the rehabilitation process (e.g. acute, sub-acute, and chronic).

Second, one of the most valuable methods of elastic therapeutic taping for the SLP may be in applying tape using E D F [TM] Taping Strategies (E D F for Epidermis, Dermis, Fascia is trademarked). E D F [TM] Taping strategies provide techniques to stimulate the body’s nervous system through the surface of the skin (Kase, 2014).

This level of taping suggests minimal tape tensions on the epidermis to affect the underlying connections between fascia, nerves and muscles (Kase, 2014). Dr. Guimberteau’s research has shown that stimulation to the most superficial layers can affect the deeper layers in the body (Guimberteau, 2007; Guimberteau et al., 2010). It appears that this taping strategy may be affecting sensory stimulation and/or fascia patterns to inhibit muscle contractions that affect jaw stability. It may also help improve spinal, upper and lower extremity dysfunction by unwinding fascia to decrease postural contractions. More data may be on the horizon to further describe the relationship of this level of taping on sensory stimulation and areas typically addressed by the SLP’s (e.g., proprioception).

Considering the areas of the brain responsible for sensory processing and executive function, the use of elastic therapeutic tape in these specific methods and locations can evoke great change. Wen et al. (2012) studied the effects of paravertebral fascial massage on brain development, associated with increased levels of IGF-1, in rat pups. His research found statistically significant increases in the areas of the subventricular zone of the lateral ventricles and denate gyrus of the hippocampus (2012). These areas are important for memory, exploration, and is the largest of three sites where neurogenesis occurs (Alvarez-Buylla and Garcia-Verdugo, 2002). Massage of the trunk and extremities in infants has also been shown to cause increases in IGF-1 in circulation and increased maturation of visual function, as compared with control group infants (Guzzetta et al., 2009).

Third, elastic therapeutic taping is a cost-effective modality. It can be used independently or in cohort with other conventional and rehabilitative techniques. Reimbursement options (e.g., CPT code 97533; Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands) may also be possible.

Presently, there are only three speech language pathologists worldwide at the instructor level for the Kinesio® Taping Method. Many licensed SLP’s, however, have taken the coursework, have become Certified Kinesio® Tape Practitioners (CKTP), and use elastic therapeutic taping as part of their repertoire of treatment procedures. Case studies, case reports, randomized controlled studies, double-blind method studies, and meta-analysis reports are rich in literature on the uses of elastic therapeutic taping for spine, upper and lower extremity dysfunctions, but sparse within the SLP discipline.

As a profession, we are becoming more versed in using modalities, such as with elastic therapeutic tape. Future research in these areas will help determine its effects within the SLP’s parameter of practice.

Conclusion

Smith et al., 2012, suggest that rehabilitative methods could have greater potential to increase swallowing safety, therefore improving long-term quality of life, than compensatory methods alone. Literature supports the use of rehabilitation methods and the use of modalities. Assessing data, along a hierarchy of systems, to interpret motor behaviors (e.g., speaking, eating, etc.) may help improve present treatment methods for our ever-changing patient. There is relevance for the SLP to use modalities for rehabilitation of speech, cognition, language, voice, and swallowing dysfunctions. Using elastic therapeutic tape with Kinesio® Tape is a good adjunct modality to any SLP’s toolbox!

Guest Bios:

Follow Logopedia Speech Therapy Services PLLC on Facebook.

Follow ABC Therapies LLC on their Facebook page or contact via email: abctherapy@homesc.com

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Macias-Harris and Harvey shared the following information regarding their newest class:

Sun Seminars is proud to announce our newest class:

“Cognitive Processing, Verbal/Auditory Performance, and Swallowing Progression with Elastic Therapeutic Tape”.

Data assessment collection and taping strategies will be practiced that focus on treatment areas associated with cognition, speech-language-hearing, respiration, and swallowing/feeding deficits.

All disciplines who have completed the approved Kinesio Tape Association (KTA) KT1, KT2 and KT3 courses are welcome to take our newest class!

There is still time to register for the KTA standardized (KT1-KT3) coursework!

Contact Judee Macias-Harris, M.S., CCC-SLP/BSLP/CKTI; 602-999-7998; judith.macias@cox.net for more information!!

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