The Effect of Scapular Taping on Compound Muscle Action Potential of Scapular Muscles & Upper Limb Function in Chronic Hemiplegic Patients

Dr. Dhwanit S. Shah; Dr. Mukesh Tiwari; Dr. Rajula Tyagi; Dr. K.N. Bhatt; Dr. Mamtarani Verma

Volume : V, Issue : III, March - 2016

The Effect of Scapular Taping on Compound Muscle Action Potential of Scapular Muscles & Upper Limb Function in Chronic Hemiplegic Patients

Dr. Dhwanit S. Shah, Dr. Mukesh Tiwari, Dr. Rajula Tyagi, Dr. K. N. Bhatt, Dr. Mamtarani Verma

Abstract :

 Introduction:Stroke is the 3rd leading cause of the death and an important cause of hospital admission and long term disability among Indian population1,2. Stroke results from a disturbance of blood supply to a section of the ain & should not be considered as an isolated event but as a clinical consequence of a progressive underlying vascular disorder, which is having two major risk factors for stroke are high B.P. & age3. The World Health Organization Defines stroke as “Rapidly developing clinical signs of focal [or global] disturbance of cereal function, with symptoms lasting 24 hours or leading to death, with no apparent cause other than vascular origin”3. Men have been reported to be at greater risk than women in two studies. Stroke accounts for 10–20% of all deaths in industrialized countries & about 88% of stroke deaths are among people over 65 years3. Most common deficit is motor impairment but not all strokes cause physical disabilities, about 16–25% of strokes have been reported to be non hemiplegic3. The most common of impairment of stroke is weakness or paralysis which is to be found in over 80% of CVA [Cereal Vascular Accident] survivors at 3 months after stroke & even after one year hemiplegia or hemiparesis is to be found in 46% of patients3. Hemiplegia is the commonest form of paralysis, involving arm, leg and sometimes the face on one side of the body. Shoulder girdle in chronic hemiplegic suffers from two sorts of problems a) the spasticity of elevators and retractors which full the scapula into a fixed elevated and retracted position4–8. b) the weakness of the opposite group of scapular muscles i.e. depressors and protractors4–8. This leads to instability of the scapulothoracic joint resulting in impaired functional use of the upper limb9. Evidence from different authors and different book saying that proximal Control of, e.g. scapula, trunk, and pelvis helps to regain early development of movements at the distal joint. In order to get the purposeful and coordinated movements at the distal extremity, we need support from proximal musculatures of the scapula10,11. Taping is method of maintaining orientation of the scapula by means of proprioceptive biofeedback to the patient12. Scapular taping has its effects in to improve alignment which promotes improved movement patterns, to alter length–tension properties by stretching tissues that are too short and reducing tension placed on tissues that are too long, to provide support and reduce stress to myofascial tissues under chronic tension13 to provide kinesthetic awareness of scapular position during rest and movement. Even taping also having effect on inhibition and facilitation of muscular structures1,14,15,16. Taping to scapula has used to inhibit hyperactive Upper Trapezius muscle to depress the scapula in its normal resting position14,16. So that it will prevent associated movements of shoulder elevation during arm raising activities. Taping also has used to facilitate the Serratus Anterior muscle which helps in elevating, laterally rotating and protracting the scapula which is restricted or absent in spastic hemiplegic patient due to disuse or weakness of the Serratus Anterior muscle15,16,17. Nerve conduction velocity (NCV) studies are usually carried out to (i) evaluate the integrity of, and (ii) diagnose diseases of, the peripheral nervous system. These studies specifically measure the conduction velocity, latency, amplitude, as well as shape of the response following electrical stimulation of a peripheral nerve through the skin and underlying tissue. Results of NCV studies can reveal the degree of demyelination and axonal loss in the segment of the nerve examined. Demyelination results in prolongation of conduction time, while axonal loss generally leads to loss of nerve or muscle potential amplitude. CMAP (Compound Muscle Action Potential): The CMAP idealizes the summation of a group of almost simultaneous action potentials from several muscle fibers in the same area. These are usually evoked by stimulation of the motor nerve18,19. There is lack of conclusive evidence to prove that taping by stabilizing scapula improves the functional performance of affected Upper Extremity. Hence the aim of this study is to check the effect of taping on scapular stability & upper limb function in recovering hemiplegics and also on CMAP of Trapezius and Serratus Anterior muscles.