Wednesday, June 13, 2012

Complementary Strategies in Cerebral Palsy: Lymphatic System, Peripheral Blood Flow, and Homeostasis

Lymphatic System
This post is intended as a fundamental follow-up to the previous post on Kinesiotaping (Kinesiotaping-and-disorders-of-movement.html) that outlined the potential assistive benefits to the body´s exisiting fascial performance and mechanical competance.  Along with the biomechanical potential, it is equally important to examine the positive systemic contribution it generates as well.  During my research, I was pleasantly surprised to find more scientific evidence on the systemic ¨positives¨ than the mechanical positives.  While the biomechanical apects are likely more inuitive, the systemic response is initially more elusive.  A logical question arises: ¨How can the application of elastic adhesive tape promote systemic health?¨  This was my initial question...and the answer is ironically very simple and basic.  However, before I examine this in more detail, I should take some time to elaborate on my own perception of  systemic health and homeostasis.  

The Lymphatic System:  The lymphatic system is essentially a very organized network composed of functionally interrelated tissue and is a transport pathway for tissue fluid.  As colourfully illustrated in the image at the beginning of this post, it consists of 3 main components: 1) migrating cells and lymphoid tissue such as lymph nodes, thymus, spleen, bone marrow, and specific tissue in the liver and and lungs.  2) vessels (intercellular space, perivascular space).  3) Fluids (tissue fluid and lymph fluid).  It is divided into 2 classifications:  Primary and Collateral Lymphatic System (also called Central and Peripheral).  The most active areas are found in the skin, abdomen, and lungs as these areas are exposed to the external environment. 

The main functions of the lymphatic system are:

-collect and transport tissue fluids from the intercellular spaces in all the tissues of the body, back to the veins in the blood system.

- plays an important role in returning plasma proteins to the bloodstream.

- antibodies (manufactured in the lymph nodes) assist the body to build up an effective immunity to infectious diseases.

- lymph nodes play an important role in the defence mechanism of the body. They filter out micro-organisms (such as bacteria) and foreign substances such as toxins, etc. 

Once the relevance of this essential system within the human organism is recognized, ANY strategy that would promote it´s health and contribute to it´s maintenance and homeostasis is indeed of benefit and worthy of consideration.  Therefore, we are left with the next fundamental question:  How does Kinesiotaping contribute?¨ 

Kinesio Taping alleviates pain and fascilities lymphatic drainage by lifting the skin. The taped portion forms convolutions in the skin thus increasing interstitial space. The result is that pressure and irritation are taken off the neural/sensory receptors. Then, slowly, pressure is taken off the lymphatic system allowing it to drain more freely.

 In a recent chiropractic journal (October 2011), Dr. Kenzo Kase explains expands on the mechanism and provides the following enhancement:

 Viruses, infections and bacteria attack when the body's immune system is lowered, whether from fatigue or in reaction to cold conditions. If the immune system is strong, the epidermis at the surface of the body affords protection. If the immune system is weakened, the cell cannot protect itself. A virus can also affect the mucosa; mucosa functions internally as a protective barrier the way epidermis does on the body's outside surface.  

The lymphatic correction with elastic therapeutic taping is used to reduce edema by directing fluid toward a less congested lymphatic pathway and lymph node. The elasticity and lifting effect of the tape decreases pressure, and may also create a massaging action during active motion. The effect of the taping on muscle is to normalize the lymphatics by allowing maximum contraction and relaxation of the muscle.

Edema and inflammation may occur when an increase in circulatory activity of the blood leaves the lymphatic system unable to keep pace. The cause may be trauma, infection, an autoimmune reaction such as rheumatoid arthritis, or excessive heat. Once inflammation occurs, it increases pressure on the touch receptors. The increased pressure in the superficial layers, and lack of skin movement, in turn may inhibit lymphatic receptors and increase edema.

Research: Studies support the use of elastic therapeutic taping for lymphoedema. In a 2007 Polish study, researchers found that "assessment of the efficiency of an upper limb in women after mastectomy shows a 20-day cycle of improvement with the use of lymphatic applications of the [elastic therapeutic taping] method, [with considerable reduction of edema lymphatic,] which increases range of motion and normalization of muscular tension, contributing to the increase of muscular strength."
The study concluded, "Lymphatic applications accelerate lymphatic and venous microcirculation, and reduce the stasis of lymph in intercellular spaces. Decrease of edema contributes to the improvement of movement range in all joints of an upper limb and normalization of muscular tension contributing to the increase of muscular strength."  A randomized, single-blinded, controlled 2009 study of 41 patients in Taiwan suggested elastic therapeutic tape "could replace the bandage in decongestive lymphatic therapy, and it could be an alternative choice for the breast-cancer-related lymphedema patient." And Polish researchers studying 24 patients in 2009 found that "the application of [elastic therapeutic taping] in the study group produced a significantly faster reduction of the edema compared to standard lymphatic massage."

 Pediatric Taping
Research: In 2006, a pilot study was conducted at the Rehabilitation Institute of Chicago. The purpose was to describe the use of elastic therapeutic taping for the upper extremity in enhancing functional motor skills in children admitted into an acute rehabilitation program. Fifteen children (10 females and five males; 4 to 16 years of age) receiving rehabilitation services at the institute participated in this study.
For 13 of the inpatients, this was the initial rehabilitation following an acquired disability, which included encephalitis, brain tumor, cerebral vascular accident, traumatic brain injury, and spinal cord injury. The Melbourne Assessment of Unilateral Upper Limb Function (Melbourne Assessment) was used to measure upper-limb functional change prior to use of elastic therapeutic tape. Immediately after application of the tape and three days after wearing tape, upper-limb function was compared using analysis of variance. The research found that "the improvement from pre- to post-taping was statistically significant, F(1, 14) = 18.9; p< .02."

The Chicago team concluded: "These results suggest that [elastic therapeutic tape] may be associated with improvement in upper extremity control and function in the acute pediatric rehabilitation setting. The use of [tape] as an adjunct to treatment may assist with the goal-focused occupational therapy treatment during the child's inpatient stay."

 Every day, health care professionals, patients and athletes are discovering new things about elastic therapeutic taping. On the research side, we work constantly to understand what works and why. It is clear that DCs all over the world have the training and creativity to take the healing sciences to the next level; elastic therapeutic taping can be a valuable asset for that progression.

In addition to the previous studies mentioned, a recent published study concluded that this form of taping improves peripheral blood flow.  
Researchers based the above study on the widely recognized principle that increased blood flow is one of the natural mechanisms of the healing process. The clinical study used nine randomly selected subjects, five of whom suffered from poor circulation and chronic disorders and four of whom were “relatively healthy.” The volume of all subjects’ peripheral blood flow to various parts of the body was measured by Doppler. For the study, Kinesio Tape was applied to the sites most likely to affect blood flow to each area being tested. Blood volume measurements were taken and recorded both before and after Kinesio Tape application. Pre-taping measurements were then compared to post-taping measurements, and differences were noted.
Results of the above Kinesio Tape study showed an approximately 60% increase in blood flow to the pectoralis major muscle, an approximately 30% increase in the pectoralis minor muscle, and an approximately 20% increase in the anterior and medial scalenus muscles after Kinesio Tape application. Results were consistent among all subjects, without exception: All five who suffered from poor circulation and chronic physical disorders showed statistically significant increases in blood flow volume, and all four who did not suffer from these conditions showed no increases and, in fact, showed slight decreases in peripheral blood flow.

To summarize a rather lengthy examination, there is quite a vast amount of data that suggests that therapeutic taping provides postive contribution to the regulation of the lymphatic system and peripheral blood flow.  Therefore, by definition, it contributes to the development and maintenance of the body´s natural homeostasis.  More importantly, it is an effective, non-invasive adjunct to most rehabilitation strategies (massage, ABR,) that quite simply enhances potential for improvement.

The main roles for therapeutic taping, as promoted by this blog, are two-fold:  1) ASSISTIVE FACILITATION (for biomechanical objectives), and 2) SYSTEMIC (enhancement of lymphatic flow and peripheral blood flow).  Therefore, in the Miscellaneous Toolbox  section of this blog, I will be posting some basic applications for both.  Although Kinesiotaping is a technique that has been actively utilized since 1973, it has primarily been used for healthy individuals and implemented in high performance sport environments.  In more recent times, it has been introduced into the rehabilitation domain (pediatrics, etc) as well.  Although it has proven to be quite valuable, proper implementation must be a result of fundamental understanding of the trans-anatomical manifestations of CP.  With this in mind, my intention is not to ¨regurgitate¨ current applications or simply ¨import¨ current implementations...rather to deliver unique applications and strategies based on the extended fascial paradigm and it´s relevance to Cerebral Palsy.  Each application is compatible with concurrent non-invasive techniques such as Fascia Therapy, hydrotherapy (therapeutic tape is resistant to water and can remain attached for 3-6 days), as well as movement associated with daily activity.

Check the Toolbox regularly upcoming taping applications, guidelines, demonstrations, and tips.


1 comment: