More or Less? Consider the Power of Microtaping Applications (MTA)

Great insights from Elizabeth G. Harvey, DPT, MSR, CKTI, CEIM, about the benefits of using smaller pieces of tape! This has been submitted to Advanced Healing for publication. Full publication with pictures will be uploaded soon!!  Elizabeth will be teaching the Kinesio Standardized Day 1- Day 3 curriculum in Maitland, FL, September 7-9, 2018. Please contact Judith Macias-Harris at judith.macias@cox.net, or visit our Sun Seminar website: http://sseminars.logopediaspeechtherapy.com for more information.

More or Less? Consider the Power of Microtaping Applications (MTA)

Elizabeth G Harvey, PT, DPT, MSR, CKTI, CEIM

Dr. Kase pioneered a therapeutic taping product that can impact body systems thru stimulus on the epidermis. Its design imitates the structure and function of skin. This is critical because as an organ, skin is dynamic, vigilant and adaptable. Within its’ architecture are the sensors that act as our interface with the environment. McGlone calls skin the “entry level to the cortex to … systems controlling perception, attention and emotion, as well as systems that integrate this information …” (2010).

Epidermis-Dermis-Fascia (EDF) taping applications asked you to take a leap of faith from previous dominance of muscle/joint tapings. It was not until the development of new technology, such as fMRI, that it was possible to operatively detect the neurologic changes that occurred. The fMRI research by Dr. Mendoza has shown that even EDF taping applications, which are smallest and most lightweight, influences neurologic activity.

Now we are moving again – to microtaping applications (MTA)! This is a new specialty curriculum created by Judith Macias-Harris and myself. In the case of sensory stimulation, these small but strategic tapings can be very effective. When skin is added to the equation of motor learning, less is more. The thought process behind MTA is the “Minimal Effective Dose”: how little do I need to add to a system to make a positive change? Neural plasticity is powerful. It is the “dynamic biological capacity of the central nervous system (CNS) to undergo maturation, change structurally and functionally in response to experience … achieved by modulating … molecular and cellular mechanisms that influence the dynamics of synaptic connections” (Ismail et al, 2017). Researcher Dr. Jefferey Kleim, works closely with rehabilitation professionals and has comprised a concept of plasticity called “Use it and Improve it” (Kleim and Jones, 2008). This Employs:

ü  Specificity (adaptation: neurologic reorganization)

ü  Repetition (repeated sufficiently)

ü  Intensity (“Goldilocks Zone”: not too easy, not too hard)

ü  Timing (repeated over time: duration)

ü  Salience (interest in activity: tolerance)

ü  Age (developmental age of brain at time of injury).

In addition to sensory benefits, maintaining skin integrity for those with fragile skin, such as pediatric and geriatric populations, is imperative. Esther De Ru’s work on mini-tapings in pediatrics, especially NICU patients, has been an important influence on the size of MTA applications. Her research discusses in detail skin’s maturation process post-partum and differences that occur depending on birth weight and prematurity (2017). The smaller MTAs have, thus far, not caused any skin irritation. They are also easy to apply and remove. Ease of removal is especially critical in cases of skin fragility or neurologic sensitivity. If it hurts coming off, rarely will you get to re-apply!

Triple Tragus Taping strategy

Initial probes into the effectiveness of these tapings has shown that MTAs can cause change in function/participation and posture, as well as biomarkers such as thermoregulation (Macias-Harris et al, 2017) and respiration (Harvey et al, 2017). Included in this article are several case studies in which manual therapy (Beckman Oral Motor Protocol) was used in conjunction with one MTA, the Tragus Taping (See Image 1). This application was created by Judith Macias-Harris, MS, CCC-SLP, BSLP, CKTI. It is intended to stimulate the skin over the TMJ and area where cranial nerves V and VII (facial and trigeminal) exit the skull. (This is the tape application that sold me on the MTA theory, so I felt it would be a great place to start your journey as well.) In all three cases, this application was applied by the same physical therapist with instruction to the caregiver to remove, from top to bottom, after three days of wear time, unless the child demonstrated discomfort. The therapist saw each patient once a week for an hour. Follow up questions on wear time and progress, as well as questions regarding any irritation from the application were reviewed at each weekly session.

The tape application process is called the “Inchworm Technique”. Minimal tension thru the tape (10%) is used, while the tape is applied with a manual superior to inferior glide up the tape. This is thought to create mini convolutions, or lift, in the skin thru the recoil process. Even in young patients with hyper vigilant sensory systems, this application has been tolerable. It has recently been demonstrated that skin stretch, in and of itself, directly affects motor behavior, or learning (apart from muscle/joint sensors) (Takayuki and Ostry, 2010). 

The MTAs can be used in conjunction with standardized KTA and as an adjunct to other modalities.

Elizabeth G Harvey, PT, DPT, MSR, CKTI, CEIM is owner of ABC Therapies LLC in Moncks Corner, SC. She can be reached at abctherapy@homesc.com

References:

1.    McGlone F, Reilly D. The cutaneous sensory system. Neurosci Biobehav Rev. 2010;34(2):148-159. https://www.ncbi.nlm.nih.gov/pubmed/19712693

2.    Ismail FY, Fatemi A, Johnston MV. Cerebral plasticity: Windows of opportunity in the developing brain. Eur J Paediatr Neurol. 2017;21(1):23-48. https://www.ncbi.nlm.nih.gov/pubmed/27567276

3.    Kleim J, Jones T. Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. J of Speech, Lang and Hearing Research. 2008;51:225-39.

4.       De Ru E. Is applying Elastic Therapeutic Tape on the skin of pre-term infants (NICU) and new-borns safe? Clinical Notes: Elastic therapeutic Taping in Paediatrics: Best Practice. 2017. Downloaded Aug 2016 from https://www.academia.edu/31331942/Clinical_Notes_2_ETT-Ped_taping_pre-term_infants_NICU_and_new-borns._Best_Practice

5.    Harvey EG, Macias-Harris J, Brown, KM. A prospective study of the posture and sensory stimulation method using a touch, treat, tape approach (PaSS Method®) to affect functional outcomes in children with dysphagia. NDTA Network. 2017; 24(3):12-14, 16-23.

6.    Macias-Harris J, Harvey EG, Lavigne T, Su Y. “Comparing surface and core temperatures between non-self-induced inflammation (NSII) and self-induced inflammation (SII) athletes with and without Kinesio tape®” Submitted for Poster Presentation at Kinesio® International Research Symposium and ASHA National Conferences. 2017.

Takayuki I, Ostry DJ. Somatosensory contribution to motor learning due to facial skin deformation. J Neurophysiology. 2010;104(3):1230–1238. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2944698/