LETTERS: NEW OBSERVATIONS
CLINICAL PRACTICE
Kinesiotaping as a Potential Therapeutic Approach in Functional Movement Disorders Oybek Turgunkhujaev, MD,1,*
Vasily Kupreychik, MD,1 and Yury Seliverstov, MD, PhD2
The current multidisciplinary approach to the management of patients with functional movement disorders (FMDs) considers physiotherapy with a focus on motor retraining as one of the key therapeutic elements.1 Kinesiotaping is a physiotherapeutic technique initially proposed for sports injuries. It is based on the application of elastic tapes on the skin with the aim of supporting underlying anatomical structures and reducing pressure on them. However, there is still insufficient evidence regarding the efficacy of kinesiotaping, particularly in the treatment of neurologic diseases.2 We hypothesized that this method may be used for the management of FMDs. Our case series included 4 patients who were diagnosed with an FMD based on positive diagnostic criteria. A comprehensive explanation of the diagnosis was given using a software–hardware metaphor, and all patients accepted the diagnosis. Elastic tapes were applied on either an affected body part or the trigger points and slightly stretched to ensure skin sensory stimulation. Patients were informed that no specific kinesiotaping techniques were used, the tapes do not affect peripheral anatomical structures, and the procedure may have a placebo effect. However, we also explained that the new sensory inputs might fix abnormal communication between the brain and body. In addition, patient 1 kindly allowed us to show a video recording of him with clinical improvements to the other 3 patients. The demographics and clinical characteristics of the patients are presented in Table 1. The video segments show the examination of patients before and after kinesiotaping. We observed the rapid (within 5 minutes) and marked improvement of motor symptoms in all cases. The use of various devices to treat FMDs has a long history. Nevertheless, to the best of our knowledge, this is the first report of kinesiotaping for FMDs. This method has been reported to enhance proprioceptive feedback.2 Therefore, we suggest that the use of kinesiotaping may create new external sensory inputs, which in turn help reestablish a sense of agency over the affected body part by disrupting pathological sensory integration.
1
For obvious reasons, we were unable to isolate the fraction of the placebo effect in the treatment response, which has its own neurobiological basis. Although we were transparent regarding the possibility of the placebo response, the video with improvements had an apparent learning effect, influencing the expectations of the other 3 patients (part of the nature of the placebo effect).3 In addition, comprehensive delivery of the diagnosis can be considered as a therapeutic communication, and an explanation of the hypothesis on the mechanism of action could enhance the potential placebo effect in a nondeceptive manner. Nevertheless, kinesiotaping can be considered as an interesting, easy-to-use, add-on physiotherapeutic method. More prospective studies with a comprehensive assessment, including functional neuroimaging, are needed to demonstrate the therapeutic effect of kinesiotaping in patients with various types of FMDs. However, one should still consider kinesiotaping as a type of adaptive device, which if applied on a long-term basis, may prevent complete recovery.
Acknowledgment We thank the patients for their consent to publish the videos with them.
Author Roles (1) Research Project: A. Conception, B. Organization, C. Execution; (2) Manuscript Preparation: A. Writing of the First Draft, B. Review and Critique. O.T.: 1A, 1B, 1C, 2A V.K.: 1A, 1B, 2B. Y.S.: 1A, 1C, 2В
Center of Complex Diagnostics, Semeynaya Clinic, Moscow, Russia; 2Research Center of Neurology, Moscow, Russia
*Correspondence to: Dr. Oybek Turgunkhujaev, Center of Complex Diagnostics, Semeynaya Clinic, Bryanskaya St. 3, Moscow, Russia; E-mail: [email protected] Keywords: kinesiotaping, functional movement disorders, placebo. Relevant disclosures and conflicts of interest are listed at the end of this article. Received 30 April 2020; revised 21 July 2020; accepted 2 August 2020. Published online 27 August 2020 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/mdc3.13051
872
MOVEMENT DISORDERS CLINICAL PRACTICE 2020; 7(7): 872–874. doi: 10.1002/mdc3.13051 © 2020 International Parkinson and Movement Disorder Society
MOVEMENT DISORDERS CLINICAL PRACTICE 2020; 7(7): 872–874. doi: 10.1002/mdc3.13051
F, 25 years
M, 36 years
Case 3 (segments 5 and 6)
Case 4 (segment 7)
1 month
10 years
8 years
10 years
Duration of Symptoms
Emotional stress
Tactile stimuli over spine
Rape with severe head and neck trauma
Sports injury of the left little finger and left pectoral muscles
Precipitating Event
FMD, functional movement disorder; M, male; F, female.
F, 28 years
M, 46 years
Case 2 (segments 3 and 4)
Case 1 (segments 1 and 2)
Cases
Gender, Age at Examination FMD Phenotype
Recurrent paroxysmal right-sided hemiparesis lasting up to 20 minutes
Bilateral postural hand tremor, truncal jerks triggered by tactile stimuli along vertebral and paravertebral lines. The severity of symptoms fluctuated depending on emotional factors
Paroxysmal dyskinesia of the left shoulder and abnormal posturing of the left hand and left little finger triggered by physical activity and by pressing the specific points on the body Fluctuating unstable gait, jerks in the right leg
TABLE 1 Demographics and clinical characteristics of the patients
Tried multiple antidepressants in the previous 2 years Levothyroxine since 17
Sertraline and alimemazine were started at the same day after kinesiotaping was applied
Dizziness, and “brain fog”
Levetiracetam, clonazepam, escitalopram for ~4 years Psychotherapy and physical therapy
Previous trials of benzodiazepines, myorelaxants, antidepressants, anticholinergics, antipsychotics, and botulinum toxin with no effect
Concomitant or Previous Treatment
Headaches and back pain Insomnia Diagnosed with bipolar affective disorder at the age of 20
Posttraumatic stress disorder
Pain and discomfort in the left shoulder
Associated Symptoms and Conditions
Same day
Same day
10 weeks
6 weeks
Time Between Communication of a FMD Diagnosis and Initiation of the Kinesiotaping
Trigger points were taped After tape application, complete resolution of all symptoms. Relapse of involuntary movements when kinesiotapes are removed Continues to regularly apply kinesiotaping following 2 years after its initiation Right calf and foot as shown in the video segment Resolution of the left leg jerks immediately after tape application Continues to use kinesiotaping as a rescue therapy following 6 months after its initiation Both upper extremities and along paravertebral lines bilaterally In 5 minutes, complete cessation of the truncal jerks when touching paravertebrally; however, palpation of the tape-free regions continued to trigger jerks No change in hand tremor Loss to follow-up Anterior surface of the right leg Complete resolution of anxiety in 4 weeks Complete resolution of the right-sided hemiparesis on examination after 5 minutes following single-tape application without further relapses within next 7 months
Part of the Body Where Kinesiotaping Was Applied and Treatment Outcomes
TURGUNKHUJAEV O. ET AL.
LETTERS: NEW OBSERVATIONS
873
LETTERS: NEW OBSERVATIONS
Disclosures Ethical Compliance Statement: We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this work is consistent with those guidelines. The work was approved by the institutional review board of the Research Center of Neurology. The authors confirm that the patient provided verbal and written consent for this work. Funding Sources and Conflict of Interest: No specific funding was received for this work. The authors declare that there are no conflicts of interest relevant to this work. Financial Disclosures for the Previous 12 Months: Oybek Turgunkhujaev and Vasily Kupreychik declare that there are no additional disclosures to report. Yury Seliverstov has received compensations from Allergan for talks on dystonia. ■
References 1. Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry 2015; 86:1113–1119. https://doi.org/10.1136/jnnp-2014-309255. 2. Krajczy M, Krajczy E, Bogacz K, Łuniewski J, Lietz-Kijak D, Szczegielniak J. The possibility of the use of Kinesio taping in internal, oncologic, and neurologic diseases: a systematic review and meta-analysis. Explor J Sci Heal 2020; 16:44–49. https://doi.org/10.1016/j.explore.2019.07.017.
874
KINESIOTAPING IN FMD
3. Kaas BM, Humbyrd CJ, Pantelyat A. Functional movement disorders and placebo: a brief review of the placebo effect in movement disorders and ethical considerations for placebo therapy. Mov Disord Clin Pract 2018;5: 471–478. https://doi.org/10.1002/mdc3.12641.
Supporting Information Supporting information may be found in the online version of this article. Video S1 Segment 1: Patient 1. Abnormal posturing of the left hand and left little finger; dyskinetic movements in the left shoulder elicited by movement and by the palpation of specific trigger points. Segment 2: Patient 1. Complete resolution of all symptoms after 5 minutes following the application of tapes. Segment 3: Patient 2. Unstable gait and jerks in the right leg interrupting gait initiation. Segment 4: Patient 2. Anatomical sites for the application of tapes; marked improvement in gait. Segment 5: Patient 3. Truncal jerks triggered by tactile stimuli along the vertebral and paravertebral lines. Segment 6: Patient 3. Sites of the application of tapes are shown. Complete cessation of truncal jerks when touching the paravertebral area; however, the palpation of tape-free regions continued to trigger jerks. Segment 7: Patient 4. Reduced right arm swing and right knee buckling. Segment 8: Patient 4. The site of tape application is shown; complete resolution of right-sided symptoms.
MOVEMENT DISORDERS CLINICAL PRACTICE 2020; 7(7): 872–874. doi: 10.1002/mdc3.13051
CLINICAL PRACTICE
Kinesiotaping as a Potential Therapeutic Approach in Functional Movement Disorders Oybek Turgunkhujaev, MD,1,*
Vasily Kupreychik, MD,1 and Yury Seliverstov, MD, PhD2
The current multidisciplinary approach to the management of patients with functional movement disorders (FMDs) considers physiotherapy with a focus on motor retraining as one of the key therapeutic elements.1 Kinesiotaping is a physiotherapeutic technique initially proposed for sports injuries. It is based on the application of elastic tapes on the skin with the aim of supporting underlying anatomical structures and reducing pressure on them. However, there is still insufficient evidence regarding the efficacy of kinesiotaping, particularly in the treatment of neurologic diseases.2 We hypothesized that this method may be used for the management of FMDs. Our case series included 4 patients who were diagnosed with an FMD based on positive diagnostic criteria. A comprehensive explanation of the diagnosis was given using a software–hardware metaphor, and all patients accepted the diagnosis. Elastic tapes were applied on either an affected body part or the trigger points and slightly stretched to ensure skin sensory stimulation. Patients were informed that no specific kinesiotaping techniques were used, the tapes do not affect peripheral anatomical structures, and the procedure may have a placebo effect. However, we also explained that the new sensory inputs might fix abnormal communication between the brain and body. In addition, patient 1 kindly allowed us to show a video recording of him with clinical improvements to the other 3 patients. The demographics and clinical characteristics of the patients are presented in Table 1. The video segments show the examination of patients before and after kinesiotaping. We observed the rapid (within 5 minutes) and marked improvement of motor symptoms in all cases. The use of various devices to treat FMDs has a long history. Nevertheless, to the best of our knowledge, this is the first report of kinesiotaping for FMDs. This method has been reported to enhance proprioceptive feedback.2 Therefore, we suggest that the use of kinesiotaping may create new external sensory inputs, which in turn help reestablish a sense of agency over the affected body part by disrupting pathological sensory integration.
1
For obvious reasons, we were unable to isolate the fraction of the placebo effect in the treatment response, which has its own neurobiological basis. Although we were transparent regarding the possibility of the placebo response, the video with improvements had an apparent learning effect, influencing the expectations of the other 3 patients (part of the nature of the placebo effect).3 In addition, comprehensive delivery of the diagnosis can be considered as a therapeutic communication, and an explanation of the hypothesis on the mechanism of action could enhance the potential placebo effect in a nondeceptive manner. Nevertheless, kinesiotaping can be considered as an interesting, easy-to-use, add-on physiotherapeutic method. More prospective studies with a comprehensive assessment, including functional neuroimaging, are needed to demonstrate the therapeutic effect of kinesiotaping in patients with various types of FMDs. However, one should still consider kinesiotaping as a type of adaptive device, which if applied on a long-term basis, may prevent complete recovery.
Acknowledgment We thank the patients for their consent to publish the videos with them.
Author Roles (1) Research Project: A. Conception, B. Organization, C. Execution; (2) Manuscript Preparation: A. Writing of the First Draft, B. Review and Critique. O.T.: 1A, 1B, 1C, 2A V.K.: 1A, 1B, 2B. Y.S.: 1A, 1C, 2В
Center of Complex Diagnostics, Semeynaya Clinic, Moscow, Russia; 2Research Center of Neurology, Moscow, Russia
*Correspondence to: Dr. Oybek Turgunkhujaev, Center of Complex Diagnostics, Semeynaya Clinic, Bryanskaya St. 3, Moscow, Russia; E-mail: [email protected] Keywords: kinesiotaping, functional movement disorders, placebo. Relevant disclosures and conflicts of interest are listed at the end of this article. Received 30 April 2020; revised 21 July 2020; accepted 2 August 2020. Published online 27 August 2020 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/mdc3.13051
872
MOVEMENT DISORDERS CLINICAL PRACTICE 2020; 7(7): 872–874. doi: 10.1002/mdc3.13051 © 2020 International Parkinson and Movement Disorder Society
MOVEMENT DISORDERS CLINICAL PRACTICE 2020; 7(7): 872–874. doi: 10.1002/mdc3.13051
F, 25 years
M, 36 years
Case 3 (segments 5 and 6)
Case 4 (segment 7)
1 month
10 years
8 years
10 years
Duration of Symptoms
Emotional stress
Tactile stimuli over spine
Rape with severe head and neck trauma
Sports injury of the left little finger and left pectoral muscles
Precipitating Event
FMD, functional movement disorder; M, male; F, female.
F, 28 years
M, 46 years
Case 2 (segments 3 and 4)
Case 1 (segments 1 and 2)
Cases
Gender, Age at Examination FMD Phenotype
Recurrent paroxysmal right-sided hemiparesis lasting up to 20 minutes
Bilateral postural hand tremor, truncal jerks triggered by tactile stimuli along vertebral and paravertebral lines. The severity of symptoms fluctuated depending on emotional factors
Paroxysmal dyskinesia of the left shoulder and abnormal posturing of the left hand and left little finger triggered by physical activity and by pressing the specific points on the body Fluctuating unstable gait, jerks in the right leg
TABLE 1 Demographics and clinical characteristics of the patients
Tried multiple antidepressants in the previous 2 years Levothyroxine since 17
Sertraline and alimemazine were started at the same day after kinesiotaping was applied
Dizziness, and “brain fog”
Levetiracetam, clonazepam, escitalopram for ~4 years Psychotherapy and physical therapy
Previous trials of benzodiazepines, myorelaxants, antidepressants, anticholinergics, antipsychotics, and botulinum toxin with no effect
Concomitant or Previous Treatment
Headaches and back pain Insomnia Diagnosed with bipolar affective disorder at the age of 20
Posttraumatic stress disorder
Pain and discomfort in the left shoulder
Associated Symptoms and Conditions
Same day
Same day
10 weeks
6 weeks
Time Between Communication of a FMD Diagnosis and Initiation of the Kinesiotaping
Trigger points were taped After tape application, complete resolution of all symptoms. Relapse of involuntary movements when kinesiotapes are removed Continues to regularly apply kinesiotaping following 2 years after its initiation Right calf and foot as shown in the video segment Resolution of the left leg jerks immediately after tape application Continues to use kinesiotaping as a rescue therapy following 6 months after its initiation Both upper extremities and along paravertebral lines bilaterally In 5 minutes, complete cessation of the truncal jerks when touching paravertebrally; however, palpation of the tape-free regions continued to trigger jerks No change in hand tremor Loss to follow-up Anterior surface of the right leg Complete resolution of anxiety in 4 weeks Complete resolution of the right-sided hemiparesis on examination after 5 minutes following single-tape application without further relapses within next 7 months
Part of the Body Where Kinesiotaping Was Applied and Treatment Outcomes
TURGUNKHUJAEV O. ET AL.
LETTERS: NEW OBSERVATIONS
873
LETTERS: NEW OBSERVATIONS
Disclosures Ethical Compliance Statement: We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this work is consistent with those guidelines. The work was approved by the institutional review board of the Research Center of Neurology. The authors confirm that the patient provided verbal and written consent for this work. Funding Sources and Conflict of Interest: No specific funding was received for this work. The authors declare that there are no conflicts of interest relevant to this work. Financial Disclosures for the Previous 12 Months: Oybek Turgunkhujaev and Vasily Kupreychik declare that there are no additional disclosures to report. Yury Seliverstov has received compensations from Allergan for talks on dystonia. ■
References 1. Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatry 2015; 86:1113–1119. https://doi.org/10.1136/jnnp-2014-309255. 2. Krajczy M, Krajczy E, Bogacz K, Łuniewski J, Lietz-Kijak D, Szczegielniak J. The possibility of the use of Kinesio taping in internal, oncologic, and neurologic diseases: a systematic review and meta-analysis. Explor J Sci Heal 2020; 16:44–49. https://doi.org/10.1016/j.explore.2019.07.017.
874
KINESIOTAPING IN FMD
3. Kaas BM, Humbyrd CJ, Pantelyat A. Functional movement disorders and placebo: a brief review of the placebo effect in movement disorders and ethical considerations for placebo therapy. Mov Disord Clin Pract 2018;5: 471–478. https://doi.org/10.1002/mdc3.12641.
Supporting Information Supporting information may be found in the online version of this article. Video S1 Segment 1: Patient 1. Abnormal posturing of the left hand and left little finger; dyskinetic movements in the left shoulder elicited by movement and by the palpation of specific trigger points. Segment 2: Patient 1. Complete resolution of all symptoms after 5 minutes following the application of tapes. Segment 3: Patient 2. Unstable gait and jerks in the right leg interrupting gait initiation. Segment 4: Patient 2. Anatomical sites for the application of tapes; marked improvement in gait. Segment 5: Patient 3. Truncal jerks triggered by tactile stimuli along the vertebral and paravertebral lines. Segment 6: Patient 3. Sites of the application of tapes are shown. Complete cessation of truncal jerks when touching the paravertebral area; however, the palpation of tape-free regions continued to trigger jerks. Segment 7: Patient 4. Reduced right arm swing and right knee buckling. Segment 8: Patient 4. The site of tape application is shown; complete resolution of right-sided symptoms.
MOVEMENT DISORDERS CLINICAL PRACTICE 2020; 7(7): 872–874. doi: 10.1002/mdc3.13051
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