Comparing the efficacy of kinesio and Mc-connell taping on knee hyperextension and gait parameters in individuals with stroke.

Stroke is considered to be a leading cause of disability throughout the world.(1) After a stroke, many patients have unilateral sensorimotor deficits, resulting in reduced ambulation ability, with approximately thirty percent unable to walk independently (2) . Even when walking unassisted, hemiparetic gait in post-stroke patients leads to many unique motions and abnormal muscle activities with various joint trajectories (3) . Restoring the ability to walk safely and efficiently is one of the major goals in stroke rehabilitation. There are considerable variations in gait abnormality in patients with stroke, depending on the severity of paresis, spasticity, limited range of motion, impaired proprioception, impaired cognition, and the difference of duration from stroke onset; however, certain typical patterns have been identified. (4-6) Genu recurvatum, or hyperextension of the knee during the stance phase of the gait which extends beyond full knee extension (zero degrees), is common in patients who experience limb paresis that is sufficiently severe to extensively impair walking speed impairs gait efficiency, augments energy expenditure during gait, and may give rise to knee pain, which can further lead to gait asymmetry, thereby affecting the cosmetic appearance. (4,5) Genu recurvatum is defined as hyperextension of the knee of the paretic leg during the stance phase of walking, with or without the use of a walking aid and/or an orthosis. (7) Approximately 65% of stroke subjects are reported to have knee hyperextension. (8) It may result from weakness in the hip extensors, weakness or spasticity in the knee extensors, limited dorsiflexion of the ankle due to spasticity or decreased range of motion, impaired proprioception, or a combination of these factors. (9) okada et.al characterized Knee hyperextension patterns by the strength of knee flexion, trunk motor function, and spasticity of ankle plantarflexors. (10) Longstanding hyperextension may lead to laxity of posterior capsule and anterior cruciate ligament resulting in altered length-tension relationship predisposing to early degenerative changes of knee joint leading to chronic knee pain (11) , poor proprioceptive control of terminal knee extension, knee pain as a result of stress to the ligaments and tendons and reduced independence in daily activities.In addition to the above undesirable effects, knee hyperextension makes knee flexion difficult for adequate ground clearance during the swing phase (12) promoting circumduction and increasing energy consumption while walking. (9,13) Neurophysiological techniques address gait abnormalities; however they do not focus on correction of knee hyperextension. Several interventions have been reported for the treatment of knee hyperextension in post-stroke gait like functional electrostimulation (FES) and electro goniometric feedback, surgical treatment, and orthotic treatment. (9) The evidence available towards robotic devices and brain computer interface in lower limb and gait training is limited. (14) Evidences suggest that the effect of orthotic devices on the paretic lower limb muscle activity is inconclusive and the subjects had concerns with respect to appearance and difficulty with application. (15) Neuromuscular electrical stimulation may lead to muscle fatigue, difficulty in electrode placement, skin irritation and discomfort. (16) In addition to the above, the quadriceps control, specifically eccentric control during loading response, which deserves emphasis due to its crucial role in normal gait, is not addressed in any of the above techniques. Kinesiotaping (KT) is an elastic adhesive tape attached to the surface of the body and is currently used to promote lymphatic circulation, ease pain, provide mechanical support, and improve proprioception. KT has long been used to strengthen weakened muscles, control muscle tone, improve the active range of motion, balance, functional use, and gait ability as a cost effective treatment (17) . It is effective in improving gait ability and muscle function among stroke patients with hemiplegia, KT therapy helps prevent falls and promotes recovery among stroke patients with hemiplegia. The McConnell MT is structurally supportive and uses a tape that is rigid, highly adhesive, and can be worn for up to 18 hours. Based on a previous study finding by Noyes FR, (18) the current study included subjects with stroke who were made to walk with knee flexion and trunk held mild forward flexion, similar to “prowling” i.e. walking in a predatory manner. (19)Walking with bilateral knee bent attitude provides dual advantage by activating quadriceps and changing the direction of moment arm of quadriceps increasing mechanical advantage. (18) It is easily adaptable by the subjects and without the use of any external support devices to reduce knee hyperextension. As there is no strong evidence for rehabiliation of knee hyperextension in post stroke , the purpose of this study was to compare the effectiveness of the prowling with kinesio taping and that of the McConnell therapy with prowling in patients with hyperextended gait in stroke patients by using bi-dimensional tool that is kinovea software to provide quantative data. It is inexpensive 2D technologies available, some of which may match leading high-end reference systems in terms of precision. Kinovea is one such software licensed under GPLv2, created in 2009 via the non-profit collaboration of several researchers, athletes, coaches and programmers from all over the world, it is one such low-cost technology that is free 2D motion analysis software. This tool evaluates the distance, angle, coordinates and spatial temporal parameter. (20) . Wisconsin Gait Scale (WGS) was used as a secondary measure that quantifies gait quality and documents major body part positions during each phase of gait cycle (21–22) . Degree of knee hyperextension, degree of ankle dorsiflexion, time taken to cover 5 m distance.It is a useful tool to rate qualitative gait alterations of post-stroke hemiplegic subjects and to assess changes over time during rehabilitation training. It may be used when a targeted and standardized characterization of hemiplegic gait is needed for tailoring rehabilitation and monitoring results.(22)