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Special Topics

Bracing and Taping

QuestionAnswer
Bandaging Purposes -Acute/ emergency situations: support/ stabilize, restrict motion, control swelling/ bleeding -Wound care: protection, absorb exudate, debridement -Other purposes: residual limb shaping, muscle assist
Bandaging Materials: Muslin -Rolled non-elastic cotton
All Cotton Elastic (ACE) bandage -Advantages: Muscle assist, compression because of elasticity, reusable -Disadvantage: limited joint support
Gauze -Open weave cotton -Rolled or as pads -Some pads are non-adhesive
Stockinet -Tube of loosely or tight knit cotton -Hold dressings in place -Plaster cast lining -Improve swelling
Bandaging Techniques; Triangular -Folded square cloth, used for UE, temporary sling
Circular -Overlapping circular turns -Typically used to anchor bandage
Spiral -Overlapping diagonal turns -Less apt to occlude circulation -Covers larger area than circular type
Spica -Series of spinal turns applied in alternate directions in the shape of the number eight that is typically across a joint -Provides more stability -Used on extremity joints Turns typically used in combination
Knee & Elbow -Anchor distal to joint -Wrap distally to proximal w/ lessening pressure as you wrap -Covers all skin with spiral turns as it lies -Finish by anchoring proximal to the jt. about 1/2 way up segment -4 in. bandage for adults and smaller for children
Hand & Wrist -Anchor at the base of fingers -Wrap distal to proximal lessening pressure -Cover all skin w/ spiral turns -Anchor just distal to forearm muscle belly -2 in. bandage for adults and smaller for children
Foot & Ankle -Position in neutral -Anchor at base of toes -Wrap distal to proximal lessening as you go -Cover all skin -Anchor just distal to gastroc muscle belly -4 in. bandage for adults and smaller for children
After bandaging -Assess function and benefit
How would you ensure proper circulation -Nail bed recovery -Pulses -Observation -Ask
Hip bandaging may be used for -Above knee amputees -Thigh muscle strains
Hip bandaging -Anchor below level of injury w/ circular turn -Wrap: prox. w/ spiral turn around thigh, then wrap pelvis/ iliac crests w/ spica and return to thigh alternately -Anchor on pelvis circular turn -Bandage: 6 in. adults & 4 in children -Double bandage
Thigh muscle strain: Hamstrings -Hamstrings -Hip position: Extended -Wrapping force: Posterior between LEs
Thigh muscle strain: Hip Flexors -Hip Flexors -Hip position: Flexed -Wrapping force: Anterior between LEs
Thigh muscle strain: Hip Adductors (Groin) -Hip adductors (groin) -Hip position: Slight adduction/ flexion -Wrapping force: Medial
Thigh muscle strain: Hip abductors (rare) -Hip abductors (rare) -Hip position: Abducted -Wrapping force: Lateral
Taping purposes -Injury prevention -Joint support/ protection -Biomechanical: repositioning, proprioceptive input, muscular activation
Taping materials -General adhesive taping: athletic taping -Specialty adhesive taping: Leukotape/Endura tape/ Kinesio-tex taping (KKT)
Athletic taping -Provides support with physical activities
Athletic taping: What is the most common sprain and specific ligament? -Lateral sprain -Anterior Talofib ligament
Athletic taping: Lateral sprain: Stirrups applied from ____ to ____ and creating _____ -from Medial to Lateral and creating Eversion -Heel locks and figure 8 turns are applied in pairs and in both directions
Medial Sprain: applied from ___ to___ and creating ____ -Similar to lateral ankle sprain taping -Exception- stirrups are applied from Lateral to Medial and creating Inversion
Athletic taping vs KTT and no taping -Improved avg. EV muscle activity with IV perturbation with a hx of ankle sprains
Athletic taping vs KTT, placebo, and no taping -Decreased vertical jump and heel raise performance with chronic ankle instability (CAI)
Athletic support: Loss of support with activity -50% loss after 15 minutes of standard vigorous exercise including jumping, pivoting, and running -20% loss after 20 minutes start/stop running on uneven ground and jumping
Ankle taping: CAI -Talar stability: position pt. in neutral to 10 degrees DF/ tape assists with posterior glide of talus -High ankle strain: tape assists with posterior glide of distal fibula and approximation of distal tibfib joint
Knee taping- McConnell -Developed by Jenny McConnell, PT -Used for patellofemoral P! syndrome; aka anterior knee P! or patellar maltracking
Patella typically deviates abnormally in a ____ direction -Lateral
Knee taping purposes -Proprioception- especially with poor initial proprioception -Biomechanics: improved medial and lateral placement, improved inferior shift to increase contact area -Improved knee extensor torque
Arch taping -Purpose: controls excessive pronation -Types: Low dye- most familiar/ recognized; Augmented low dye-rare; Tear drop-rare
Arch taping indications -Plantar fasciitis -1st MTP OA -PFPS -Tibiofemoral lateral compartment OA -Hip impingement/OA -Those with contributing pronation -Benefits: Positional changes in the entire LE
Augmented low dye benefits -More effective than Low Dye @ maintain med longit arch -Increase peak & mean max pressure on the lat mid foot with walkin & joggin Decrease mean max pressures on med forefoot & peak pressure on med rearfoot durin walkin -Controls excessive pronation
Augmented low-dye benefits in runners -Delayed onset of gluteus medius, vastus medialis, and vastus lateralis -Increased lateral midfoot plantar pressure
Shoulder taping -Shoulder complex: Supraspinatus/Biceps tendon tendonitis/-osis -Indication: lowest tolerant pts when gravity is irritating their condition, better option than sling
Shoulder taping cont... -Impaired scapular companion motions with impingement -Indication: impingement with poor scapular control -Assist with LT activity -Promotes: Scapular upward rotation and _____retraction? Improved posture
Spinal taping -Purposes: cervical/ thoracic spine- bilateral scapular positioning -Indication; C-DJD or stenosis/ thoracic P, functional instability, osteoporosis/ vertebral bofy fx -Promote Flex bias in upper and middle c-spine -Promote Ext bias in lower c&t spine
Spinal taping cont... -Lumbar spine for ext bias -Meta-analysis on spinal P! and disability- taping lacked firm support and not clinically relevant
Kinesio-tex Taping -Developed by Dr. Kenzo Kase, DC -Unidirectional elasticity -Latex free -Hypoallergenic- last 3-5 days -Water resistant version available
KTT claims to... -Alter muscle function -Reduce pain -Reposition subluxed joints by relieving muscle tension -Promote circulation by “lifting” skin -Limited research to substantiate claims as of Summer 2012 but growing
KTT vs manipulation with MND after 1 wk -Similar improvements in P! , disability, and ROM (except for rot) -Only clinically meaningful changes with P! for both interventions -No control group
KTT evidence -No change with thoracic myofascial trigger points compared to placebo -Did not facilitate muscle performance at the knee
KTT evidence: CAI vs athletic tape -Similar or greater performance
KTT evidence: CAI vs athletic and no taping -No significant effect on EV mm activity
KTT evidence: CAI vs placebo and no taping -No significant differences for dynamic balance -Faster and equal difference in the hopping and single limb hurdle
KTT evidence: CAI vs athletic, placebo, and no taping -Better vertical jump and heel raise performance
Created by: alovedaytn