Reciprocal Electrical Stimulation Versus Kinesio Taping

A. Patients preparation All the children demographic and outcome measures data will be collected in specially well-designed sheets1. Evaluation of fine motor skills using PDMS-2 Evaluation of hand function using Besta scale

. The traditional exercise program (given to both groups):

• Treatment protocol in Group A, Reciprocal electrical stimulation protocol

• The device has two channels that can stimulate two opposing groups of muscles alternatively (reciprocate).
• During ES, the child sits in a chair with his treated forearm resting on a pillow placed on the bed in front of him.
• The electrodes will be placed as follows:
• Channel 1 (stimulates wrist and hand extensors) electrodes placed over the dorsum of the forearm as follows: the active electrode is placed over the common extensor origin, while in different over the motor point of extensor pollicis longus, abductor pollicis longus, and extensor indices.
• Channel 2 (stimulates wrist and hand flexors) electrodes placed on the palmar side of the forearm are as follows: the negative electrode is placed between the finger flexors and wrist flexors. The positive electrode is placed over the tendonportion of the forearm,
• The treatment duration will be 20 minutes.
• The treatment protocol will be repeated 3 times per week for 12 weeks.
• Treatment protocol in Group B, Kinesio taping protocol:

• Kinesio taping will be applied on both sides of the upper limb.
• The applied area will be from the proximal one-third of the forearm to the wrist and then will be split into 5 straps into the distal interphalangeal joint of fingers.
• On the dorsal side, KT will be applied on the forearm, wrist, and fingers extensors for improvement of wrist and fingers extension.
• On the plantar side, KT will be applied on the forearm, wrist, and fingers flexors for inhibition of wrist and fingers flexion.
• Taping will be applied for 6 days, 24 h a day, on the affected upper limb, and it will be removed for only one day per week.

Inclusion criteria

• A medical diagnosis of spastic hemiplegic CP made by paediatricians or pediatric neurologists.
• Children with spasticity grades ranged from 1 to 1+ according to MAS.
• Their age range from 4 to 6 years.
• Children who can sit on the chair with good balance and recognize and follow verbal orders and commands included in both testing and training techniques

Exclusion criteria

• They had a permanent deformity (bony or soft tissue contractures).
• Children having visual or auditory defects.
• Children with intelligence quotient less than 70.
• Children who had Botox application to the upper extremity in the past 6 months or had undergone a previous surgical intervention to wrist and hand.
• A history of epileptic seizure and any diagnosed cardiac or orthopaedic disability that may prevent the use of assessment methods.
• Children who are absent in two taping change sessions