PHYSIOTHERAPY TREATMENT FOR BELL'S PALSY

BELL'S PALSY is the most common type of facial paralysis and responds well to various physiotherapy treatment.

1. Physiotherapy treatment for Bell’s palsy By TANVI PATHANIA

2. Table of content DEFINITION INCIDENCE SYMPTOMS CAUSES DIAGNOSIS TREATMENT CONCLUSION 14-Jun-19 2

3. What is Bell’s Palsy???   Bell's Palsy is the paralysis or severe weakness of the nerve that controls the facial muscles on the side of the face - the facial nerve or seventh cranial nerve. Charles Bell known for his studies on the nervous system and the brain. In the 19th century discovered that lesions of the 7th cranial nerve causes facial paralysis. 14-Jun-19 3 Aishwarya Balakrishnan /J. Pharm. Sci. & Res. Vol. 7(11), 2015, 1004-1006

4. INCIDENCE It more commonly affects people over 15 and under 60 years of age. Affects men and women equally. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control . 14-Jun-19 4

5. WHAT ARE THE SYMPTOMS? Signs and symptoms of Bell's palsy come on suddenly and varies from person to person may include: Rapid onset of mild weakness to total paralysis on one side of your face Facial droop and difficulty making facial expressions, such as closing your eye or smiling Drooling Pain around the jaw or in or behind your ear on the affected side Increased sensitivity to sound on the affected side Headache A decrease in your ability to taste Changes in the amount of tears and saliva you produce In rare cases, Bell's palsy can affect the nerves on both sides of your face. 14-Jun-19 5

6. BELL’S PHENOMENON O n closing the eye ,the eyeball moves upwards and inwards. This is on the affected side due to ineffective closure of the eyelids . 14-Jun-19 6

7. What causes Bell's Palsy Bell's palsy occurs when the nerve that controls the facial muscles is swollen, inflamed, or compressed, resulting in facial weakness or paralysis. Exactly what causes this damage, however, is unknown . A viral infection such as viral meningitis or the common cold sore virus— herpes simplex —causes the disorder. 14-Jun-19 https://www.mayoclinic.org/diseases-conditions/bells-palsy/diagnosis-treatment/drc-20370034 7

8. OTHER CAUSES Chronic Middle Ear Infection High Blood Pressure Diabetes Sarcoidosis Tumors Lyme Disease, Trauma Such As Skull Fracture Or Facial Injury. 14-Jun-19 8

9. DIAGNOSIS No specific test for Bell's palsy. Mainly on clinical presentation. Electromyography (EMG).  This test can confirm the presence of nerve damage and determine its severity . Imaging scans.  Magnetic resonance imaging (MRI) or computerized tomography (CT) may be needed on occasion to rule out other possible sources of pressure on the facial nerve, such as a tumor or skull fracture. 14-Jun-19 9

10. House- Brackmann grading system Grade I - Normal Grade II - Mild dysfunction, slight weakness on close inspection, normal symmetry at rest Grade III - Moderate dysfunction, obvious but not disfiguring difference between sides, eye can be completely closed with effort Grade IV - Moderately severe, normal tone at rest, obvious weakness or asymmetry with movement, incomplete closure of eye Grade V - Severe dysfunction, only barely perceptible motion, asymmetry at rest Grade VI - No movement 14-Jun-19 https://emedicine.medscape.com/article/2172449-overview 10

11. Treatment Most people with Bell's palsy recover fully with or without treatment. There's no one-size-fits-all treatment for Bell's palsy Medical ( Corticosteroids, Antiviral drugs) Surgical (Decompression surgery  ) Physiotherapy Allied therapy 14-Jun-19 11

12. Physiotherapy treatment According to clinical practice guidelines, physiotherapy is not recommended in Bell's palsy . Electrotherapy is commonly used ,its main purpose is to reestablish facial control and movement in Bell’s palsy and when denervation occurs, to delay muscular atrophy; it is also useful to diminish pain, muscle weakness and to facilitate facial movement . 14-Jun-19 Eberstein A, Eberstein S (1996) Electrical stimulation of denervated muscle: is it worthwhile? Med Sci Sports Exerc 28: 1463-1469 12

13. Dosage of electrotherapy G alvanic (continuous) / F aradic (pulsating) of 0.2-100 Hz commonly used frequencies Duration- 10-30 min,depending of the lesion type. For denervated muscles 5 to 10 unidirectional & rectangular pulses per day with 30 to 300 ms pulse duration, and 4 or more seconds between pulses are used 14-Jun-19 Arnulfo RJ, Rivera JMG, Torres RPH, Holguin E, Molina RV (2015) Effectiveness of Electro-stimulation as a Treatment for Bell’s Palsy: An Update Review. J Nov Physiother 5: 260. doi:10.4172/2165-7025.1000260 13

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15. ELECTROTHERPAY OTHER THERAPY INCLUDES Ultrasound Laser Pulsed electro magnetic waves Infra red rays All these therapy are well established and has been proven to be beneficial for bells palsy when given in combination with stimulator and exercises . 14-Jun-19 The efficacy of electrotherapy for Bell's palsy: a systematic review Quinn R, Cramp F 15

16. Dosage for ultrasound Intensity- 0.9w/cm2 Duration – 5 to 8 mins Mode – continuous at 1 MHz 14-Jun-19 Ultrasound for Bell's Palsy Talmi , Yoav P et al. Physiotherapy , Volume 74, Issue 11, 565 16

17. REVIEW OF LITERATURE Two case reports were studied on facial palsy after resection of recurrent pleomorphic adenoma and their progress with electrical stimulation . Subjects received electrical stimulation twice daily for 24 weeks during which photographs of expressions, facial measurements and Sunnybrook scores were recorded. Both subjects recovered good facial function demonstrating Sunnybrook scores of 54 and 64 that improved to 88 and 96, respectively. Study concluded that electrical stimulation is a safe treatment and may improve facial palsy in patients after resection of recurrent pleomorphic adenoma. 14-Jun-19 Goldie S, Sandeman J, Cole R, Dennis S, Swain I. Electrical stimulation treatment for facial palsy after revision pleomorphic adenoma surgery.  J Surg Case Rep . 2016 Apr 22;2016(4 ) 17

18. CONVENTIONAL EXERCISES Exercises include elevating eyebrows after brushing forehead. Elevating corner of lips like saying “E” cheek after brushing of affected side of face. Closing slowly eyes, closing only one of eyes alternately. Wrinkling and opening wings of noise. Opening mouth and saying “a”, “o”, saying alternately “e”, “a”, “o”, Smiling with and without showing teeth. Wind-upping cheeks with closed lips. Reading and speaking aloud 14-Jun-19 : Mirzakhani N, Angooti Oshnari L, Akbarzadeh Baghban A, Eliyspoor D, Javantash A, Kamalifar M, Parsamanesh T. The Comparison between Exercise Therapy and Biofeedback Therapy in Facial Function and Quality Of Life of Bell’s palsy. J Clin Physio Res. 2017; 2(3): 139-143. 18

19. PNF EXERCISES Techniques of PNF is applied to facial motions include Pressure, Stretch, Resistance, Reinforcement, Repeated contractions Reversal of antagonistic. Relaxation techniques may be used as indicated. 14-Jun-19 20

20. REVIEW OF LITERATURE A study was done to compare the effects of PNF (proprioceptive neuromuscular facilitation) versus conventional exercises in subjects with Bell’s palsy for improving facial symmetry and facial motor function. Two groups of 10 subjects . Group A received PNF along with electrical stimulation and group B received conventional exercises along with electrical stimulation for 6 weeks. Results concluded that PNF group showed better improvement than conventional group. 14-Jun-19 Tharani , G et al (2018) ' Comparision of Pnf Versus Conventional Excercises for Facial Symmetry and Facial Function in Bell’s Palsy', International Journal of Current Advanced Research, 07(1), pp. 9347-9350. DOI: http://dx.doi.org/10.24327/ijcar.2018.9350.1542 21

21. Alternative medicine Although there's little scientific evidence to support the use of alternative medicine for people with Bell's palsy, some people with the condition may benefit from the following: Acupuncture.  Placing thin needles into a specific point in your skin helps stimulate nerves and muscles, which may offer some relief. Biofeedback training.  By teaching you to use your thoughts to control your body, you may help gain better control over your facial muscles. 14-Jun-19 22

22. Key message Bells palsy can be treated effectively with PT There are various treatment options available Stimulator Ultrasound Various forms of exercises Allied therapy Exercises are must for complete recovery . 14-Jun-19 23

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