Physiotherapy Treatment for Patient with Bell's palsy

On the last post we Bell Palsy we show the common causes and sign of Bell's Palsy, On this post we will show the Physiotherapy way for treat the Bell's Palsy

First of all Patient Education and Reassurance
A- Explain for patient the causes, incidence, prognosis and treatment
B- Its better to take the advice from the physician, and to avoid therapy given by non professionals
C- If eyes are involved, the patient should :

1- Use antiseptic eyes drops
2- Avoid stand on direct sunlight
3- Avoid watching TV closely, and avoid strong room lighting
4- Wear sunglasses to protect eyes
5- Avoid direct contact with air conditioners

D- Explain to the patient how the psychological state can affect the treatment, so avoid any emotional conflict and seek family or friend support to increase self awareness and self esteem
E- Follow the given home program

Physical Therapy Treatment

A. Electrotherapy

The electrotherapy modalities reviewed included:
electrical stimulation (ES), Ultrasound, electromyography and biofeedback
No evidence support electrical stimulation benefit for acute facial paralysis but it's effective for chronic condition
Biofeedback is more effective when muscle activity presents
Ultrasound can be beneficial for acute conditions

B. Neuromuscular retraining

When each muscle group is being assessed, the patient observes the action of these muscles in the mirror and instructed to perform small symmetrical specific movements on the sound side to identify the right response. Each patient presents with different functional disability, so there are no general list of exercises.

The movements should be initiated slowly and gradually so that the patient can observe the angle, strength, and speed of each movement, because rapid movements can't help the patient in controlling the abnormal movement

The patient can apply a manual resistance as isolated facial movement improved in affected side to be obvious without synkinesis.(with out other muscle move ) abnormal movement

C. Manual massage
Massage can be done with other treatment options. It can be done to improve perceptual awareness.

Massage technique on the face include:

1. Effleurage
2. Finger or thumb kneading
3. Wringing
4. Hacking
5. Tapping
6. Stroking

D. Exercise
by applying different Facial expressions like

1- Cheek puff and hold without let the air outside
2- ٍSmile
3- Frowning moving Eyebrows several time