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.
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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 .
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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.
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6. BELL’S PHENOMENON
• On closing the eye ,the eyeball
moves upwards and inwards.
This is on the affected side due
to ineffective closure of the
eyelids.
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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.
6/14/2019 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.
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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.
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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
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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
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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.
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Eberstein A, Eberstein S (1996) Electrical stimulation of denervated muscle: is it worthwhile? Med Sci
Sports Exerc 28: 1463-1469
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13. Dosage of electrotherapy
• Galvanic (continuous) / Faradic (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
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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
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15. ELECTROTHERPAY
OTHER THERAPY INCLUDES
1. Ultrasound
2. Laser
3. Pulsed electro magnetic waves
4. 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.
6/14/2019 The efficacy of electrotherapy for Bell's palsy: a systematic reviewQuinn R, Cramp F 15
16. Dosage for ultrasound
• Intensity- 0.9w/cm2
• Duration – 5 to 8 mins
• Mode – continuous at 1 MHz
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Ultrasound for Bell's Palsy Talmi, Yoav P et al. Physiotherapy, Volume 74, Issue 11, 565
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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.
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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)
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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
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: 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.
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19.
20. PNF EXERCISES
Techniques of PNF is applied to facial motions include
1. Pressure,
2. Stretch,
3. Resistance,
4. Reinforcement,
5. Repeated contractions
6. Reversal of antagonistic.
7. Relaxation techniques may be used as indicated.
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21. 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.
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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
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22. 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.
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23. 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.
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