REHAB Management for Bell’s Palsy

1. REHAB Managementfor Bell’s Palsy

2. The majority of Bell's palsy cases will resolve without intervention or exercise. • Patience is more important during recovery than pushing to exercise muscles that are likely to return to full function without assistance. • Some cases will result in incomplete recovery or leave residuals. 

3. Warm Compress • During the earliest days of Bell’s palsy, when muscles are completely flaccid, it's probably advisable to limit therapy to moist heat to ease soreness and reduce swelling.

4. Massage • Massage also helps to ease soreness, plus to provide a degree of motion & stimulation to the muscles and increase circulation.

5. Mental Exercises • Mental exercises hel to retain the "memory" of facial motions.

6. Neuromuscular Retraining • A growing field of practice in US & Canada • Gaining recognition as an effective element for optimal recovery from facial nerve paresis. • Retraining techniques have been developed for treating sequelae that range from flaccidity to mass action and synkinesis, improving facial motor control and enhancing patient satisfaction and outcomes.

7. Neuromuscular Retraining • Patient education is the most basic aspect . • Facial therapist provides training in basic facial anatomy, physiology and kinesiology. • Tools such as surface EMG (sEMG) feedback & specific mirror exercises provide augmented sensory information to enhance neural adaptation and learning  • The application of learning theory maximizes motivation through individualized instruction and active patient participation. 

8. Muscles of facial expression & Facial nerve branches

9. Facial Muscles corrugator depressor labii inferiorislevator labii superioris alaeque nasiorbicularis oris inferiorisorbicularis oculi superiorisrisorius depressor anguli orisfrontalislevator labii superiorisorbicularis oris superiorisplatysmazygomaticus major dilator narislevator anguli orismentalisorbicularis oculi inferiorisproceruszygomatiicus minor CORDLILLAOOIOCS RIS DAOFROLLSOOS PLAZYJ DINLAOMENOCIPROZYN

10. Facial Movements

11. General Principles • Slow ExecutionInitiating movements slowly and gradually allows the patient to observe and modify the angle, strength and speed of the excursion as it occurs.Small MovementsSmall movements preserve isolated responses of the facial muscles by limiting motor unit recruitment to those muscles targeted.SymmetryPatients are instructed in symmetrical excursion of movements to reinforce the normal physiological response. Attempts to produce symmetrical movements initially include limiting excursion on the contralateral side.

12. Eye Protection • Manually blink the eye using the back of the finger at regular intervals, and especially when it feels dry • Artificial tears • Moisture chamber or eye patch.

13. Botox • Facial muscles have a tendency to become hypertonic (overactive) after paralysis. • Weakening or re-paralyzing the muscles with Botox can temporarily ease the effects of some synkinetic and hypertonic muscles.

14. Surgery • ACUTE STAGE • Decompression of the facial nerve can be accomplished by a delicate microsurgical procedure. For Bell’s Palsy it remains highly controversial, even when nerve degeneration is severe. • FOR LONGTERM WEAKNESS AND RESIDUALS • reconstructive options for long-term weakness or paralysis. Some are "static" - purely cosmetic; some may help regain function. Often performed when the nerve has been cut or severely compressed than after the "typical" short-term compression of viral and bacterial induced paralysis. • May offer improvement (better symmetry at rest or some improvement to the smile), but can’t fully restore natural movement or expressions.