Difference between Facial palsy & Bell's Palsy and treatment procedure.

Difference between Facial palsy & Bell's Palsy and treatment procedure.

Facial Palsy:  Facial palsy (A.K.A acial Paralysis) is the loss of movement in the facial muscles. A person with facial paralysis cannot move the muscles freely. Facial palsy can occur on either side or both sides of the face. Facial palsy results in disproportionate face, facial nerve being injured or experiencing some kind of trauma. Facial paralysis can also occur due to infection, tumors, and other diseases. which can cause difficulty in speaking, chewing, and swallowing the food.

 

Bell’s palsy: Bell’s palsy involves a weakness or paralysis on one side of the face. Symptoms often appear first thing one morning. A person wakes up and finds that one side of their face does not move.

The person may find that they suddenly cannot control their facial muscles, usually on one side. The affected side of the face tends to droop. The weakness may also affect saliva and tear production, and the sense of taste.Many people are afraid they are having a stroke but if the weakness or paralysis only affects the face, it is more likely to be Bell’s palsy.

Approximately 1 in 5,000 people develop Bell’s palsy each year. It is classed as a relatively rare condition.

In very rare cases, Bell’s palsy can affect both sides of the face. 

 

Difference between Facial palsy & Bell's Palsy.

Facial palsy  :

• Facial palsy is an upper motor neuron paralysis which means it is always related the nerve roots inside the brain. 
• Facial palsy can occur due to any tumor, injury in the nerve root of 7th cranial nerve which is facial nerve. 
• In facial palsy some muscles get paralyzed on the affected side of face leads to chewing ,biting difficulties. Affected opposite size lower half of the face.
• Spastic type tone.
• The prognosis of facial palsy is poor as it is of permanent or long duration paralysis. 

Bell's Palsy: 

• Bells palsy is a lower motor neuron paralysis. 
• In bells palsy inflammation of facial nerve occurs around the stylomastoid foramen which is due to any viral or unspecific causes. 
• It leads to weakness of the same side half of facial muscles mostly.
• Flaccid type tone. 
• The symptoms of Bell's palsy can develop one to two weeks after you have a cold,ear infection or eye infection. They usually appear abruptly, and you may notice them when you wake up in the morning or when you try to eat or drink. 
• 80% patients recover within a few weeks. 2-12 weeks. 

Physiotherapy Treatment of Facial palsy:

• Neuromuscular Retraining (NMR) 
• Electromyography (EMG) and mirror biofeedback 
• Trophic Electrical Stimulation (TES)
• Proprioceptive Neuro Muscular Facilitation Techniques
• Kabath technique
• Mime therapy

Evidence of Physiotherapy Treatments:

• According to clinical practice guidelines, physiotherapy is recommended ("weak recommendation") in Bell's palsy, and Neuromuscular Retraining techniques are effective in increasing facial range of movement and symmetry, as well as reducing/minimising synkinesis
• Mime therapy can improve functionality for patients with facial palsy. The therapy consists of exercises with mirrors.
• The effect of electrical stimulation is controversial.
• One study found that PNF technique is more effective than conventional exercises.
• One study found PNF/Kabat technique is more effective than no exercise

 

Physiotherapy Manegement on Bells’s Palsy

Bell’s palsy facial exercises:

Exercises will help to strengthen the specific muscles of the face and should be done 4-5 times a day in front of a mirror or as per the advice of your Physiotherapist.  The mirror will also help you avoid letting the good side overcompensate by moving in an exaggerated way. Facial exercises are preformed to keep your brain trained in what electrical impulses are needed to control the different muscles in your face. This will help you transition back to using your facial muscles as you recover from Bell’s Palsy and the paralysis goes away.

Facial exercises for Bell’s Palsy involve doing basic actions with the different muscle groups throughout your face.

      What can you Do’s:

• Facial exercises can be performed at home.
• You need to be patient, and work the muscles gently.
• You should go through the exercises not less than three times each day.
• Repetitions & frequency of exercises should be modified according to improvement status.
• Pay attention to your face as you exercise – focus on watching and feeling what the good side is doing, and then mentally visualize it on the Bell’s palsy side and try to recreate it in tiny increments.
• Exercise in short sessions, but increase the frequency of exercises, more if you can. Quantity is not as important as quality, so don’t do your exercises when you’re tired. It’s better to exercise correctly just a few times than to do it incorrectly many times.

     What can you Don’t:

• When performing these exercises, you should not exert yourself or worry much about whether you are successfully completing all of them.

• Don’t force things to the point that the two sides pull against each other. If you see a motion pulling other muscles that shouldn’t be moving, back off a little, and freeze it at that point, and relax the muscles that shouldn’t be moving.

Facial Exercises:

Sit relaxed in front of a mirror	Gently raise eyebrows
Draw your eyebrows together, frown	Wrinkle up your nose
Gently try and move corners of mouth outwards	Lift one corner of the mouth
Fill up your cheek with air	Bring your lips together and forward

Source: Image 2015 – Physiotherapy Department, Taiping Hospital.

Exercises To Help Close the Eye

Look down	Gently place back of index finger on eyelid, to keep the eye closed

With opposite hand gently stretch eyebrow up…working along the brow line. This will help relax the eyelid and stop it from becoming stiff.

Close your eyes as much as u can.	Gently press the eyelids together with your fingers

 Source : Image 2015 – Physiotherapy Department, Taiping Hospital.

Electrical Stimulation:

Another method of physiotherapy treatment is using electrical stimulation. Unlike facial exercises which you mostly perform at home, you will need to visit a therapist for electrical stimulation.

Electrical stimulation uses small amounts of electricity to activate the muscles in your face. This causes your muscles to twitch as if electrical impulses from your brain activated them. During the stages of Bell’s Palsy when your face is most paralyzed, this may be the only way for you to activate these facial muscles.

Manual Massage:

Massage can be performed in conjunction with other treatment options. It can be done to improve perceptual awareness. Massage manipulations on the face include:

• Effleurage
• Finger or thumb kneading
• Hacking
• Tapping
• Stroking

Other methods of treatments includes..

• Apply moist heat to the paralyzed area to help reduce pain.

• Try drinking with straw.

• Eat on the side of your mouth that feels most comfortable.