Efficacy of different modalities and exercise therapy on facial palsy patients (A mini review)

Abstract

Background: Facial palsy is a neurological condition characterized by facial muscle weakness

or paralysis, which can lead to reduced functional recovery, difficulty teaching functional

movement, life challenges and also reduced quality of life. While the condition can stem from

wither central or peripheral lesions, this review focuses primarily on peripheral facial palsy,

especially Bell’s palsy. Medication plays a vital role during the acute stage, while physical

therapy and rehabilitation help support facial motor recovery and improve long-term

functional outcomes.

Objective: Reviewing the available evidence or literature for checking the efficacy of

pharmacological treatments and physiotherapy-based modalities and exercise therapy used in

management of facial palsy, with focus on Bell’s palsy and peripheral facial palsy.

Methods/Design: Previously published clinical trials, relevant clinical guidelines and

systemic reviews or meta-analysis were used for this literature review. Its main focus is the

pharmacological and rehabilitation interventions for facial palsy. The literature evidence that

was published within ten to fifteen year gap was considered, where emphasis was on

corticosteroids, antiviral therapy, facial exercises, neuromuscular training, mirror therapy,

biofeedback, electrical stimulation, proprioceptive neuromuscular stimulation and low level

laser therapy. Setting: Primary care and outpatient physical rehabilitation settings.

Participants: The adults diagnosed with facial palsy, specifically patients diagnosed with

(acute, sub-acute, or chronic) idiopathic peripheral facial paralysis or Bell’s palsy.

Interventions: From pharmacological point of view, interventions included systemic

corticosteroids, antiviral therapy, and supportive eye care. From physiotherapy the

interventions included facial exercises, neuromuscular training, mirror-based therapy,

biofeedback, proprioceptive neuromuscular facilitation, electrical stimulation and low-level

laser therapy. Primary Outcome Measures: Facial motor recovery and functional symmetry,

measured chiefly by the House-Brackmann Scale and Sunnybrook Facial Grading system

alongside patient reported facial disability and quality of life tools where available. Results:

Within 72 hours of symptoms onset, early administration of corticosteroid provides the best

management for acute stage Bell’s palsy. Due to limited additional benefits antiviral therapy

may be added depending on the disease severity and clinical symptoms of the patient. In the

rehabilitation approach optimal facial exercises and neuromuscular retraining are helpful in

improving facial function and enhancing patient’s quality of life. Mirror therapy and

biofeedback may improve facial symmetry, but the supporting evidence remains limited. On

the other hand, electrical stimulation has shown inconsistent results while laser therapy has

limited supporting research. Overall, variations in treatment settings, disease stages, and

severity and treatment protocols make it difficult to compare these different therapies.

Conclusion: For facial palsy, treatment requires individualized, team work rehabilitation. In

the acute stage of Bell’s palsy, evidence-based pharmacologically treatment is effective while

physiotherapy and rehabilitation exercises also contribute to recovery and improve the well

being of patients. Various modalities may be helpful in treating this condition; however, future

research is required to identify optimal treatment strategies, either alone or in combination

with other treatment for effective management of the condition.

Trial Registry: Not applicable.