Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
MANAGEMENT FOR
FACIAL NERVE PARALYSIS
Prepared by:
Committee of Physical Therapy Protocols
Office of Physical Therapy Affairs
Ministry of Health – Kuwait
2007
According to reviewed studies about the effect of • Considering the Physiological effects of electrotherapy
electrotherapy modalities used for treatment of facial nerve modalities & the stage of the disease can help in facial
paralysis it was found that neither modalities had a superior paralysis management
effect; (electrotherapy modalities can be used as an adjunct
therapy) • Lesion recovery depend on type of lesion, age, nutritional &
metabolic status of the patient
The electrotherapy modalities reviewed included: electrical
stimulation (ES), electromyography biofeedback (EMG Effect of electrotherapy in relation to classification of lesion 6, 7
bio), ultrasound, laser, and short-wave diathermy (SWD).
1. Neuropraxia: nerve conduction is block temporary with
a) Electrotherapy still lacking evidence due to inappropriate preserve axon, it's response to electrical stimuli, and usually has
research methodology, small sample size, inadequate a complete recovery
treatment parameter, inconsistent follow up • Ultrasound effective to reduce edema & provide normal
b) No evidence support electrical stimulation benefit for acute healing environment (still no appropriate parameter
facial paralysis but it's effective for chronic condition recommended)
c) Biofeedback is more effective when muscle activity presents • Studies prefer to delay use ES unless poor prognosis factors
d) No evidence supports the benefit of using continues mode of present, also galvanic current still not prove it's beneficial.
short wave diathermy, while pulse mode can facilitate healing • Pulsed SWD used to facilitate healing & reduce edema (no
process in acute condition study review found, but according to physiological affect)
e) Lazar still has no study supporting to use it with acute or
chronic condition
• Lazar increases the energy of the inflammatory area, also B) Neuromuscular retraining: 4, 7, 16
consider as anti inflammatory, recommended to use it for • Neuromuscular retraining is applied using selective motor
elderly with poor metabolic or nutrition training to facilitate symmetrical movement and control
• EMG bio is not effective due to absent of muscle undesired gross motor activity (synkinesis*).
contraction
• Patient re-education is the most important aspect of the
2. Axonotmesis: axon is interrupted but with intact nerve sheath treatment process. EMG feedback and/or specific mirror
and axon regenerated 1mm/day, potential has a complete exercises will provide a sensory feedback to promote learning.
recovery
• Research6 mention that using the ES for 3 h/day, can lead to • When each muscle group is being assessed, the patient observes
change capillary density the action of these muscles in the mirror and instructed to
• EMG bio will be effective as voluntary movement present, perform small symmetrical specific movements on the sound
help to prevent synkinesis side to identify the right response. Each patient presents with
• Ultrasound & heat have a poor efficiency, while Laser can different functional disability, so there are no general list of
be effective at this phase exercises.
(Further studies need to prove relevance of modalities on
healing process) • As patient identifies the specific area of dysfunction, patient can
begin to perform exercise to improve facial movements' guided
3. Endoneurotmesis: endoneurium & axon are destroy while by the affected side so isolated muscle response is preserved
perineurium is intact, axon regenerate with scar lead to partial and coordination improved. Repetitions & frequency of
re-innervation & synkinesis therefore incomplete recovery exercises can be modified according to improvement status
4. Perineurotmesis: only epineurium is intact while other nerve (appendix C)
tissues destroyed, lead to abnormal regeneration, synkinesis &
incomplete recovery • The movements should be initiated slowly and gradually so that
5. Neurotmesis: complete nerve rupture with little or no the patient can observe the angle, strength, and speed of each
regeneration & recovery option, can develop painful neuromas movement, because rapid movements can't help the patient in
beside the nerve controlling the abnormal movement (synkinesis).
• ES & EMG bio may maintain muscle tone • The patient can apply a manual resistance as isolated facial
• ES is significant with nerve or muscle grafting, according to movement improved in affected side to be obvious without
its physiological affect such as improving circulation synkinesis.
Synkinesis: D) Kabat Rehabilitation12
• The site of synkinesis should be identified in order to teach the
patient how to control abnormal movement pattern. • Kabat rehabilitation is type of motor control rehabilitation
technique based on proprioceptive neuromuscular facilitation
• The treatment of synkinesis depends on inhibition of the (PNF).
unwanted movements that occur during volitional &
spontaneous movements; by perform facial movement slowly • During Kabat, therapist facilitate the voluntary contraction of
without triggering the abnormal movement. Stretching is the impaired muscle by applying a global stretching then
recommended here to prevent muscles tightness. resistance to the entire muscular section and motivate action by
verbal input and manual contact. (table 1)
C) Manual Massage: 17
• When performing Kabat, 3 regional are considered: the upper
• Massage can be performed in conjunction with other treatment (forehead and eyes), intermediate (nose), and lower (mouth).
options. It can be done to improve perceptual awareness.
• Prior to Kabat, ice stimulation has to perform to a specific
• Massage manipulations on the face include: muscular group, in order to increase its contractile power.
1. Effleurage
2. Finger or thumb kneading
3. Wringing
4. Hacking
5. Tapping
6. Stroking
• Poor recovery is usually determined after 6 months of onset. PRESENT HISTORY (D.O. Onset: ___________________________)
• Poor recovery notice for patients with history of diabetes, ______________________________________________________________________________________________
______________________________________________________________________________________________
P.T.
hypertension and obesity ______________________________________________________________________________________________
______________________________________________________________________________________________
Table 2: Risk Factors that may lead to poor prognosis: Receiving Traditional Treatment: ______________________________________________________________
NET* response Significant worse recovery seen in (83%) PAST MEDICAL HISTORY (include number of years):
High Risk of patients who showed poor or no Heart Disease Prior CVA / TIA DM Type: Cancer
Hypertension Lung Disease Previous Episode Other:
Factors response to NET on the affected side. Details: ___________________________________________________________________________________
Recovery after 79% of Patients who exhibit grade 4 and
Moderate facial paralysis (grade 5 and above) had poor prognosis MEDICATION Analgesic Corticosteroids Antibiotic Antiviral
Risk than patients with incomplete paralysis _______________________________________________________________________________________________
SENSATION
_______________________________________________________________________________________________
* Nerve excitability test, examined by ENT specialist __________________________________________________________________________________________
** varicella-zoster virus
FUNCTIONAL STATUS
*** examined by ENT specialist. _______________________________________________________________________________________________
__________________________________________________________________________________________
FACIAL MUSCLE STRENGTH
Date Database for Facial Paralysis Assessment
Muscle Grade
Facial Muscle Strength: muscle test as per Oxford grading (key illustrated)
P.T. Name & Signature: _____________________
Appendix (B)
Problem List: concise summary of main problems observed from assessment, which require
intervention
Treatment Plan: specific outline of treatment plan, essential details of treatment procedures
with specific treatment techniques
Appendix (C)
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