1.

Discuss on the type of current, pulse, shape and duration for treatment of right side bells
palsy patient. APR’11 10M
2. Explain the treatment for Bell's Palsy JULY’21 10M
3. Explain the management of Bell’s Palsy. OCT’13 10M
4. Bell’s palsy DEC’20 5M

DEF: Bell's palsy is a form of facial paralysis resulting from a dysfunction of the cranial nerve VII (the
facial nerve) that results in the inability to control facial muscles on the affected side

TREATMENT/ MANAGEMENT OF BELL’S PALSY:

Electrical stimulation is sometimes given to patients with facial palsy. The facial nerve normally emits
electrical impulses to give muscles their tone and shape. When the facial nerve is damaged the
muscle no longer receives these messages and as a result the muscles become weak and floppy.
External electrical stimulation can try and mimic these electrical impulses and help restore muscle
tone.

1. It should only be used under the guidance of a therapist with specialist training in the
management of facial palsy.

2. Use of electrical stimulation should be closely monitored by the therapist.

3. Patients should not try this treatment without supervision as there are some indications that it
may cause harm when used incorrectly.

4. If there is every possibility that the nerve will recover spontaneously, albeit incompletely, then it
may be better to let nature take its course.

5. The person should massage their face twice daily which helps to maintain circulation and mobility
of the facial muscles and also maintains the feeling of movement (which cannot be gained via
electrical stimulation).

6. The main focus in the early weeks of recovery is protecting the eye and facial massage. 7. As the
facial nerve recovers it will start to fire electrical impulses back into the facial muscles and you will
see the muscle tone return.

8. If you continue to use external electrical stimulation at this point the muscles will become over
stimulated.

9. The result is short, tight, stiff muscles that cannot move. Tight muscles become painful and may
spasm or twitch. It may also cause unwanted movement in the muscles on the affected side of your
face, (Synkinesis).

10. There is one group of patients who may benefit from electrical stimulation and who are not at
risk of developing muscle tightness or synkinesis.

11. These patients have complete loss of their facial nerve which may have been cut or irrevocably
damaged by disease.

12. In some cases the person may have been born without a facial nerve. The presence of the nerve
is not required for external electrical stimulation to be used. It is the muscles which are stimulated
not the nerve.
13. The benefits are short lived so that once you stop using the electrical stimulation the muscle will
lose its tone.

14. The key message is that this treatment should only be given under strict guidance from a
specially trained therapist.

15. It is not necessarily the optimum treatment of choice and the majority of people often make a
good recovery with other forms of more evidenced based therapy.

 Receiving the patient: Good morning. I am a physiotherapist and going to treat you. Please,
cooperate with me during the treatment and wait until I go through your case sheet.
 History taking or going through the case sheet:
Name
Father's and mother's name
Age
Sex
Occupation
Address: Correspondence and permanent.
 Chief complaints.
History
History of any previous treatment taken.
 Examination:
To the examiner
Side: Right or left
Site.
 Checking for any general and local contraindications:
Fever
Hypertension
General condition of the body
Open wound
Hypersensitive skin
Metal in the tissue or in surrounding
Loss of sensation, etc.
 Knowledge of anatomy:
Bell's palsy: This is the lower motor neuron lesion of the facial nerve and resultant paralysis
of the muscles that it supplies.
Course of the nerve: It starts from seventh cranial nerve nucleus. It is situated in the ventral
part of tegmentum of pons, rounds VI nucleus along its course expands to form geniculate
ganglion, it gives a branch to stapedius muscle, a branch supplying anterior two-third of
tongue. Emerging from stylomastoid foramen it enters the parotid gland and divides into:
Temporal
Zygomatic
Mandibular
Buccal
Cervical branches.
 Muscles supplied:
Occipitofrontalis
Orbicularis oculi
Corrugator and procerus
 Zygomaticus major and minor
Levator anguli oris
Levator labil superioris
Buccinator
Orbicularis oris
Risorius
Mentalis
Depressor anguli oris Depressor labii inferioris.
 Causes-
Idiopathic
Exposure to chill weather
Fracture of mandible
Fracture of mastoid process Dislocation of temporomandibular joint
Middle ear infection
Anesthesia during middle ear surgery Trauma to jaw, parotid region
Cerebellopontine angle tumors
Hemorrhage at the site of the nucleus of the nerve.
 Clinical features:
Bell's phenomenon
Loss of facial expression.
 Receiving the patient.
 Knowing details of condition.
 Preparation of trays.
 Preparation of apparatus.
 Preparation and position of the patient:
Supine lying position with the hair duly tied up and eyes closed, ask the patient to wash his
face before treatment.
 Position of therapist:
Stride/walk standing position at the side of the patient.
 Checking for local contraindications:
Acne
Tooth clips
Eye infections
Hairy surface
Mouth ulcers
Mumps, measles, etc.
 Checking of apparatus.
 Correct placing of electrodes:
Inactive: Over the nape of neck
Active: Over the motor point.
 Instructions to the patient:
Feel of current
Inform if any burning
Warning: Not to touch anything.
 Treatment:
Selection of current:
For the muscles: Interrupted galvanic
 For the nerve trunk: Surged faradic.
 Regulating current.
 Winding up.
 Home programs:
Look surprised and then "frown".
Smile, grin, say "O"
Say a, e, i, o, u
Squeeze eyes closed then make wide open Hold straw in mouth, suck and blow
Whistle.
Advice:
Avoid intake of cold substances
Cover up the head and face with a scarf
Avoid taking in hot substances when there is sensory loss in anterior two-third of tongue.