Bell’s Palsy Physiotherapy

Bell’s palsy is a very specific type of temporary facial paralysis that can affect the patient’s

  • day to day living activities
  • communication with others
  • self esteem
  • quality of life

Bell’s palsy happens when the nerve that controls one half (usually the long half eg right side of face or left side of face) becomes swollen and inflamed, followed by a sudden experience of weakness and paralysis on the affected half.

WARNING: These symptoms also can indicate a potentially dangerous or severe condition, such as a stroke. IF YOU EXPERIENCE ANY TYPE OF FACIAL WEAKNESS, YOU NEED TO SEEK MEDICAL CARE IMMEDIATELY! Call an ambulance if the weakness is accompanied by:

  • Pain in the ear, cheek, or teeth
  • Loss of facial sensation
  • Confusion
  • Weakness of arms or legs
  • Vision changes
  • Fever
  • Headache

What’s bell’s palsy?

Sadly, bell’s palsy comes without warning, causing a variable level of facial weakness…but the good news is that 70% of the time, it will recover naturally over time within 6-12 months. The remaining 30%…do not recover completely.

The medical community isnt exactly sure what causes bell’s palsy, but they theorized that it may got something to do with the herpes virus affected one side of the nerves.

That being said, there are risk factors that increases the chance of developing bell’s palsy, which are:

  • pregnancy
  • obesity
  • chronic high blood pressure
  • diabetes mellitus
  • upper respiratory infections and
  • severe preeclampsia (a complication of pregnancy)

Facial weakness or paralysis also may be caused by several other conditions including

  • trauma
  • congenital (present at birth) condition
  • surgery
  • tumors

How does bell’s palsy feel like?

Because it comes without any warning, most patients report feeling a sudden weakness on one side of the face, feeling like it’s weird or weak or just cant move it naturally (especially they try to talk, and the half of lips dont move well so they tend to slur / unable to vocalize well).

Bell’s palsy can worsen rather quickly, and other symptoms that patients may experience:

  • Inability to close the eye on the affected side
  • Drooping of the affected side (within a few hours to overnight)
  • Teariness or dryness of the affected eye
  • Pain in or behind the ear on the affected side
  • Sensitivity to sound
  • Drooling
  • Loss of the sense of taste
  • Difficulty speaking due to weakness around the mouth

How do we diagnose bell’s palsy?

Your doctor will observe your facial movements such as

  • blinking your eyes
  • lifting your brow
  • smiling
  • frowning
  • etc

The examining physician may additionally recommend magnetic resonance imaging (MRI) for an individual with facial weakness or paralysis to rule out more serious conditions such as tumors or strokes just in case.

Once testing has ruled out other possible conditions, your doctor will diagnose Bell’s palsy, and recommend treatment by a physiotherapist. You may receive a prescription of steroid medication to reduce the swelling around the nerve that controls the movement of the face.

Some patients additionally gets antiviral medication too.

How physiotherapists can help

In the first couple of days to a week after symptoms start, the physiotherapist will evaluate your condition, including:

  • Review your medical history, and discuss any previous surgery or health conditions
  • Review when your current symptoms started and what makes them worse or better
  • Conduct a physical examination, focusing on identifying the patterns of weakness that are caused by Bell palsy:
    • Facial movements of the eyebrow
    • Eye closureAbility to use the cheek in smiling
    • Ability to use the lips in a pucker
    • Ability to suck the cheeks between the teeth
    • Raising the upper lip
    • Raising or lowering the lower lip
  • They will also immediately:
    • Educate you about how to protect your face and your eye
    • Show you how to manage your daily life functions while you have facial paralysis
    • Explain the expected path to recovery, so that you will know the signs and symptoms of recovery
    • Evaluate your progress, and determine whether you need to be referred to a specialist if progress is not being made

The first priority

…is to protect your eye.

Why? The difficulty or inability to completely and quickly close your eye makes the eye vulnerable to injury from dryness and debris. Simple debris can damage the cornea with scratches—the transparent front part of the eye that covers the iris, pupil, and front chamber of the eye—and could permanently harm your vision.

The physiotherapist will immediately show you how to protect your eye, such as:

  • Using self-made and commercial patches
  • Setting a regular schedule for refreshing eye fluids
  • Carefully closing the eye with your fingers

If you have partial facial movement, your therapist will teach you a few general facial exercises to do at home. These exercises will help you learn to move the weak side of your face and help you use both sides of your face together. One of the exercises is a gentle blowing action through your lips.

During Recovery

Physiotherapists will help you regain the healthy pattern of movements that you need for facial expressions and function. Recovery can be challenging because:

  • Normally, the ability to make facial expressions and many facial movements is “automatic”;—that is, you’re born with this ability and never had to think about it before
  • Unlike other muscles in your body, the facial muscles do not have sensors that tell your brain all of the necessary “details” about how to move

They will coach throughout this challenging time, guiding you through special exercises that are designed to help you relearn facial movements based on your particular movement problems.

Your exercises may change over the course of recovery:

“Initiation” exercises. In the early stages, when you might have difficulty producing any facial movement at all, we will teach you exercises that cause (“initiate”) facial movement. We will show you how to position your face to make it easier to move (called “assisted range of motion”) or how to “trigger” the facial muscles to do what you want them to do.

“Facilitation” exercises. Once you’re able to initiate movement of the facial muscles, we will design exercises to increase the activity of the muscles, strengthen the muscles, and improve your ability to use the muscles for longer periods of time (“facilitate” muscle activity).

Movement control exercises. We will design exercises to:

  • Improve the coordination of your facial muscles
  • Refine your facial movements for specific functions, such as speaking or closing your eye
  • Refine movements for facial expressions, such as smiling
  • Correct abnormal patterns of facial movement that can occur during recovery

To work on coordinating your facial muscles, you’ll need to have a sufficient level of activation of facial muscles first. Your therapist will determine when you’re ready.

Relaxation.During recovery, you might have facial spasms or twitches. We will design exercises to reduce this unwanted muscle activity. We will teach you how to recognize when you are activating the facial muscle and when the muscle is at rest. By learning to contract the facial muscle forcefully and then stop, you will be able to relax your facial muscles at will and decrease twitches and spasms.

After Recovery

Some people might have greater difficulty moving their face after a period of improvement in facial movement, which can make them worry that the facial paralysis is returning. However, actual recurrence of facial paralysis of the Bell Palsy type is uncommon.

New difficulty in moving the face is more likely the result of increasing the strength of the facial muscles without improving the ability to coordinate and control the movement. To keep this from happening, our senior physiotherapist will show you what facial movements you should avoid during recovery. For instance, the following might lead to abnormal patterns of facial muscle use:

  • Trying to make the biggest facial movement or muscle contraction that you can, such as smiling as much as you can
  • Chewing gum with great force
  • Blowing up a balloon with all of your effort to work the facial muscles

We will coach you to use your face as naturally as possible, without trying to restrict facial expressions because they look “different.”

Where To Next?

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