Bell's Palsy: What is it and what is the role of physiotherapy

What is Bell's Palsy

Bell's Palsy is a condition that causes sudden paralysis or weakness of the facial muscles. This condition occurs when the facial nerve becomes inflamed or swollen so that it cannot send signals to the facial muscles. As a result, Bell's palsy sufferers have difficulty controlling facial expressions and certain movements on part or all of the face.

Symptoms of Bell's Palsy

The most common symptoms of Bell's palsy include:

1. Facial muscle paralysis
   • Patients have inability or difficulty moving part or all of their face. Usually this paralysis is unilateral, meaning it only affects one side of the face.

2. Difficulty Blinking
   • People with eye muscle paralysis often have difficulty blinking, which makes the eyes feel dry and susceptible to infection.

3. Inability to Control the Mouth
   • Patients may have difficulty controlling their lips, which can result in food or drink spilling or spreading when eating or drinking.

4. Difficulty speaking
   • In some cases, people also experience difficulty speaking due to facial muscle paralysis, which affects voice production.

Causes of Bell's Palsy

The exact cause of Bell's palsy is not completely understood, but it is believed that the condition is related to an autoimmune reaction, or inflammation, that affects the facial nerves. Risk factors that can increase a person's risk of developing Bell's palsy include:

• History of viral infections such as the herpes simplex virus (which causes herpes) or the varicella-zoster virus (which causes chickenpox and shingles).
• History of infectious diseases such as flu or colds.
• History of certain diseases, such as diabetes or high blood pressure (hypertension).
• Pregnancy, where the risk of Bell's palsy is slightly higher in pregnant women, especially in the third trimester and early after giving birth.

Primary Treatment in Bell's Palsy Cases

Treatment for Bell's palsy usually involves symptomatic therapy and a medical approach that focuses on facial nerve repair

1. Obat anti inflamasi nonsteroid (NSAID) atau kortikosteroid
   • Digunakan untuk mengurangi peradangan dan pembengkakan saraf wajah.

2. Antiviral Drugs
   • In some cases, a doctor may prescribe antiviral medications if Bell's palsy is thought to be caused by a certain viral infection.

3. Physiotherapy
   • Exercises provided by physiotherapy can help maintain facial muscle flexibility and prevent muscle stiffness.

4. Eye protection
   • To prevent eye irritation or inflammation, eye blinking cannot be controlled properly.

The Effect of Bell's Palsy on Daily Life

Bell’s palsy dapat berdampak signifikan pada kehidupan sehari-hari penderitanya. Efek ini bervariasi sesuai dengan tingkat keparahan dan durasi kelumpuhan serta area wajah yang terkena. Berikut beberapa dampak Bell’s palsy dalam kehidupan sehari-hari:

1. Difficulty speaking

Paralysis of facial muscles involved in speech production can cause difficulty speaking clearly. This can cause problems in communicating and interacting with other people, especially when speaking is not fluent or difficult to understand due to this condition.

2. Eating and drinking disorders

Facial muscle paralysis can cause difficulty controlling the mouth and lips. This can cause food or drink to spill or spread while eating or drinking. In addition, sufferers may have difficulty chewing food properly.

3. Eye problems

Difficulty blinking can cause dry and irritated eyes. Additionally, lack of protection when blinking also increases the risk of corneal injury.

4. Expression disorders

Due to facial muscle paralysis, there may be disturbances in facial expressions. This can affect the ability to express emotions normally, and other people may also have difficulty reading the sufferer's emotions.

5. Decreased self-confidence

Bell's palsy can cause drastic changes in a person's facial expressions, especially if the facial paralysis is visible and lasts a long time. This can affect the sufferer's self-confidence and self-esteem, especially when interacting with other people or in social situations.

6. Social isolation

Some people with Bell's palsy feel confused or uncomfortable with changes in facial appearance, so they tend to avoid social interactions or hide their paralysis. As a result, they may feel more isolated from friends and family.

7. Difficulties at work:

For those whose work depends on clear facial expressions or the ability to speak well (for example actors, presenters or teachers), Bell's palsy can make their work more difficult.

The Role of Physiotherapy in Bell's Palsy Cases

Physiotherapy plays an important role in the treatment of Bell's palsy. The goal of physical therapy for this condition is to speed facial nerve recovery, reduce paralysis, and facilitate the restoration of normal facial muscle function. Physiotherapy treatment for Bell's palsy is usually started after consultation and diagnosis by a doctor.

Here are some important roles of physiotherapy in Bell's palsy:

1. Facial muscle training and rehabilitation

The physiotherapist creates a special exercise program that stimulates and strengthens the paralyzed facial muscles. These exercises can help prevent muscle stiffness, keep facial muscles flexible, and help them return to normal function.

2. Nerve stimulation

Physical therapists can use electrical stimulation (NMES) techniques to stimulate the affected facial nerve with the goal of speeding healing and restoring nerve function.

3. Psychosocial education and care

Apart from the physical aspects, physiotherapists can also provide psychosocial support to patients. This may include helping patients overcome feelings of anxiety, confusion, or social isolation that may result from changes in facial expressions.

4. Education and self-management

Physiotherapists educate patients about their condition and how to treat and maintain healthy facial muscles at home. This may include simple exercises that the patient can do independently.

PNF in Bell's Palsy Cases

PNF (Proprioceptive Neuromuscular Facilitation) is a physical therapy method used to stimulate normal muscles and develop muscle strength and flexibility. This method can be used as an additional measure in the treatment of Bell's palsy cases.

PNF intervention in cases of Bell's palsy can include various techniques and exercises aimed at stimulating and strengthening the paralyzed facial muscles. PNF techniques commonly used in this case include:

1. Rhythmic Stabilization

The goal of this technique is to develop facial muscle strength and stability. The physiotherapist presses the paralyzed facial area with his hands rhythmically and encourages the patient to maintain the position and resist the pressure. This exercise helps stimulate facial muscles and increase their strength.

2. Contract-Relax

The aim of this technique is to increase the flexibility of paralyzed facial muscles. The physiotherapist asks the patient to stretch the affected muscles maximally for a few seconds and then asks them to suddenly relax. This stimulates the muscles to stretch more effectively.

3. Slow Reversal

The aim of this technique is to develop facial muscle coordination. The patient is asked to move slowly in one direction and then slowly change the direction of movement. This exercise helps stimulate muscles and improves their ability to coordinate movements.

4. Facial Traction

The purpose of this technique is to stretch facial muscles that are stiff or tense due to paralysis. A physical therapist gently stretches the affected area of the face, which helps increase muscle flexibility and improve blood circulation.

PNF  intervention in cases of Bell’s palsy should be performed by a physiotherapist trained and experienced in this technique. PNF is usually part of a broader rehabilitation program that also includes other exercises, nerve stimulation, and other treatments designed to maximize facial muscle recovery and normal function. In some cases, patients must perform these physiotherapy exercises independently at home as part of subsequent treatment.

Also read: Cerebral Palsy: What It Is and Physiotherapy in Cerebral Palsy

Reference :

1. Warner MJ, Hutchison J, Varacallo M. Bell Palsy. [Updated 2022 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482290/
2. Puspitaningrum, DA., Herawati, I., Prihati, E., Rahman, F. (2022). Efektivitas Proprioceptive Neuromuscular Facilitation Terhadap Kemampuan Motorik Wajah Pasien Bell’s Palsy: Case Report. Jurnal Kesehatan dan Masyarakat (Jurnal KeFis). Vol : 2. No. 1, 7-13.
3. Kumar, a., & Bagga, T. (2015). Comparison between Proprioceptive Neuromuscular Facilitation and Neuromuscular Re-Education for Reducing Facial Disability and Synkinesis in Patients with Bells palsy: A Randomized Clinical Trial. International Journal of Physical Medicine and Rehabilitation, 3, 1-8. https://doi.org/10.4172/2329-9096.1000290