Conditions & Treatments - Bell's Palsy

Bell's palsy affects about 30,000 - 40,000 people a year in the United States (1). It is most common in persons between the ages of 20 to 40 years with higher incidences in individuals with diabetes mellitus and pregnant women (2). Bell's palsy involves irritation to the seventh cranial (facial) nerve. Movement of the muscles of the face are controlled by this nerve and when irritated could result in weakness or paralysis of the facial muscles. In most cases only one side is affected and the occurrence of left or right side palsy is approximately equal and remains equal for recurrences (3).

Symptoms of Bell’s Palsy
The onset of paralysis is sudden with Bell’s palsy and can worsen during the early days (3). Symptoms will usually manifest and peak within 2-3 days, although it can take as long as 2 weeks (2, 3). Symptoms can include:

General (from bellspalsy.wps)
Muscle weakness or paralysis
Forehead wrinkles disappear
Overall droopy appearance
Impossible or difficult to blink
Nose runs
Nose is constantly stuffed
Difficulty speaking
Difficulty eating and drinking
Sensitivity to sound (hyperacusis)
Excess or reduced salivation
Facial swelling
Diminished or distorted taste
Pain in or near the ear
Drooling

Eye Related (from bellspalsy.wps)
Eye closure difficult or impossible
Lack of tears
Excessive tearing
Brow droop
Tears fail to coat cornea
Lower eyelid droop
Sensitivity to light

Causes of Bell's Palsy
The exact cause of Bell’s Palsy is uncertain (1, 2) but viral and bacterial infections, as well as autoimmune disorders are suspected (3). Herpes zoster infection, HIV infection, Lyme disease, middle ear infection and sarcoidosis are among some of the possible diseases which could contribute to Bell’s Palsy (1, 3).

PT Implications in Patients with Bell's Palsy
VanSwearingen et al (4) believe that simply identifying the pathology is not an effective way in determining physical therapy intervention. They suggest that when conducting an evaluation on a patient who is suspected of having Bell’s palsy, the therapist should observe signs of: resting posture changes, voluntary movement, abnormal movements accompanying voluntary movement, or abnormal spontaneous movements and reported symptoms of difficulties in usual facial functions (4). They go further in their research report by developing a classification system based on physical signs and symptoms that enables clinicians to place patients with facial neuromotor disorders into four treatment-based categories which will not only assist with clinical decision making but assist with linking treatment intervention to outcomes. These four categories include initiation, facilitation, movement control and relaxation and is described in more detail in their research report.

Bell's Palsy Treatment Options for a PT
• Moist Heat
• Massage
• EMG / Biofeeback
• Mirror Feedback
• Electrical Stimulation
• Facial Neuromuscular Retraining
• Therapeutic Exercises

Last revised: February 18, 2011
by Chai Rasavong, MPT, MBA

References
1) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001777
2) Goodman and Boissonnault. Pathology: Implications for the Physical Therapist. W.B. Saunders Company 1998;820-821.
3) http://www.bellspalsy.ws/
4) VanSwearingen JM & Brach JS. Validation of a Treatment-Based Classification System for Individuals With Facial Neuromotor Disorders. Physical Therapy. 1998:78(7):678-689.