SLP Treatment Procedures for Bell¹s Palsy

 

Please note that due to the fact that most cases of BP seemingly resolve themselves as unexpectedly as they occur, the need for treatment has been debated, particularly in mild cases. Therefore, the purpose of therapy is to prevent or minimize significant and long-term paralysis, disfigurement and disability. In some instances treatment may include medications and although very rare in the event of extreme conditions, surgery. A longer recovery period is required if axon degeneration has occurred. Axon regeneration may take over a year, and is often incomplete. However,  90% of patients have only demyelination of the nerve, and recover in a few weeks.

 

The Facial Nerve

is predominantly tested using the muscles of facial expression. While you take the medical history, you should note any asymmetries that are present in the face. During the examination, you should ask the patient to wrinkle the forehead by looking upward, to close the eyelids forcefully while you try to pry them open, to show the teeth and to whistle or purse the lips. The platysma muscle can be the most sensitive in detecting minimal facial weakness. This can be tested by asking the patient to draw the lower lip and mouth downward while tensing the surface of the skin of the neck. It is similar to the action that men use while shaving. While you are testing this, you need to appreciate two different patterns of facial weakness. In face weakness that results from upper motor neuron lesions, there is relative sparing of the muscles of the forehead and the degree of unilateral weakness increases as you move down the face. In peripheral facial nerve lesions, one entire side of the face may be weak (this is the usual case) or if there's been traumatic lesion of only one of the branches, there may be just partial weakness that corresponds to the temporal, zygomatic, buccal, mandibular, or cervical branches. Also recall that the facial nerve carries taste for the anterior 2/3 of the tongue, which is not tested in the screening evaluation.

 

 

Neuromuscular Retraining

§       Visual feedback (mirror feedback), using a mirror to change the motor facial pattern and to reinforce proper responses can be used in conjuction with biofeedback or surface electromyography feedback to assist in strengthening and retraining muscle fibers. (see below)

 

Electromyography

When a muscle fiber loses its nerve supply, it exhibits a characteristic irritability manifested as spontaneous discharges at rest. Singe muscle discharge, called FIBRILLATIONS have a short duration (.5 to 1.5 msec), low amplitude (50-300 microvolts) and a REGULAR rhythm. They are usually positive (downward) in their initial deflection.

EMG's are an invasive procedure and as such should only be done by physicians and even then only when indicated by the clinical history after careful evaluation.