From the Guidelines
Physiotherapy is not recommended as a treatment for Bell's palsy due to lack of evidence supporting its benefit or harm. The current evidence, as highlighted in the clinical practice guideline: Bell's palsy 1, suggests that there is no significant difference in clinical outcomes between different rehabilitation techniques, and no treatment has been shown to produce significantly more improvement than untreated control groups.
Key Points to Consider
- The role of physical therapy in Bell's palsy is uncertain, with no accepted and consistent definition of physical therapy for the condition 1.
- Various therapy modalities, including thermal treatment, electrotherapy, massage, facial exercise, and biofeedback, have been discussed, but most studies combine more than one treatment method, making it difficult to assess the effectiveness of individual therapies 1.
- Risks associated with physical therapy have not been identified in the literature, but the lack of standardized therapy modalities and protocols makes it challenging to recommend physiotherapy as a treatment option 1.
Clinical Implications
- In the absence of strong evidence supporting the use of physiotherapy for Bell's palsy, clinicians should exercise caution when recommending physical therapy as a treatment option.
- Patients with Bell's palsy should be closely monitored for spontaneous recovery, and treatment should focus on managing symptoms and preventing complications, rather than relying on physiotherapy as a primary treatment approach.
From the Research
Physiotherapy for Bell's Palsy
- Bell's palsy is characterized by an acute onset of unilateral, lower motor neuron weakness of the facial nerve in the absence of an identifiable cause 2
- The diagnosis of Bell's palsy is based on exclusion, and a thorough history and physical examination are essential for establishing the correct diagnosis 2
Treatment Options
- Corticosteroids are the mainstay of treatment for Bell's palsy and should be initiated within 72 hours of symptom onset 2, 3, 4
- Antiviral therapy in combination with corticosteroid therapy may confer a small benefit and may be offered on the basis of shared decision making 2, 3
- Physical therapy, including exercises and massage, may be beneficial in improving functional facial movements and electrophysiologic outcome measures 5, 6
Electrical Stimulation
- The addition of electrical stimulation to conventional physical therapy may improve functional facial movements and electrophysiologic outcome measures in patients with Bell's palsy 5, 6
- Selective electrical muscle stimulation may accelerate recovery from Bell's palsy without increasing synkinesis 5
- Further research is warranted to determine the most effective dosage and length of intervention with electrical stimulation 5, 6
Recovery Rates
- The recovery rate for Bell's palsy patients treated with steroid monotherapy is higher than those treated with combined steroid and antiviral therapy 3
- Initiating treatment within 72 hours of symptom onset is associated with a higher recovery rate 3
- Patient factors, such as age and electroneurography results, may affect recovery rates 3