Kabat Technique and Neuromuscular Effect in Patients With Bell's Palsy
Condition: Bell Palsy
MeSH terms: Bell Palsy; Facial Paralysis; Paralysis
Study type: Interventional

Summary: 
      Bell's palsy is the sudden one-sided peripheral weakness of seventh cranial nerve (Facial
      nerve), represents 50% to 75% of all etiologies with a rate of 58.2 to 8 new cases per 1
      million per year. The objective is to compare the effects of Kabat techniques and
      Neuromuscular Re-Education on facial disability and synkinesis in patients with bell's palsy.
      A Randomized Control Trial was conducted on 20 participants, equally allocated in Kabat and
      PNF training group from February-2020 until December- 2020. Participants were selected
      according to inclusion and exclusion criteria on purposive sampling technique and
      randomization was done by sealed envelope method. The assessment was done after taking
      consent before the first and last session. The tools included Facial disability index,
      Sunnybrook facial grading system and synkinesis assessment questionnaire. Data were analyzed
      using SPSS v.20.
    

Detailed description: 
      Bell's palsy is the sudden one-sided peripheral weakness of seventh cranial nerve (Facial
      nerve), represents 50% to 75% of all etiologies with the rate of 58.2 to 8 new cases per 1
      million per year. It can be either a complete palsy or weakness of facial nerve. This
      condition may start with pain over half of face especially mastoid region with other symptoms
      like decreased sensation over half of face, decrease lacrimation, hyperacusis, pain and
      numbness over half of face. Bell's palsy patients may show signs of absent/decrease facial
      creases, positive bells phenomenon and forehead folds, associated with other disabilities
      like contracture in facial muscles and synkinesis due to which patient cannot close his
      eye.The cause of bell's palsy is unknown therefore it is also called idiopathic facial palsy
      but recent studies claim that "herpes simplex virus" can be a cause of bell's palsy.Other
      causes such as tooth extraction, removal of the tumour, local anaesthesia, TMJ surgery,
      ischemic neuropathy, facial fracture can also be considered. Different studies were carried
      out on the incidence, risk factors and treatments methods of bell's palsy.The most common
      risk factors for bell's palsy, reported by a study, is diabetes, and hypertension. A study
      reported that patients with diabetes are 4 to 5 times more likely to have Bell's palsy.Men
      and women are equally affected by this disorder.There are different treatment methods for
      Bells palsy i.e. medical management, physical therapy management, surgical management
      etc.Although Physical therapy management is not considered to be treatment of choice in
      treating bell's palsy but there is several clinical studies which claims the benefits of
      rehabilitation if applied in early stage. Physical therapy managements include different
      techniques, namely Proprioceptive neuromuscular facilitation, Kabat rehabilitation, Kinisio
      taping, cryotherapy, massage therapy biofeedback, muscular reeducation.As claimed in a study
      in 2013, Kabat technique is quite effective in treating the facial disabilities if the
      therapist is trained. In this study different Kabat techniques namely "rhythmic initiation on
      those patients who did not perform any movement, repeated stretch was used at the start and
      also through full ROM in case of muscular weakness, isotonic were used when patients had
      voluntary movement control, were used on three patients .A study claimed in a case report in
      2017 that PNF techniques are very effective in improving functional outcomes in Childs with
      "bell's palsy".Several studies were done on effects of "Kabat rehabilitation" in "Bell's
      Palsy". As another conducted a study in 2017.Two groups of Bell's palsy were compared after
      application of two different treatment protocols. Participants of group A was given Kabat
      exercises with electrical stimulation and kinesio taping while group B was given electrical
      stimulation plus home exercises. Study reported that Kabat exercise is quite effective in
      improving facial asymmetry in bell's palsy.A study was done in 2015 in Islamabad compare the
      effects of Kabat exercises and Taping in reducing facial synkinesis and disability.The study
      reported that Kabat exercises are more effective in reducing facial synkinesis and
      disability.A study was done in 2007, Comparing Neuromuscular reeducation techniques with
      conventional physical therapy in treating Bell's palsy. This study was done in manipal, India
      in which he reported that neuromuscular reeducation techniques are more effective in
      improving facial asymmetry in patients with bell's palsy .The previous studies showed that
      clinician have worked either with Neuromuscular Re-Education or with kabat in treating Bell's
      palsy. There is no study done which compare the effects of Neuromuscular Re-Education vs.
      Kabat in treating Bell's palsy. So the aim of this study is to determine the effect of Kabat
      and Neuromuscular Re-Education on facial disability and synkinesis and to compare both
      treatments effects.Kabat Exercises rehabilitation of the facial nerve, 3 fulcrums are found,
      whose muscles can be stimulated. Upper fulcrum: includes the frontalis, corrugator and
      orbicularis muscles of the eye.Intermediate fulcrum: Includes the common elevator muscle of
      the upper lip and wing of nose, the dilator naris and the multiform. Lower fulcrum includes
      the zygomaticus major, the zygomaticus minor, the risorius, the orbicularis, the triangular
      of the lower lip, buccinator, chin muscle and square muscle of the chin.
    

Intervention name(s): Kabat Technique's; Neuromuscular Re-Education
Intervention type(s): Other; Other
Intervention description(s): As with all cranial nerves, some specific techniques can also be applied on the facial nerve to enhance responses and improve recovery; the most important are: The rhythmic start: shows and guides the subject into the movements and the scheme; agonist investigation utilizes sequential concentric and eccentric contractions; The inversion of the antagonist: reinforces responses through the induction phenomenon; Repeated contractions: calls for a response with repeated stretching that briefly enables movement; Isometric contractions: for stabilizing and reinforcing the response.
Conventional therapy exercises; After the baseline assessment, the participant in the control will receive Neuromuscular Re-Education. The duration of session will be 45 minutes.Neuromuscular Re-Education: For initiation (acute phase): Active-assisted exercise,Massage and stretch for affected side.For Facilitation ,Active-assisted exercise.For Movement control:Massage and stretching for facial retraction,Assisted and active exercises on involved side.
For Relaxation,Thermotherapy,Relaxation exercises,Alternating rhythmic movements.
Conventional therapy exercises
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Bell Palsy; PNF; Kabat therapy; synkinesis