Mirror Therapy on PC in Acute Bell's Palsy.
Condition: Bell Palsy
MeSH terms: Bell Palsy; Facial Paralysis; Paralysis
Study type: Interventional

Summary: 
      The objective of this study is to compare the effects of mime therapy using mirror therapy
      application of tablet PC vs mime therapy on acute bell's palsy. Study Design was Randomized
      control trial with Sample Size was 22. Sampling Technique was Purposive sampling.
      Randomization was done through a sealed envelope method. Study Setting included Physiotherapy
      department of DHQ Teaching Hospital, Mirpur Azad Kashmir. Inclusion criteria were Age between
      30-60year, Both male & female and Acute bell's palsy ( 2-3 weeks). Exclusion criteria were
      Individuals with the other neurological deficits, Visual impairment, History of facial palsy
      of central type, Surgical intervention for ear and facial nerve palsy and Non-co-operative
      patients. tools used for assessment was Sunnybrook Facial Grading system scale,
      House-Brackmann Facial Grading System and Patients Global Impression of Change. Individuals
      who met the inclusion criteria were included in this study. All participants went through
      randomization and divided into two groups Experimental group 1 (these individuals will
      receive mime therapy using tablet PC mirror application)and Experimental group 2 (these
      individuals will receive the control intervention including the mime therapy).
      Pre-intervention assessment is made for both groups. Then intervention will apply to both
      groups. Estimated time of treatment protocol will be 30 minutes session, 4 times/week for 4
      weeks in the hospital setting. Subjects will be evaluated at baseline, then 2nd week and
      4th-week assessment will be the final. All statistical analyses were performed through SPSS
      21. Normality of data was assessed and after checking normality parametric or non-parametric
      test was applied accordingly.

      .
    

Detailed description: 
      Damage or dysfunction of the facial nerve can result in paralysis, abnormal muscle tone,
      abnormal movement patterns, eye irritations, and decreased facial expression. Medical
      conditions that can typically result in facial nerve dysfunction are Bell's palsy,
      herpesvirus, temporal bone fracture, facial or head trauma, acoustic neuroma excision, facial
      nerve schwannoma, vascular damage, and neoplasms. The facial nerve sustains impairment more
      often than any other nerve in the body. The term Bells' Palsy is defined as an idiopathic,
      acute and unilateral paresis or paralysis of the face which may be partial or complete
      occurring with equal frequencies on right and left sides of the face. The major cause of
      Bell's Palsy is idiopathic, accounting for 50% of all cases. Other few suggested causes are
      exposure to cold, middle ear infections, dental and ENT surgeries and traumatic. The problems
      faced in the acute phase of Bell's palsy include difficulty in closing the affected side-eye,
      facial deviation to the unaffected side, difficulty in drinking, eating and speaking along
      with psychological problems and facial appearance is the main concern in any phase of Bell's
      palsy. Complete recovery of facial function in Bell's palsy occurs in 70% of people within
      three months (Peitersen 1994) with about 30% of people continuing to suffer facial asymmetry
      at rest and during movement, as well as synkinesis. Treatment of Bell's palsy is
      controversial due to the lack of large, randomized, controlled, prospective studies. There
      are indications that steroids or antiviral agents are beneficial but also studies, which show
      no beneficial effect. Additional measures include eye protection, physiotherapy, acupuncture,
      botulinum toxin, or possibly surgery. A Cochrane review done by in February 2011 has
      concluded that there is only very low-quality evidence that facial exercise reduces sequel in
      acute cases. A study done in 2009 has concluded that massage done in mime therapy has shown
      to create new growth and increase the production of collagen and connective tissue in facial
      muscles and restore facial muscle action. A study done on mime therapy efficacy in patients
      with long term facial nerve paresis shows that mime therapy improves facial symmetry.A study
      of 2014 observed the half-mirror biofeedback exercise in combination with three botulinum
      toxin after facial paralysis. Half-mirror biofeedback rehabilitation designed for facial
      sequelae shows good results in combination with botulinum toxin therapy. This facial
      rehabilitation strategy, consisting of three injections of botulinum toxin and half-mirror
      biofeedback exercises, proceeds over the course of 2 years and offers a long-lasting cure for
      facial synkinesis and facial symmetry as well as improved facial aesthetics. A study in 2011
      on facial biofeedback rehabilitation with a mirror after administration of a single dose of
      botulinum A toxin on facial synkinesis was examined in patients with chronic facial palsy
      concluded that Facial biofeedback rehabilitation with a mirror after administration of a
      single dose of botulinum A toxin can be a long-lasting treatment of established facial
      synkinesis. A study of, 2013 Mime therapy improves facial symmetry and functions more than
      conventional therapy and home exercises in people with acute Bell's Palsy. No difference was
      found between conventional therapy and home exercise program. A study in, 2016 investigate
      the effects of mirror therapy using a tablet PC for post-stroke central facial paresis. A
      prospective, randomized controlled study was performed. Twenty-one post-stroke patients were
      enrolled. All patients performed 15 minutes of orofacial exercise twice daily for 14 days
      concluded that mirror therapy using a tablet PC might be an effective tool for treating
      central facial paresis after stroke. The past research records are evident that therapists
      have worked with mime therapy and mirror therapy. The two protocols have not been
      complimented for rehabilitation. So the aim of this study is to observe and determine the
      combined effect of these two treatment protocols to get the results and improve the facial
      symmetry in acute bell's palsy patients.
    

Intervention name(s): mime therapy using tablet PC mirror application; the control intervention including the mime therapy
Intervention type(s): Other; Other
Intervention description(s): After the baseline assessment, The patient in the experimental group will receive mirror therapy and mime therapy.
Exercises time period is 30 min/session
Mime Therapy Using Tablet PC:
Mirror therapy using tablet PC mirror application We will use a tablet PC mirror application that can convert images from right to left. In the mirror group, the mirror application was used during the exercise. Patients watched the tablet PC screen. The mirror application converts the image from right to left.
• Mime therapy include Mime therapy will consists of auto massage- effleurage and kneading for 10 to 15minutes on both the sides of the face, stretching exercises of the muscles of the affected side followed by facilitation, specific low intensity exercises to co-ordinate both the halves of the face, active assisted exercises for affected side of the face, exercises of mouth and eye with simultaneous inhibition of synkinesis if present.; After the baseline assessment, The patient in the experimental group will receive mime therapy Mime therapy include Mime therapy will consists of auto massage- effleurage and kneading for 10 to 15minutes on both the sides of the face, stretching exercises of the muscles of the affected side followed by facilitation, specific low intensity exercises to co-ordinate both the halves of the face, active assisted exercises for affected side of the face, exercises of mouth and eye with simultaneous inhibition of synkinesis if present.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Bell Palsy; mime therapy; mirror therapy