Kabat Technique and Neuromuscular Effect in Patients With Bell's Palsy

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.

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.

Eligibility Criteria:
Inclusion Criteria:

* Diagnosed cases of bell's palsy
* Non traumatic onset ( conditions like infectious, hypertensive patients, diabetic patients

Exclusion Criteria:

* • History of significant psychiatric illness

  * Upper motor neuron disease ( stroke, TBI, tumor)
  * Non co-operative patients
  * Post-surgical case