Physical therapy for facial nerve paralysis (Bell's palsy): An updated and extended systematic review of the evidence for facial exercise therapy

Abstract

Objective To conduct a systematic review of the effectiveness of facial exercise therapy for facial palsy patients, updating an earlier broader Cochrane review; and to provide evidence to inform the development of telerehabilitation for these patients. Data Sources MEDLINE, EMBASE, CINAHL, Cochrane Library, PEDro and AMED for relevant studies published between 01 January 2011 and 30 September 2020. Methods Predetermined inclusion/exclusion criteria were utilised to shortlist abstracts. Two reviewers independently appraised articles, systematically extracted data and assessed the quality of individual studies and reviews (using GRADE and AMSTAR-2, respectively). Thematic analysis used for evidence synthesis; no quantitative meta-analysis conducted. The review was registered with PROSPERO (CRD42017073067). Results Seven new randomised controlled trials, nine observational studies, and three quasi-experimental or pilot studies were identified ( n = 854 participants). 75% utilised validated measures to record changes in facial function and/or patient-rated outcomes. High-quality trials (4/7) all reported positive impacts; as did observational studies rated as high/moderate quality (3/9). The benefit of therapy at different time points post-onset and for cases of varying clinical severity is discussed. Differences in study design prevented data pooling to strengthen estimates of therapy effects. Six new review articles identified were all rated critically low quality. Conclusion The findings of this targeted review reinforce those of the earlier more general Cochrane review. New research studies strengthen previous conclusions about the benefits of facial exercise therapy early in recovery and add to evidence of the value in chronic cases. Further standardisation of study design/outcome measures and evaluation of cost-effectiveness are recommended.

Minimization of facial synkinesis

“…As highlighted in the 2022 systematic review by Khan et al , the heterogeneity of and lack of standardization among facial rehabilitation programs complicates evaluations of the outcomes of such approaches. In their evaluation of the efficacy of facial exercise therapy among patients diagnosed with Bell's palsy, Khan et al concluded that facial rehabilitation does provide a benefit to patients with facial paralysis in both the acute and chronic phases of recovery, however their inability to pool the data precluded any more specific conclusions [15 ▪ ].…”

Ocular and Palpebral Manifestations of Facial Palsy: An Epidemiologic Descriptive Study

“… 15 Techniques such as neuromuscular re-education, biofeedback, electrostimulation, and facial expression exercises are available, but they do not have a strong level of evidence. 5 , 15 , 16 The term “facial disability” was coined to describe patient’s quality of life impairments, such as eating and speaking handicaps, as well as the emotional and social aspects that this ailment can entail. 17 , 18 …”

Predicting synkinesis caused by Bell's palsy or Ramsay Hunt syndrome using machine learning‐based logistic regression

“…Indeed, early rehabilitation intervention in facial nerve patients has been reported to reduce complications and sequelae such as synkinesis and dry eye 6 . Moreover, synkinesis may arise from dysfunction in both the central and peripheral nervous systems, and the effectiveness of drug therapy such as botulinum toxin injections in addition to rehabilitation has also been demonstrated 7 …”

“…6 Moreover, synkinesis may arise from dysfunction in both the central and peripheral nervous systems, and the effectiveness of drug therapy such as botulinum toxin injections in addition to rehabilitation has also been demonstrated. 7 The electroneurography (ENoG) value of <40% and the ratio of the interpalpebral distance of <85% [8][9][10] have been reported to be correlated with the occurrence of synkinesis. Based on our previous studies, [11][12][13][14][15][16][17] we hypothesized that the characteristics of patients with early-onset facial paralysis measured with values of "ENoG," "the difference in the nerve excitability test (NET)," and "Yanagihara score" could be used to exquisitely predict facial synkinesis using machine learning (ML).…”