The partial facial paralysis caused by Bell's Palsy can, in many cases, be treated by performing certain facial exercises. These exercises, known as neuromuscular facial retraining, are best performed under the supervision of a trained therapist. If performed successfully, they can significantly reduce even long-standing cases of facial paralysis.
History
Bell's palsy was first diagnosed and given a name in the late 19th century. As early as 1927, it was being treated with a variety of nonsurgical techniques including electrical stimulation, massage and facial exercise. It wasn't until 40 years later however, that specific techniques were developed for neuromuscular facial retraining. By 1982, Dr. Richard Balliet, Director of the Neuromuscular Retraining Clinic of the Department of Rehabilitation Medicine at the University of Wisconsin, had developed a comprehensive program involving electromyographic (EMG) feedback as well as home exercise programs tailored to individual Bell's palsy sufferers. Balliet's techniques are still in use today.
Techniques
The most important aspect of neuromuscular retraining is patient education, as the patient must be trained by a facial therapist to recognize the different muscular groups that govern facial motions and to distinguish proper function from dysfunction. Once the patient is aware of how the facial muscles ought to be performing, he will be able to learn and perform the specific exercises prescribed by the therapist to help the affected portions of his face resume normal functionality.
Patients are taught to perform all of the exercises slowly and to observe and modify the muscle actions and reactions. They are shown how to perform the exercises symmetrically, so neither side of the face becomes dominant. Patients are also taught to target specific muscle groups with small movements, to achieve maximum accuracy and effectiveness with the desired facial motions.
Supervised treatment sessions are typically scheduled in a therapist's office on a schedule that can range from weekly to just two days per month. After these treatment sessions, the patient performs the prescribed exercises on his own at home on a daily basis. Neuromuscular retraining therapy may last from three to five years. Results are achieved slowly but are usually long-lasting or even permanent.
Treatment Environment
Privacy is an important element in successful neuromuscular facial therapy, as Bell's palsy patients are often embarrassed about their appearance. The exercises should be performed in a quiet area, away from distractions so the patient can concentrate. Mirrors are also important, as they provide the patient with immediate feedback on how her efforts are succeeding.
During the treatment sessions that take place at a therapist's office, EMG feedback may also be used. This technique involves attaching surface electrodes to the patient's skin over the muscles being monitored. When the sensors detect muscle contraction, they display these contractions on a video monitor. Patients may then use this feedback to help them perform the contractions and achieve desired results, such as speeding up or slowing down muscle motion.
Evaluation
Although doctors have a variety of methods for measuring facial features, there is no universal method of assessing minute changes in facial muscular motions. The main method used for determining the progress of neuromuscular facial retraining is video assessment, in which patients are videotaped performing a variety of facial motions such as raising and lowering their eyebrows or puckering their lips. Patients are also given photographs to help them monitor the progress of changes made over time.
Finally, patient self-assessment is perhaps the most valuable tool in assessing success of the facial retraining program---patients themselves are the ones most familiar with the subtleties of their own facial expressions and how these have or have not changed over time.
Benefits
Although no type of treatment for Bell's palsy can result in 100 percent success and restoration of the face to its former full range of motions, neuromuscular facial retraining usually results in a much higher degree of patient satisfaction than surgery alone. In large part, this is because the patient is involved in the therapy and is able to have some control over how effective the treatment is rather than having to be satisfied with whatever results can be achieved by a surgeon.
