Combined Effects of Proprioceptive Neuromuscular Facilitation (PNF) and Neural Mobilization on Improving Facial Symmetry in Patients With Bells Palsy

Foundation University Islamabad38 enrolled

Overview

Bell's palsy is an acute,unilateral facial paresis that significantly affects patient's facial symmetry,motor function and quality of life.The primary goal of this randomized controlled trial is to determine if integrating the targeted neural mobilization with proprioceptive neuromuscular facilitation improves facial symmetry and motor function more effectively than using pnf alone.participants allocated to either experimental group receiving neural mobilization and pnf or control group receiving pnf alone.after approval from ERC FUSH, participants are assessed using housebrackman scale and sunnybrook facial grading system(scales to asses the degree of severity of facial paralysis) at first and fourth week of intervention application.data will be analysed using spss v.22.

Bell's palsy is an acute lower motor neuron facial nerve paralysis caused by dysfuntion in facial nerve (cranial nerve 7), leading to impairements in facial expression,speech, eating and psychological wellbeing, ultimatemately affecting the quality of life. Despite the individual benefits of rehabilitation techniques like facial proprioceptive neuromuscular facilitation and neural mobilization,there is limited evidence about the combined effects of these two verses pnf alone in the rehabilitation of bell's palsy. This randomized controlled trial is conducted in foji foundation hospital ,rwp, for the duration of one year after approval including a sample size of 36 patients. Sampling technique would be purposive.After ethical approval from ERC FUSH ,eligible participants will be allocated in two groups via coin toss method.the participants would be assessed through house brackman scale and sunny brook facial grading system (scales to asses the degree of severity of facial paralysis) at fisrt and forth week of intrvention application (3 sessions per week,30-45 minutes per seesion, for consecutive four weeks).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Interventions

GROUP A COMBINED THERAPY GROUPPROCEDURE

Receives proprioceptive neuromuscular facilitation (pnf), neural mobilization and conventional therapy. DESCRIPTION * PNF using rhythmic initiation and resisted voluntary movements directed at the frontalis, orbicularis oculi, zygomaticus major and minor, orbicularis oris and buccinator; three to five repetitions per pattern, three to four sets per session. Progression governed as tolerated with resistance and repetitions increased as recovery allowed. * Gentle facial nerve mobilization within a pain-free range, ten to twelve minutes per session; six to ten repetitions per technique or thirty to sixty seconds per glide, advancing glide range as tolerated. * Conventional therapy; clinic-based facial expression exercises with interrupted galvanic stimulation (rectangular waveform, 100 ms, 3 sets × 30 contractions), 2-3 sessions weekly, 15-20 minutes; plus daily home facial exercises with mirror feedback (smiling, blinking, puckering), 10-15 minutes.

GROUP B PNF GROUPPROCEDURE

Receives proprioceptive neuromuscular facilitation and conventional therapy. DESCRIPTION * Proprioceptive neuromuscular facilitation, using rhythmic initiation and resisted voluntary movements. Progression governed by the participant's tolerance and motor control, with resistance and repetitions increased as recovery allowed. * Conventional therapy: clinic-based facial expression exercises with interrupted galvanic stimulation (rectangular waveform, 100 ms, 3 sets × 30 contractions), 2-3 sessions weekly, 15-20 minutes; plus daily home facial exercises with mirror feedback (smiling, blinking, puckering), 10-15 minutes.

Eligibility

Sex: ALLMin age: 15 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age 15-60 years. * Both male and female. * Patient diagnosed with bells palsy by neurologist or relevant specialist. * Patients with moderate to severe Bell's palsy evaluated by Modified House-Brackman SCALE * Patient without exposure to any other rehabilitation program * Patients within the acute or subacute phases (within 6 months of onset) Exclusion Criteria: * Patients with a history of recurrent Bell's palsy or other neurological disorders (e.g., stroke, multiple sclerosis) * Patients with pacemakers, metal implants or other contraindications for electrical muscle stimulation. * Presence of facial trauma or surgical interventions that might interfere with rehabilitation outcomes. * Co-existing medical conditions (e.g., diabetes mellitus, infections, or malignancies) that might impair nerve recovery or affect study outcomes

Outcomes

Primary Outcomes

Symmetry of face

It is measured by Sunnybrook facial Grading system (SFGS) SFGS Score = (Voluntary Movement Score) - (Synkinesis Score) - (Resting Symmetry Score) Minimum value: 0 (Complete paralysis) Maximum value: 100 (Normal facial function) Higher scores indicate a better outcome

Time frame: 4 weeks

Severity of facial paralysis

It is measured by the House-Brackmann scale. Patients graded IV-VI show severe impairment, and patients graded I-III have mild-to-moderate dysfunction. Minimum value: I (Normal facial function) Maximum value: VI (Total paralysis) Outcome interpretation: Higher scores indicate a worse outcome