This document summarizes a dissertation presentation comparing the effectiveness of proprioceptive neuromuscular facilitation (PNF) and mirror exercises in improving facial symmetry and function in patients with Bell's palsy. The study used a randomized clinical trial design to compare the outcomes of PNF and mirror exercises, as measured by three facial assessment scales. Both interventions showed highly significant improvements from pre-to-post treatment within each group. However, there was no significant difference found between the two treatment groups. The conclusion is that PNF and mirror exercises are equally beneficial in the early stages of Bell's palsy.

1. Dissertation presentation
Mr. Ashik Dhakal
Reg no. 17MT567
Under the guidance of
Mr. Sydney Roshan Rebello

2. Title
COMPARING THE EFFECTIVENESS OF PROPRIOCEPTIVE
NEUROMUSCULAR FACILITATION AND MIRROR EXERCISES IN
IMPROVING FACIAL SYMMETRY AND FUNCTION IN PATIENTS
WITH BELL’S PALSY: A RANDOMISED CLINICAL TRIAL

3. Background
Bell’s palsy is an idiopathic condition that causes paresis or paralysis of the
muscles in the face, which may be partial or complete and has equal chance on both
side.
Many treatment options are introduced where physiotherapeutic options are not
universally accepted.
Individually PNF and Mirror exercise, both the techniques have been found to
improve function and facial symmetry.
But there are no studies which compare the two techniques which could be helpful
in deciding which of the two would be a more appropriate treatment option.

4. Aims and Objective
Aims
• To compare the effectiveness of PNF and Mirror exercise in improving facial symmetry and function in
patients with Bell’s palsy
Objectives
• To determine the effectiveness of PNF in improving facial symmetry and function in patients with Bell’s
palsy
• To determine the effectiveness of Mirror Exercise in improving facial symmetry and function in patients with
Bell’s palsy
• To compare the outcome between the two types of intervention

5. Methodology
• Study setting: physiotherapy OPD,FMMCH
• Source of data: Bell’s palsy patients referred to physiotherapy OPD
• Study duration: One Year (March 2018-19)
• Study design: RCT
• Sampling technique: purposive sampling

6. Outcome measures
Sunnybrook facial grading system
Facial clinimetric evaluation scale
House - Brackmann Facial Grading System

7. Procedure
• Ethical committee approval
• Inclusion-Exclusion criteria
• Written informed consent
• Demographic data was collected
• Randomly allocated into 2 groups, group A (PNF) group B (Mirror exercise)
• Both groups received ES and massage for the facial muscle
• Treatment was held for one hour , six days a week for a period of two weeks.
• Pre and post intervention outcome measures were compared between groups

8. Statistical analysis
Was performed using SPSS, version 23.0 by IBM corporation.
The comparison of pre and post intervention values within the groups was
analysed using Wilcoxon signed rank test.
Between groups was analysed using Mann-Whitney U test.
A value of p<= 0.05 was considered statistically significant.

9. Results
Highly significant difference in within group comparison.
Non significant difference in between group comparison.

10. Conclusion
Both PNF and Mirror exercise are equally beneficial during the early stage
of the disease and have excellent acceptance among patients.
A therapist can choose between either approach, based on the patient’s
goals and expectations.

11. Thank you