PILOT STUDY PRESENTATION, on Bell's palsy.

2. Topic
Comparing Proprioceptive Neuromuscular Facilitation And Mirror Exercises
in improving facial symmetry and function in bell’s palsy: A pilot study

3. Introduction
• Bell’s palsy is an idiopathic condition that causes a unilateral paresis or paralysis of
the muscles in the face, which may be partial or complete and has equal chance of
occurring on either side of the face.
• It is seen when the nerve that controls the facial muscles becomes inflamed, swollen
or compressed.
• It results in temporary loss of function of the nerve producing a lower motor neuron
(LMN) type of facial paralysis.
• This disorder of the facial neuromuscular system can result in marked disfigurement
of the face and difficulty in performing activities of daily living such as eating,
drinking and communicating.

4. • Rehabilitation involves different therapies including proprioceptive neuromuscular
facilitation, neuromuscular re-education, mirror biofeedback therapy, mime
therapy, facial massage, electrical stimulation, etc.
• Proprioceptive Neuromuscular Facilitation (PNF) and Mirror Exercises (ME) are
two approaches for facial rehabilitation that can promote recovery and improve
functionality through the use of feedback.
• Previous studies have proven PNF and ME when used individually have shown to
be effective techniques in improves facial symmetry and function more than
conventional therapy.

5. Objectives
• To compare the effectiveness of Proprioceptive Neuromuscular Facilitation and
Mirror Exercises in improving facial symmetry and function in patients with
Bell’s palsy.

6. Methods
• A pilot study was carried out with 10 subjects randomly allocated into two groups,
Group A (PNF) and Group B (ME).
• Pre and Post intervention outcome of Sunny Brook Facial Grading Scale (SBFGS),
and Face Clinimetric Evaluation (FaCE), were measured at baseline and end of 2
weeks of treatment.

7. Results
• The between group comparison for Post Treatment scores in
SunnyBrook facial grading scale (p=0.43) and FaCE scores (p=0.38)
showed no significant differences (p>0.05) between both the groups.

8. • SB pnf and mE post treatment

9. • FaCE PNF and ME post treatment

10. • SB pre and post

11. • FaCE pre and post treatment

12. Discussion
• PNF a widely used approach, developed during the 1940s and 1950s by the
pioneering work of Kabat, Knott and Voss,
• It is a therapeutic exercise combining functionally based diagonal patterns of
movements with techniques of neuromuscular facilitation, evoking motor
responses and improving neuromuscular control and function.
• Mirror Exercises are done to stimulate the muscles of facial expression in front of
the mirror. Exercises like elevating eyebrows, smiling, scowling, etc. are done
facing the mirror to facilitate respective muscles.

13. Conclusion
• Proprioceptive Neuromuscular Facilitation and Mirror Exercises in the
present pilot study showed improvements in facial symmetry and function
at the end of two weeks showed significant improvement within the
groups.
• Effectiveness of either treatment technique between the groups showed
no superiority of one technique over the other.
• Hence, both the treatments can be used interchangeably or a combination
of both may yield better outcome.