Bell's palsy

[Dr Damien]

There is some controversy on the use of TENS for any lower motor neuron problem and the reason being that the frequencies available on the TENS were designed for pain relief mostly. When used to initiate contraction, these frequencies begin to imitate a proper electrical muscle stimulator and whether or not it is bad practice remains a question open for debate-I've never witnessed any adverse effects for its use. If Tens/electrical muscle stimulation is to be considered,it should only be used only as a reeducation tool. This means that nothing should substitute for an active contraction done by the patient. Tens/elec stim will facilitate the ease with which impulses travel in a nerve which will allow easy conscious stimulation . By having the patient imitate the contraction as it happens in time, the is a biofeedback mechanism set in place.I emphasis that TENS should be used (if at all) for reeducation and possibly maintenance of muscle physiology(prevetion of atrophy due to disuse). Patient's with bell's palsy often recover overtime(as the swollen nerves reduce). Some patient's will not respond to the use of TENS because of the over reliance on it as a magic tool that brings back power and coordination to their muscles when infact the bulk of the exercise lies on them.Some will, while others will fall into the lot who experience spontaneous recovery and as such may attribute treatment success to the tens. Some patients will not tolerate TENS too. The effects tens provides is achievable with certain massage techniques such as point stimulation and kneading. If TENS is to be considered I believe the therapist should constantly encourage the patient to follow the contractions with conscious effort, however there are questions that will be raised in this treatment e.g how much of coordination can be achieved (there is a limit to the isolation of a stimulating machine, can the tens machine train you to smile or blow out ur cheeks?).I only have three words for the bells palsy patient, exercise,exercise and exercise...