Hi

I had a look at a recent systematic review (Cochrane) of physiotherapy for Bells Palsy. Here is the link:

http://www.mrw.interscience.wiley.co...stract_fs.html

In a nutshell:

The reviewers conducted a fairly exhaustive search and from that search only identified six studies of sufficient quality from which to draw conclusions. Three of these studies examined electrostimulation and three studies examined exercise. None of these studies examined ultrasound.

The results were disappointing in that neither exercise nor electrostimulation were better than controls or no treatment. However there was some limited evidence that exercise may speed recovery. The authors concluded that such treatment neither helps or harms recovery and that further evidence is needed to examine if exercise speeds recovery.

Probably the concern that treatment can cause or increase synkinesis is therefore unfounded. That is often the way isn't it. For example we used to believe that strengthening might make spasticity worse in UMN lesions when there is no evidence it does - in fact quite the reverse.

So we may not be harming our patients but are we really able to make them better.