Bell's palsy

[vasanth]

A patient with Bell's palsy under my care recently.

Apart from electrical stimulation, massage and exercise, what other ideas do you have?

I also want to know the effectiveness of acupuncture in this type of patient.

These articles may be of benefit please visit the following web site i.d.

ES Is it Helpful? - http://www.ptjournal.org/cgi/content...urcetype=HWCIT

Exercises - http://www.ptjournal.org/cgi/reprint...urcetype=HWCIT

[1234nale]

Sdkshif

says''Let me explain that ultrasound waves cannot traverse the bone. That means ultrasound has zero penetration in the bone. Infact, ultrasound waves are reflected away from the bone. So there is no fear in applying the ultrasound on face.''

The study was done for different purpose but that study proves that US penetrates the human temporal bone, that’s means that us even in small portion get to brain tissue that is very us sensitive and substantial for proliferation. My point was don’t use methods for what you are not sure what is the greater benefit (cause there is not enough study to support beneficial effect on nerve recovery) or risk factor (cause US may reach to brain tissue). Always ask your self what you try to accomplish.

[physiobob]

Sdkshif


The study was done for different purpose but that study proves that US penetrates the human temporal bone, that’s means that us even in small portion get to brain tissue that is very us sensitive and substantial for proliferation. My point was don’t use methods for what you are not sure what is the greater benefit (cause there is not enough study to support beneficial effect on nerve recovery) or risk factor (cause US may reach to brain tissue). Always ask your self what you try to accomplish.

No one is suggesting that they actually use US as a standard treatment in Bell's Palsy. However holding a tuning fork to one's head transmits sound waves to the brain. The study cited suggested that in fact US to the head in the temporal bone region might well be useful for clot lysis. One could infer from that that they are suggesting it might provide a useful tool when dealing with brain clots. They mention no precautions other than what we know to be the standard one's. i.e. apply enough gel, use an appropriate w/cm2, choose the right US head, choose the right pulse frequency and keep that thing moving. We all learn about the possibility of burning the patient from standing US waves if the head is not moved but then this is a problem when using US anywhere in the body.

Whilst I agree with your approach to say that one should not use something in an area that we don't know that much about I cannot say that we don't know much about US. We know a lot and most of it doesn't promote it's extensive use but nor does it say we should not use it. The jury remains out on that so I suppose as clinicians we can take sides depending on the case before us and our clinical experience with past results. Thanks again for providing some debate on this topic.

[1234nale]

I am sorry if mentioning this study can confuse someone. I could not find better that explicitly says that US penetrate human bone. Study was performing in vitro, that’s not on the living man. And also interfering with blood cloth in the brain is matter of neurosurgeons not physios. So, let’s keep our profession. In almost every book for electrotherapy there could be found contraindication for using US on aria of the head and front of the neck. But I find similar debate on this topic few times that’s why I posted this answers.

[sdkashif]

Dear 1234nale thanks for your query and questions. let me have a look over your query and answer it.

Low-frequency Ultrasound Penetrates the Cranium and Enhances Thrombolysis In Vitro.

The article that you have mentioned tells that low frequency ultrasound only penetrates the cranium while The frequencies used in therapy are typically between 1.0 and 3.0 MHz (1MHz = 1 million cycles per second). And these are high frequencies and therefore there will be no chance of penetration with high frequencies.

Ultrasound is a form of MECHANICAL energy, not electrical energy and therefore strictly speaking, not really electrotherapy at all. Mechanical vibration at increasing frequencies is known as sound energy. Below about 16Hz, these vibrations are not recognisable as sound, and the normal human sound range is from 16Hz to something approaching 15-20,000 Hz (in children and young adults). Beyond this upper limit, the mechanical vibration is known as ULTRASOUND. The frequencies used in therapy are typically between 1.0 and 3.0 MHz (1MHz = 1 million cycles per second). For detail about ultrasound see Therapeutic ultrasound

And again, aria of the head, easy, ears, ovaries, testicles, brain, spinal cord are highly ultrasound-sensitive organs!!!

I understand you concern regarding the contraindications of ultrasound. every good therapist is well aware of contra indication of ultrasound. Let me mention contraindication of ultrasound here. Please also see the detail for contraindications Contraindications of Ultrasound

CONTRAINDICATIONS OF ULTRASOUND

Avoid exposure to the developing foetus
Malignancy
Vascular abnormalities including DVT and severe atherosclerosis
Acute infections
Haemophiliacs not covered by replacement factor
Application over :
Specialised tissue e.g. eye and testes
The stellate ganglion
The cardiac area in advanced heart disease
The spinal cord following laminectomy
The cranium
Active epiphyseal regions in children

PRECAUTIONS OF ULTRASOUND

Anaesthetic areas should be treated with caution if a thermal dose is being applied
Subcutaneous major nerves and bony prominences
Always use the lowest intensity which produces a therapeutic response
Ensure that the applicator is moved throughout the treatment
Ensure that the patient is aware of the nature of the treatment and the expected effects
If pain, discomfort or unexpected sensations are experienced by the ptient, the treatment intensity should be
reduced. If the symptoms persist, the treatment should be terminated.

My point was don’t use methods for what you are not sure what is the greater benefit

There is recommendation in good physiotherapy text book for the use of ultrasound. During paralysis, ultrasound given over the nerve trunk just in front of the tragus of the ear may reduce the inflammation. For Reference see " Tidy's Physiotherapy 12th Edition page #162"

See For more information upon ultrasound dosage calculation

However, let me say that I was mentioning ultrasound recommendation only during the paralysis phase of Bell's palsy when the nerve is inflammed. There are also other options available for reducing inflammation like LASER, SWD. However, these are only of benefity during the stage of paralysis.

There are other modes of treatment like electrical stimulation and exercises. for detail you may see the articles below.

Evidence In Practice- Does electrical stimulation improve motor recovery in patients with idiopathic facial (Bell) palsy?

Physical therapy for Facial Palsy- A tailored treatment approach

[1234nale]

Thanks for enlightening us about US therapy methods but nobody did put that in question. Just you confirm my point of view: why use unsafe methods, when you have more safe ones with no risk for same result?

[physiobob]

Thanks for enlightening us about US therapy methods but nobody did put that in question. Just you confirm my point of view: why use unsafe methods, when you have more safe ones with no risk for same result?

OK guys. Enough now on ultrasound. Now let's all please only remark on any other ideas as asked by the original question below.

A patient with Bell's palsy under my care recently.

Apart from electrical stimulation, massage and exercise, what other ideas do you have?

I also want to know the effectiveness of acupuncture in this type of patient.

thanks

[emad]

Physiobob,

I think a worth point ,When to begin our role as therapists with facial Palsy ?

Emad

[physiobob]

Physiobob,

I think a worth point ,When to begin our role as therapists with facial Palsy ?

Emad

I have always begun asap with facial palsy. The moral or sense of the self is usually pretty darn low following a facial palsy. People often think they have had a stroke and that in someway they are facing a death sentence somewhere in the near future. Physiotherapy has a strong educational role as well as a direct treatment. if is often the PT who has the time to explore the disease process and explain things to the client. Thus on this point alone I would recommend PT intervention asap. it gives the client a good understanding, a direction and a structured approach as to what expect in the early, mid and late phases of the process.... hopefully leading to near if not full recovery.

It might be nice to know that one of the main physiobase/physiobob/physio forum design team had a facial palsy 12 months ago. This was a young male in his early 30's, someone who plays regular sport and leads a healthy lifestyle. It was his treatment early on by me that gave him the peace of mind to work through to full recovery and he continues to design the great stuff you see through out our site week on, week out...