Bell's Palsy

[angel76]

Hi Physios,
Please let me know the parameters of electrical stimulation ( Type of pulse,pulse duration etc)for Bell's palsy patient.i think there has been a recent study that Galvanic current is preferred.But can anyone let me know the advantage of using galvanic current over faradic current in bell's palsy.


Thanks.
Angel

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[physiobob]

Hi Physios,
Please let me know the parameters of electrical stimulation ( Type of pulse,pulse duration etc)for Bell's palsy patient.i think there has been a recent study that Galvanic current is preferred.But can anyone let me know the advantage of using galvanic current over faradic current in bell's palsy.


Thanks.
Angel

Have at look at the existing threads on Bell's or Facial Palsy

http://www.physiobob.com/forum/tags/...hp?tag=/palsy/

[angel76]

Hi,
thanks for the reply.i went through these replies.but i still did not find an answer to the reason why galvanic current is preferred over faradic current in stimulaion.please let me know if there are any available reasons.
thanks.

[sdkashif]

The faradic current has a frequency of 50 Hz and hence so produces the tetanic muscle contraction. It is ,therefore, surged to produce the alternate contraction and relaxation of the muscles. Moreover, faradic current having short pulse duration can not be used to stimulate dennervated muscles as dennervated muscles requre pulses of longer duration for having its effects. So galvanic current has fair long duration impulses selections that can be used to stimulate dennervated muscles. Although in early days of nerve injury a response of muscle can be obtained witth faradic or faradic type of current depending upon the reaction of degeneration but when walerian degenration takes place, it is not possible to get the response from faradic type of current. Furthermore, facial muscles are very delicate and soft as they can tolerate the tetanic type of contraction produced by faradic current and this could lead to the secondary contractures of the facial muscle. Hence the most suitable current in that case will be interrupted galvanic current, that produces a brisk twitches of the facial muscles. And there will no danger secondary contractures.

[jjose_01]

The prognosis of bell's palsy is always good. And recent research on efficacy of aciclovir makes physiotherapy just an adjunct to the medical management of bell's palsy! Research on effectivity of aciclovir with PT and aciclovir without PT must be done! So for PT students,hope this will be a good research topic!

[mistrysunil]

The faradic current has a frequency of 50 Hz and hence so produces the tetanic muscle contraction. It is ,therefore, surged to produce the alternate contraction and relaxation of the muscles. Moreover, faradic current having short pulse duration can not be used to stimulate dennervated muscles as dennervated muscles requre pulses of longer duration for having its effects. So galvanic current has fair long duration impulses selections that can be used to stimulate dennervated muscles. Although in early days of nerve injury a response of muscle can be obtained witth faradic or faradic type of current depending upon the reaction of degeneration but when walerian degenration takes place, it is not possible to get the response from faradic type of current. Furthermore, facial muscles are very delicate and soft as they can tolerate the tetanic type of contraction produced by faradic current and this could lead to the secondary contractures of the facial muscle. Hence the most suitable current in that case will be interrupted galvanic current, that produces a brisk twitches of the facial muscles. And there will no danger secondary contractures.

Can u prove ur theory.........??
is it issued anywhere.....??

[sdkashif]

Well you may have a look over the following

Clayton's Electrotherapy by Forster & Palastanga 7th Edition

Clinical Electrotherapy by Nelson & Currier 2nd Edition

There numerous references at chapters of electrical stimulation in bibliography.

[khaing thazin oo]

hi physios,

i wanna to know motor point for electrical stimulation in mouth in facial palsy.My patient recover all area but they have problem in mouth.they mouth were move to sound side,After 4 session of treatment with electical stimulation other part were recover but mouth is still left.I wanna to know how treatment is give.

[jjose_01]

from the corner of the eye, you go down to the upper cheek, you must feel where there is contraction in both the eye and upper corner of the mouth, take time stimulating at that point, the more and harder the contrations, the better.
then go down to the point between the corner of the nose and the corner of the mouth.
then go to the corner of the mouth, go laterally and down, feel the platysma contracting, but dont go down to prevent stimulating vasovagal reflex. go up and laterally keeping contractions of the corner of the mouth and go up to your main motor point which is near the ear and the corner of the eye.

your main exercise is very hard to instruct to the patient, so keep a mirror with you. let him to feel how his normal side corner of his mouth move fast, then, let him try to move it fast but not hard keeping his normal side not contracting.

you must not let his teeth grind as he do this, never instruct him to chew a gum, you are stimulating CNIII not VII.

let him to try to see his upper then his lower teeth then his molars. when he is showing you his lower teeth, look for the platysma.

next is to let him hold his lips on his normal side close then you will try to open it with your fingers, then at the center of his lips, then at his involved lips.

then let him to hold air inside of his cheeks, don't let him hold his lips, just let the air out, it's one way for him to know if he is getting better or not. but others let him to hold his lips just to stretch the muscles, but i dont know their reasons.


i hope you get what i mean, as i said at my reply back up, bells palsy is very easy to treat, that even without electrotherapy or even PT, it will become okey, what we do is just let him to feel every movement that was lost/impaired as he go through the natural healing process.

[aprilandy]

hi jjose,

seems you encounter this kind of problem already. it's so comprehensive and the details were just right. i will follow what you stated maybe it works to my uncle.

wish me luck

[jjose_01]

I'm sorry, it is cranial nerve 5 not 3...trigeminal. dont let your patient chew gum, it is the action of 5 not 7. i have patients who started to show reinnervation by 3 months so dont be dismayed. but the younger the patient, the better the prognosis. for adults, my prognostic sign is after 2-3 weeks, if he/she didn't show improvement at this time (spontaneous recovery), it's a bad sign. always decrease your sessions from 3 times per week to two times per week after 6 weeks. one more thing...dont use electrical stimulation until 2 weeks as you will hamper the spontaneous recovery.

off topic, i am very disappointed about FSBPT's decision to halt NPTE for foreign-trained PTs from my country. I am planning to take the exam by December because I am ready financially. All my professional life I have always been making the US PT standard...my standard of practice. All I wanted is to experience practicing it there. Now, I have to wait again for another year.