Comparative Effects of Neural Mobilization and Proprioceptive Neuromuscular Facilitation in Patients with Bell’s Palsy
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Abstract
Background: Bell's palsy, characterized by sudden unilateral facial nerve paralysis, presents significant challenges in physical therapy and rehabilitation. Proprioceptive Neuromuscular Facilitation (PNF) and Neural Mobilization have emerged as potential interventions, yet their comparative efficacy remains underexplored. This study aims to fill this gap by evaluating the effectiveness of these treatments in improving facial function in patients with idiopathic Bell's palsy.
Objective: The primary objective of this randomized control trial (RCT) was to compare the effects of PNF and Neural Mobilization on physical and social functioning in patients with mild to moderately severe idiopathic Bell's palsy.
Methods: This RCT involved 36 participants, aged 25 to 45, diagnosed with idiopathic Bell's palsy, randomly allocated into two groups: PNF and Neural Mobilization, with 18 participants in each. The study spanned three weeks, with treatments administered 3-4 days per week. Conventional physiotherapy, including facial exercises and electrical muscle stimulation (EMS), served as the baseline treatment for both groups. The Shapiro-Wilks test assessed data normality, employing parametric tests for intra-group reliability analysis. The Mann-Whitney Test and Wilcoxon signed-rank test were utilized for inter and intra-group comparisons, respectively.
Results: Post-treatment, the PNF group exhibited significant improvements with a mean post-treatment House Brackmann Scale score of 90.28, compared to 73.61 in the Neural Mobilization group. Similarly, significant enhancements were noted in the Facial Disability Index, with both physical and social scores increasing from a median of 48 to 80 post-intervention. Statistical analysis revealed significant differences in treatment outcomes (p<0.001 for House Brackmann Scale; p<0.001 for Physical and Social FDI scores), favoring the PNF approach.
Conclusion: PNF was more effective than Neural Mobilization in improving the physical and social functions of patients with idiopathic Bell's palsy. This study underscores the potential of PNF as a superior treatment modality, advocating for its inclusion in conventional physiotherapy regimens for Bell's palsy patients.
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References
Twain M. Musculoskeletal Pathologies, Disorders, and Injuries. Mosby's Pathology for Massage Professionals-E-Book: Mosby's Pathology for Massage Professionals-E-Book. 2021:114.
Seth NH, Kariya SK, Patil SP. Effectiveness of facial PNF along with effleurage in idiopathic facial nerve palsy–. 2022.
Schuermans J, Van Hootegem A, Van den Bossche M, Van Gendt M, Witvrouw E, Wezenbeek E. Extended reality in musculoskeletal rehabilitation and injury prevention-a systematic review. Physical therapy in sport. 2022;55:229-40.
Robinson MW, Baiungo J, Hohman M, Hadlock T. Facial rehabilitation. Operative Techniques in Otolaryngology-Head and Neck Surgery. 2012;23(4):288-96.
Pro S, Vinti L, Boni A, Mastronuzzi A, Scilipoti M, Velardi M, et al. Peripheral nervous system involvement in non-primary pediatric cancer: From neurotoxicity to possible etiologies. Journal of Clinical Medicine. 2021;10(14):3016.
Park I, Park C, Kim K, Cha Y. The effects of dynamic neuromuscular stability exercise on the scoliosis and pain control in the youth baseball players. Journal of Mechanics in Medicine and Biology. 2021;21(09):2140030.
Oliver Z. Essentials of Physical Medicine and Rehabilitation. Academic Page; 2021.
Nshimiyimana J, Uwihoreye P, Muhigirwa JC, Niyonsega T. Neurofunctional Intervention Approaches. Neurorehabilitation and Physical Therapy: IntechOpen; 2023.
Niethamer L, Myers R. Manual therapy and exercise for a patient with neck-tongue syndrome: A case report. journal of orthopaedic & sports physical therapy. 2016;46(3):217-24.
Neville C, Beurskens C, Diels J, MacDowell S, Rankin S. Consensus Among International Facial Therapy Experts for the Management of Adults with Unilateral Facial Palsy: A Two-Stage Nominal Group and Delphi Study. Facial Plastic Surgery & Aesthetic Medicine. 2023.
Means Jr KR, Saunders RJ, Graham TJ, Cannon NM, Yousaf I. Pathophysiology and surgical management of the stiff hand; postoperative management of metacarpophalangeal joint and proximal interphalangeal joint capsulectomies. Rehabilitation of the Hand and Upper Extremity, E-Book. 2020:345.
McGonigal EA. Focal Hand Dystonia in Musicians: The Florida State University; 2020.
Maugeri G, D'Agata V, Trovato B, Roggio F, Castorina A, Vecchio M, et al. The role of exercise on peripheral nerve regeneration: from animal model to clinical application. Heliyon. 2021;7(11).
Martineau S, Rahal A, Piette E, Moubayed S, Marcotte K. The “Mirror Effect Plus Protocol” for acute Bell's palsy: A randomized controlled trial with 1-year follow-up. Clinical rehabilitation. 2022;36(10):1292-304.
Martineau S, Rahal A, Piette É, Chouinard A-M, Marcotte K. The Mirror Effect Plus Protocol for acute Bell’s palsy: a randomised and longitudinal study on facial rehabilitation. Acta Oto-Laryngologica. 2021;141(2):203-8.
Loyo M, Ng JD, Louie D, McReynolds M. Evaluation and Management of Facial Palsy. Albert and Jakobiec's Principles and Practice of Ophthalmology: Springer; 2021. p. 1-26.
Kukadia SK, Murphy CI, Shah H, Drakos MC. Modern Surgical Techniques for Treatment of Chronic Lateral Ankle Instability. Techniques in Foot & Ankle Surgery. 2022;21(4):180-7.
Joshua AM, Misri Z. Peripheral Nerve Disorders. Physiotherapy for Adult Neurological Conditions: Springer; 2022. p. 621-729.
Hetzler L, MacDowell S, Diels J, VandeWater T, Azzizadeh B. Chemodenervation algorithm: functional and aesthetic considerations for facial harmony in patients with post-facial paralysis synkinesis. Facial Plastic Surgery & Aesthetic Medicine. 2023.
Gonçalves RAM, Costa GJV, Afonso MAL, Jerónimo LMMAL. Rehabilitation of unilateral peripheral facial paralysis in Guillain-Barré: a case study. Revista CEFAC. 2021;23:e4021.
Glazebrook C, Scribbans T, Singer J, Parsons JPT. How cryokinetics affect sensory perception, range of motion and postural stability of uninjured and previously injured ankles 2021.
Deshmukh NS, Kannao VV, Phansopkar P, Wadhokar OC. Impact of Physical Therapy on a Patient with Bell’s Palsy: A Case Report. Journal of Pharmaceutical Research International. 2021;33(33A):97-102.
de Sire A, Marotta N, Agostini F, Drago Ferrante V, Demeco A, Ferrillo M, et al. A telerehabilitation approach to chronic facial paralysis in the COVID-19 pandemic scenario: what role for electromyography assessment? Journal of Personalized Medicine. 2022;12(3):497.
Dagenais F, Neville C, Desmet L, Martineau S. Measuring the potential effects of mirror therapy added to the gold standard facial neuromuscular retraining in patients with chronic peripheral facial palsy: protocol for a randomized controlled trial. JMIR research protocols. 2023;12(1):e47709.
Criss CR. Central Nervous System Contributions to Subjective and Objective Measures of Function after Anterior Cruciate Ligament Reconstruction: Ohio University; 2021.
Cassidy S. Investigating the Impact of Neurologic Music Therapy on the Spatiotemporal Gait Parameters and Mood for Adults and Children who Have an Acquired Brain Injury: University of Limerick; 2022.
Bersch I, Krebs J, Fridén J. A Prediction Model for Various Treatment Pathways of Upper Extremity in Tetraplegia. Frontiers in Rehabilitation Sciences. 2022;3:889577.
Bahniuk B. How Cryokinetics Affect Sensory Perception, Range of Motion and Postural Stability of Uninjured Ankles and Previously Injured Ankles: University of Manitoba; 2021.
Andreatta RD, Etter NM. The Chemical Senses: Olfactory and Gustatory Systems, and the Neural Substrate of Swallowing. Neuroscience Fundamentals for Communication Sciences and Disorders. 2022:435.
Alhakeem N. Effects of Surgical Intervention for Spastic Upper Extremity on Gait in Spastic Adults: University of Miami; 2020.