What Is Bell’s Palsy?
Bell’s Palsy, also called idiopathic facial paralysis, is a form of temporary facial paralysis resulting from damage or trauma to the facial nerves. The disorder is fairly rare, with fewer than 200,000 US cases reported each year. It is important to note that, while it is not related to stroke, it is the most common cause of facial paralysis. The condition most often comes on very suddenly but does improve on its own within a few weeks. Although it is not clear as to the actual cause of Bell’s Palsy, it is thought that the cause in some cases might be the herpes virus that also causes cold sores
What Are The Signs And Symptoms Of Bell’s Palsy?
The onset of Bell’s Palsy normally begins with a sudden weakness on one side of your face, which gets worse fairly quickly. Other symptoms may include:
The inability to close your eye on the involved side
Drooping of the entire side of the face on the involved side (within a few hours to overnight)
Drooling
Dryness or teariness of the eye
Sensitivity to sound
Pain in or behind your ear
Loss of sense of taste
How Can Physical Therapy Help?
Within a week of the onset of symptoms from Bell’s Palsy your Physical Therapist should evaluate your condition. Things they should be looking for include:
A thorough review of your medical history, including prior surgeries or health conditions
When your symptoms started and what makes them better or worse
A thorough facial examination, paying particular attention to the following:
Eye Closure
Movements of the eyebrow
Ability to pucker the lips
Ability to use the cheek in smiling
Raising the upper lip
Raising or lowering the lower lip
Ability to whistle
Your Physical Therapist should immediately:
Instruct you in how to cover and protect your eye
Instruct you on how you can manage your daily activities while you have Bell’s Palsy
Educate you as to the prognosis, and what to expect along your path to recovery
Monitor your progress to determine if appropriate gains are being made or if they feel you should be referred to a specialist
Of primary importance is protecting your eye. Your eye will be very vulnerable to injury from debris and dryness since you will lack the ability to quickly and completely close your eye. Debris can scratch your cornea and could cause permanent damage to your vision. Some tips your Physical Therapist should go over with you regarding eye care include:
Use of patches, both commercial and home made
Setting a regular schedule for refreshing eye fluids
Carefully using your fingers to close your eye
Your Physical Therapist should instruct you in some general facial exercises for you to do at home. These exercises are important as they will help you to be able to learn to move the weak side of your face and to be able to use both sides of your face together.
What Can You Expect During Recovery?
Your Physical Therapist should work closely with you to help you to restore your normal facial movements needed for expressions and function. However, recovery can be challenging as well as frustrating for several reasons. First of all, the ability to make facial expressions is normally automatic–that is, you are born with this ability and have never had to think about it before. Secondly, unlike other muscles in your body, the facial muscles do not have sensors that relay information to the brain about all of the necessary “details” about how to move.
Your Physical Therapist should monitor your progress and alter your exercise program based on your individual movement problems. Your exercises should certainly change over the course of your recovery and may include the following:
Initiation Exercises–Early on, you will most likely have tremendous difficulty making any facial movements at all. Your Physical Therapist should instruct you in exercises that will create (initiate) facial movement. You should be instructed in assisted range of motion where you will position your face to facilitate movement as well as how to trigger the facial muscles to do what you want them to do.
Facilitation Exercises–As soon as you are able to initiate movement of your facial muscles, your Physical Therapist should instruct you in exercises that will improve the activity of the muscles, increase the strength of the muscles, as well as working on endurance of the muscles (be able
to use them for longer periods of time).
Movement Control Exercises–Your Physical Therapist should create exercises specifically designed to:
Improve coordination of your facial muscles
Correct abnormal patterns of facial movement that can occur during recovery
Refine movements for specific functions, such as closing your eye or talking
Refine movements for facial expressions, such as smiling
Relaxation–If you experience twitches or facial spasms during recovery, don’t worry–it’s not uncommon. Your Physical Therapist should instruct you in exercises to decrease this unwanted muscle activity. You will learn to recognize when you are activating the fascial muscle and when the muscle is at rest. By learning how to contract the facial muscle forcefully and then stop, you will be much more adept at being able to relax your facial muscles at will and diminish twitches and spasms.
What Can You Expect After Recovery?
It happens sometimes that certain individuals might have more difficulty moving their face after a period of improvement–this can lead to increased anxiety and worry that the facial paralysis is returning. The good news? Actual recurrence of facial paralysis from Bell’s Palsy is uncommon. New difficulty in getting your face to move is likelier the result of increasing the strength of the facial muscles without improving your ability to control and coordinate the movement. To prevent this from happening, your Physical Therapist should instruct you what facial movements you should avoid during your recovery. For example, the following might make you more prone to abnormal patterns of facial muscle use:
Chewing gum with increased force
Blowing up a balloon with all your might to work the facial muscles
Attempting to make the biggest facial muscle contraction you can, such a smiling as much as you can
Your Physical Therapist should work with you so you can use your face as naturally as possible, without trying to restrict facial expressions because the look “different.”
How Can I Be Sure It’s Bell’s Palsy And Not Something Worse?
Since Bell’s Palsy usually begins with a sudden weakness on one side of your face or a sudden feeling that you can’t move one side of your face, it’s extremely important to know that these can also be symptoms of such conditions as stroke. If your facial weakness is accompanied by any of the following, seek medical care immediately:
Confusion
Weakness of arms or legs
Loss of facial sensation
Pain in the ear, cheek, or teeth
Severe headache
Vision changes
Fever
Malaise
If you or someone you know are experiencing the signs and symptoms of Bell’s Palsy, don’t wait to take action. Call my office at once at (302)691-9055 or go to my website at www.wildermanphysicaltherapy.com and schedule your free 30-minute consultation to see how Physical Therapy can help. Don’t wait–schedule now!
Photo Antonika Chanel, mayo clinic
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