It hit hard and fast — you had trouble talking and moving your face. You looked in the mirror and saw that one half of your face was drooping. You thought you were having a stroke and went to the emergency room, only to be told you had Bell's palsy.
Bell's Palsy is hallmarked by a distinct droop of the facial features, as well as numbness and tingling to the involved areas. The muscles responsible for blinking, smiling, frowning and other facial expressions (like raising your eyebrows) cannot be voluntarily controlled and are rendered essentially paralyzed. Although it can strike on both sides, it typically affects only half of the face.
The cause of Bell's palsy is unknown and there are many theories ranging from a central nervous system disorder to an acute viral attack that targets only the facial nerve. Both women and men can contract the disorder, but women have a slightly elevated risk.
Interestingly, the two most commonly reported precipitating events are child-birth and sleeping next to an open window. Nearly thirty-percent of people with Bell's palsy relate their disorder to one of these factors, but science has yet to prove a link to either.
Bell's palsy has three stages — an acute, a sub-acute and a chronic phase. The acute phase is marked by a rapid onset of facial drooping combined with numbness and a fair amount of pain. This stage may last anywhere from forty-eight hours to two weeks and is a frightening time for the patient. The sub-acute phase lasts from two weeks to two months, and during this timeframe patients will see a reduction in pain and numbness, but usually no improvement in the ability to create a facial expression.
During the chronic phase, patients will begin to see improvements in the feeling and function of their face. Progress is gradual and should only be measured on a week to week basis to avoid feelings of discouragement. The chronic phase can last up to eighteen months, but most patients will see near-full if not complete resolution well inside of a year.
Bell's palsy is benign in nature and rarely if ever results in long term dysfunction or disfigurement of the face. There are no medicinal or surgical interventions available for patients with Bell's palsy. There are, however, some conservative treatment options that can be explored in physical therapy.
Physical therapy treatment is aimed to restore muscle function and muscle tone in the face, thus resolving the impairments associated with the disorder. Here are some of the many treatment options.
Electrical stimulation to the facial muscles. E-stim to the muscles of the face preserves muscle tone and prevents muscle degeneration. It even assists with muscle and nerve healing, shortening the overall recovery time
Facial exercises. There is a series of exercises to help patients with Bell's palsy regain muscle function. General movements of the face and eyes are not enough to make measurable improvements, therefore a specific regimen is indicated to properly rehabilitate the muscles.
Eyelid weights. One of the most devastating side effects of Bell's palsy is the inability to fully close the eyelid. This deficit will dry out the eyeball causing scarring of the cornea and often irreversible damage to the eyeball. A physical therapist can custom fit a set of eyelid weights to your eyes that prevents your eye from drying out, helping you avoid eye surgery.
TENS stands for Trans-cutaneous Electrical Nerve Stimulation. This type of treatment may help patients that have persistent nerve pain. This pain occurs in ten to fifteen percent of the cases and can sometimes be remedied with a special TENS unit that patients can use at home.
Bell's palsy also makes many patients anxious about leaving the house. If you're tired of your muscles not working properly, see a physical therapist about starting rehab.
Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He works in the outpatient division of Beverly Hospital and writes "On the Mend" weekly. Questions may be submitted to Joe by e-mail: joedivincenzo@comcast.net.
