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DOI Number: 10.5958/j.0973-5674.7.3.

073
98 Indian Journal of Physiotherapy & Occupational Therapy. July-September 2013, Vol. 7, No. 3

Efficacy of Taping in Bell's Palsy


Kaushal M1, Saini S S2, Singh N3, Ghotra P K4
Physiotherapist, 2Assoc. Prof., 3Prof. Medicine, 4Asstt. Prof.,COP,CMCH, Ludhiana

ABSTRACT
Objectives: To study &compare the efficacy of taping protocol/Technique over Conventional
treatment technique protocol in Bells Palsy.
Materials and Method: The study was conducted on 30 subjects. Subjects were divided into two
groups. One group was given Electrical stimulation and exercises and other group was given electrical
stimulation , facial exercises and taping.
Results- There exists significant difference between post-treatment scores of both the groups. The
study concluded that the treatment of Es+facial exercise+tapping is effective in curing bell's palsy
Conclusion: Group B protocol is more effective for functional retraining than conventional treatment
in subjects with Bells Palsy.
Keywords: Bell's Palsy, Taping, Electrical Stimulation, Facial exercises

INTRODUCTION
Bells palsy, also known as acute idiopathic facial
paresis, is an idiopathic neuropathy of the facial nerve
(cranial nerve VII). It is a rapid onset facial paralysis
that is not life-threatening. While acute immune
demyelination triggered by a viral infection may be
responsible for Bells palsy, its exact cause is still
unclear. Bells palsy is usually self-limiting with the
majority of patients recovering spontaneously without
treatment within 6 months of onset of the disorder.
However, a recent study by Kanazawa et al (2007)
reported that recovery from Bells palsy in diabetics is
delayed, and the facial movement score remains low
in comparison with non-diabetics.1Facial paralysis has
been primarily considered a cosmetic inconvenience
with associated functional problems such as speech,
eating, facial asymmetry, drooling, and an inability to
close the eye on the paralyzed side .The patient with
facial paralysis cannot convey the normal social signals
of interpersonal communication. Incidence of Bells
Palsy is about 23/100000/annum.
Facial nerve is responsible for voluntary facial
movements,& can be tested by asking a patient to
perform movements such as wrinkling the brow,
showing teeth, frowning, closing the eyes tightly,
pursing the lips and puffing out the cheeks & noticing
asymmetry. The recovery phases of Bells palsy tends
to follow one of two pathways2

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1. Rapid recovery group


2. Delayed / partial recovery
The treatment options available for Bells palsy
includes (Medical & Surgical Management)

Eye drops & Eye lubricants or viscous ointments,

Therapeutic injections of botulism toxin & vitamin


B12 supplements,

Anti-inflammatory & Antiviral medication,

Alternative treatment,

Facial massage and exercises,

Acupuncture,

Chiropractic manipulation,

Surgery.

The diagnosis of Bells palsy is primarily one of


exclusion, however certain features in the history and
physical examination can aid in distinguishing it from
facial paralysis as a consequence of other conditions.
These clinical features include abrupt onset with
complete, unilateral facial weakness at 24 to 72 hours,
and, on the affected side, numbness or pain around
the ear, a reduction in taste, and hypersensitivity to
sounds.3

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Indian Journal of Physiotherapy & Occupational Therapy. July-September 2013, Vol. 7, No. 3 99

The objectives of facial retraining therapy are: (i)


to normalize movement of facial muscles, (ii) to
increase symmetrical movement patterns of the face,
(iii) to increase volitional movements of the face, (iv)
to inhibit undesired movements and synkinesis, and
(v) to normalize muscular tone.
Most cases of Bells palsy resolve uneventfully in
children, some do not. It is possible that rehabilitation,
including retraining the brain through facial exercises
or even surgical correction for weakened facial muscles
can be necessary in extreme cases. In the early stage of
Bells palsy, when facial muscles are the most flaccid,
it is desirable to allow the muscles to simply rest and
recover on their own. Gentle massage and moist
warmth may provide pain relief and improve
circulation, but stronger interventions should wait.
Usually facial exercises will not be necessary for
children with Bells palsy unless the paralysis does not
resolve itself and there is long-term damage to nerves.
However facial exercises such as wrinkling the
forehead, flaring and sniffling the nostrils, curling and
puckering the lips, and several others may be used to
retrain the brains messages to facial muscles. Even
younger children can often be taught to do these
exercises, and they can be presented by parents or
therapists as playing a gamemaking faces in the
mirror. Sessions of facial exercise should be brief and
performed two to three times a day. A surgical
procedure involving decompression of the facial nerve
through extremely delicate microsurgery has, in severe
cases, also been done. But its effectiveness in Bells
palsy remains at issue among child health-care
providers. Benefits of this surgery are considered by
some child health specialists to be insufficient
compared to the risks involved.
Nutritional concerns
Because compromise of the immune system is so
often a facet of children contracting Bells palsy, good
nutrition is necessary to rebuild and strengthen that
immune system. This involves following the American
Dietetic Association (ADA) nutritional guidelines for
children, and possibly the addition of a multivitamin
if the pediatrician feels it is advisable. Semi-solid foods
such as yogurt, jello, pudding, or ice cream may be
easier to take in than liquids if the child is experiencing
swallowing difficulty.
ADA nutritional guidelines for children include

Grain group: Six servings per day. Includes, per


serving, one slice of bread, one-half cup cooked

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99

rice or pasta, one-half cup cooked cereal or 1 oz


(28 g) of ready-to-eat cereal.

Vegetable group: Three servings per day. Includes,


per serving, one-half cup of chopped raw or
cooked vegetables, one cup of raw, leafy
vegetables.

Fruit group: Two servings per day. Includes, per


serving, one piece of fruit or melon wedge, threequarters cup of fruit juice, one-half cup of canned
fruit, onequarter cup of dried fruit.

Milk group: Two servings per day. Includes, per


serving, one cup of milk or yogurt, or 2 oz (57 g) of
cheese.

Meat group: Two servings per day. Includes, per


serving, 23 oz (5785 g) of cooked lean meat,
poultry or fish, one-half cup of cooked dry beans,
one egg, or two tablespoons of peanut butter.

Fats and sweets group: Should be limited as much


as possible.

Prognosis
The potential outcome from Bells palsy is quite
hopeful. NINDS notes that the majority of all Bells
palsy sufferers improve dramatically, with or without
treatment, within two weeks. The Bells Palsy
Information Site notes that half of all people
contracting this condition recover completely within
a short time, and another 35 percent have good
recoveries within a year. The outlook for children is
better. Eighty-five percent of children with this disease
recover completely. Ten percent of the children who
contract Bells palsy will have mild weakness
remaining afterward, and 5 percent will have severe
residual facial weakness. Statistically, 7 percent of all
children that develop Bells palsy will have a recurrent
episode in the future.4
AIMS AND OBJECTIVES
To study& compare the efficacy of taping protocol/
Technique over Conventional treatment protocol.
HYPOTHESIS
Null Hypothesis (Ho)
Both taping protocol/Technique and Conventional
treatment protocol are equally effective in subjects with
Bells palsy .

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100 Indian Journal of Physiotherapy & Occupational Therapy. July-September 2013, Vol. 7, No. 3

Alternate Hypothesis (Ha)


(1) Taping protocol/Technique is more effective than
Conventional treatment protocol in subjects with
Bells palsy
(2) Conventional treatment protocol is more effective
than Taping protocol/Technique in subjects with
Bells palsy.
Review of Literature
Vijay Batra and Meenakshi Batra 2007 study
conducted on 30 subjects with diagnosis of bells palsy
showed VM functional dynamic taping protocol is
more effective functional retraining then conventional
treatment in subjects with bells palsy.
Ross, et al (1991), compared two treatment groups
with a third control group received no treatment. After
comprehensive evaluation, one group was trained with
EMG and mirror feedback, while the second group
used mirror feedback alone. Patients were re evaluated
after one year of treatment .A significant difference was
found between the treatment groups and the control
group.7
Cederwall E, Olsen MF, Hanner P, Fogdestam
(2006) I did a study on evaluation of physiotherapeutic
treatment intervention in Bells facial palsy.In
conclusion, patients with remaining symptoms of Bell,s
palsy appear to exterience positive effects from a
specific training program.5
Dalla Toffola, BossiD,BuonocoreM,Montomli C,
Petrucci L, Alfonsi E(4) did a study on Usefulness of
BFB/EMG infacial palsy rehabilitation. The objective
of study was toanalyze and to compare the recovery
and the development of synkinesis in patients with
idiopathic facial palsy (Bellspalsy) following treatment
with two methods ofrehabilitation, kinesitherapy (KT)
and biofeedback/EMG (BFB/EMG). It was concluded
that BFB/EMG seems to bemore useful than KT in
Bells palsytreatment.6
METHODOLOGY

into two groups Group A: Electrical Stimulation and


Facial Exercises Group B: Conventional (Group A
Protocol) and Taping. Subjects were taken from
Christian Medical College and Hospital, Ludhiana and
consent form was signed by them.
Inclusion criteria: Subjects with age group 15-45
years, Acute onset (1-3 week), Diagnosed case of Bells
palsy, Non-traumatic onset, No other neurological
deficit.
Exclusion Criteria: Psychiatric illness, UMN lesion,
Neurotmesis, Skin infection & open wounds
Hypersensitive skin, Skin Allergy to micropore.
PHYSIOTHERAPY TREATMENT
A. ELECTICAL STIMULATION
Facial muscles and nerve trunks are stimulated at
their motor points.
B. FACIAL STRAPPING
It is a procedure to correct the deviation of the angle
of the mouth by correcting the hyper action of
antagonistic commonly used technique.
PROCEDURE
Two strips of adhesive tape are cut and one is
sticked near to chin below the lower lip and is pulled
unto lower part of ear whereas the other strip is taken
part of the ear.
MATERIAL USED

SURGICAL TAPE

MICROPORE TAPE

ELASTOPLAST

C. FACIAL MASSAGE
The patients often derive great comfort from
massage. The following manipulation can be
given:
1. STROKING

Design: Randomised Controlled trial

It should be given from the chin upward to the


temple from middle of the forehead downward
toward the ear.

SUBJECTS
Subjects taken were 30 with age group 18-45 years
with a diagnosis of bells palsy of non-traumatic onset.
Subject pool was taken from CMC & Hospital
&consent form signed by them. Subjects were divided

20. Mayank Kaushal--98--103.pmd

100

2.

FINGER KNEADING
Small circular all over the affected side of the face
,care being taken not to stretch the muscles.

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Indian Journal of Physiotherapy & Occupational Therapy. July-September 2013, Vol. 7, No. 3 101

3.

TAPOTEMENT
May be administrated in the from of tapping with
the finger tips quickly & lightly.

Although Both taping protocol/ technique &


Conventional treatment protocol were effective for
functional retraining but subjects in Group B showed
better recovery than Group A.

D. FACIAL EXERCISES

TEST 1: Ex+Facial Exercises

1. Drink all liquids through a straw. Youll be


dribbling all over yourself for a few days. But it
does help the muscles around the mouth.

Ho: There exists no significant difference between


pre-treatment and post treatment scores of group I

2. Sniff strongly. Wrinkle nose. Flare nostrils.

H1: There exists no significant difference between


pre-treatment and post treatment scores of group I

3. Curl upper lip up and raise and protrude upper


lip. Try to touch nose.
4. Using your index finger and thumb pull the
corners of your lips in toward the center.

Applying t-test we get


Pre

Post

Mean

117.8667

143.2

Variance

155.2667

184.7429

Observations

5. Chew gum.

15

Pearson Correlation

6. Chew and suck on ice.


For the eye

Hypothesized Mean Difference

Df

14

t Stat

1. Placing 4 finger tips on the eyebrow rub using a


firm slow stroke up to the hairline. Return
downward to the eyebrow.
2. Using finger tips placed on the cheek tap lightly
and slowly along the bone under the eye to the
face.
3. Try to close the eye slowly.
RESULTS
Student t test was used to compare quantitative
characteristic & baseline outcome variables. Statistical
analysis was done & P value (< .05) was found to be
significant for group B

15

0.333768

6.512843

P(T<=t) one-tail

6.86E-06

t Critical one-tail

1.761309

P(T<=t) two-tail

1.37E-05

t Critical two-tail

2.144789

The test reveals that the calculated value is higher


than the table value. Hence, the Ho is rejected. Thus,
there exists significant difference between pretreatment and post-treatment scores of group I. The
treatment of Es+facial exercise is effective in curing.
TEST 2: Ex+Facial Exercises+Tapping
Ho: There exists no significant difference between
pre-treatment and post treatment scores of group II
H1: There exists no significant difference between
pre-treatment and post treatment scores of group II
Applying t-test we get
Variable 1 Variable 2
Mean
Variance
Observations

101

172.0667
370.8857

15

Pearson Correlation

20. Mayank Kaushal--98--103.pmd

142.2
309.3524
0.879939

Hypothesized Mean Difference

Df

14

t Stat

12.61168

P(T<=t) one-tail

2.46E-09

t Critical one-tail

1.761309

P(T<=t) two-tail

4.93E-09

t Critical two-tail

2.144789

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15

102 Indian Journal of Physiotherapy & Occupational Therapy. July-September 2013, Vol. 7, No. 3

The test reveals that the calculated value is higher


than the table value. Hence, the Ho is rejected. Thus,
there exists significant difference between pretreatment and post-treatment scores of group II. The
treatment of Es+facial exercise+tapping is effective
in curing Bell,s Palsy

69

78

72

78

72

74

90

100

95

88

85

98

Comparative Results of Group I and Group II


The objective of the study was to examine whether
Es+facial exercise + tapping is more effective in
curing the Bells Palsy. For this purpose, the
hypothesis was framed and then post treatment
results of group I and that of group II were compared
and t-values were calculated.
Ho: There exists no significant difference between
post-treatment scores of both the groups
H1: There exists significant difference between posttreatment scores of both the groups
Applying t-test we get
Group I
Mean
Variance
Observations

Group II

143.2

172.0667

184.7429

309.3524

15

Hypothesized Mean Difference


Df

15
0

28

t Stat

5.02964

P(T<=t) one-tail

1.55E-05

t Critical one-tail

1.705616

P(T<=t) two-tail

3.11E-05

t Critical two-tail

2.055531

The test reveals that the calculated value is higher


than the table value. Hence, the Ho is rejected. Thus,
there exists significant difference between significant
difference between post-treatment scores of both the
groups.
From the above analysis, it can be concluded that
the treatment of Es+facial exercise+tapping is effective
in curing bells palsy

DISCUSSION
On the basis of analysis of result the alternating
hypothesis stating that Group B taping protocol is more
effective than conventional treatment protocol subjects
with bells palsy. Although both Group B taping
protocol & conventional treatment protocol were
effective for retraining but subjects in group b showed
better recovery than Group A in term of facial
symmetry & ability to perform functional activities
such as chewing, balloon blowing & speech. But taping
protocol being more effective , sequential & systematic
show better results. Also the intricacy of the movement
that can be achieved by the facial muscles should
preclude the use of maximum effort, gross exercises
where motor units other than those targeted are
recruited due to overflow. Basically taping help to
retrain paralyzed facial muscle maintaining symmetry
& facilitating the paralyzed muscle thereby preventing
over activity of normal muscle and act as a normal
mechanism by promoting the desired symmetrical
movement pattern that need to be repetitively
reinforced before it will be learned.
Conflict of Interest: No conflict of study is reported
for this study.
Source of Funding: No source of funding is reported
for this study
Ethical Clearance: Approved had been taken.
REFERENCES
1.

Comparison results of Group 1 and Group 2


2.

3.

4.

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102

Kanazawa A, Haginomori S, Takamaki A, et al.


Prognosis for Bells palsy: A comparison of
diabetic and nondiabetic patients. Acta
Otolaryngol. 2007;127(8):888-891
Batra V and Batra M, (2007) To Study and
compare the efficacy of taping protocol /
technique over conventional treatment protocol
in Bells Palsy .2007;39(2):35-40
Ahmed A. When is facial paralysis Bell palsy?
Current diagnosis and treatment. Cleve Clin J
Med. 2005;72(5):398-401, 405.
Schonbeck, joan 2006,Gale Encyclopedia of
children health: Infancy through adolescence.

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Indian Journal of Physiotherapy & Occupational Therapy. July-September 2013, Vol. 7, No. 3 103

5.

6.

Cederwall E, Olsen MF, Hanner P, Fogdestam I


Department of Physiotherapy, Skene lasarett,
Skene, Sweden (2006); Evaluationof a
physiotherapeutic treatment intervention in
Bells facial palsy.Physiotherapy Theory Pract.
Jan 22(1): 43-52.
Dalla Toffola, Bossi D, BuonocoreM, Montomli
C, Petrucci L, AlfonsiE (2005); Usefulness of BFB/

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103

7.

EMG in facial palsy rehabilitation, Disabil


Rehabil. Jul 22; 27(14): 809-15.
Ross B, Nedzelski JM, McLean JA (1991): Efficacy
of feedback training in long- standing facial nerve
paresis. Laryngoscope 101:744-750.

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