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The Efficacy of Mirror Therapy in Facial Palsy Among Subjects with Facial Paralysis

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The Efficacy of Mirror Therapy in Facial Palsy Among Subjects with Facial Paralysis International Journal of Research and Scientific Innovation (IJRSI) | Volume VI, Issue IX, September 2019 | ISSN 2321–2705 The Efficacy of Mirror Therapy in Facial Palsy among Subjects with Facial Paralysis K. Bharathi1, Ramya.S2, Prof. D. Malarvizhi3 1B.P.T., MIAP, Senior Physiotherapist, SRM Institute of Science and Technology, Kattankulathur, Chennai, Tamil Nadu, India 2Student, SRM Institute of Science and Technology, Kattankulathur, Chennai, Tamil Nadu, India 3Dean, SRM Institute of Science and Technology, Kattankulathur, Chennai, Tamil Nadu, India I. INTRODUCTION components receive motor input from both hemispheres of the cerebral cortex (bilaterally), whereas the anterior components The seventh cranial nerve has the nucleus over pons. It exits receive strictly contralateral input. This means that the the skull through Stylomastoid foramen and passes through temporal branch of the facial nerve receives motor input from parotid gland and gives five branches, they are Temporal, both hemispheres of the cerebral cortex whereas the Zygomatic, Buccal, Mandibular and Cervical. The facial zygomatic, buccal, mandibular and cervical branches receive motor nucleus has dorsal and ventral divisions that contain information from only contralateral hemispheres .Now, lower motor neurons supplying the muscles of the upper and because the anterior facial motor nucleus receives only lower face. The dorsal division receives bilateral upper motor contralateral cortical input whereas the posterior receives that neuron input while the ventral division receives only which is bilateral, a corticobulbar lesion (UMN lesion) 1 contralateral input .Lesions over Corticobulbar tract and the occurring in the left hemisphere would eliminate motor input nucleus reduce or inhibit or stop the input to ventral division, to the right anterior facial motor nucleus component, thus but dorsal division input is maintained or not affected. So the removing signalling to the inferior four facial nerve branches, facial palsy is found with hemiparesis of the contralateral thereby paralyzing the right mid- and lower-face. The facial muscles. Facial palsy comprises of peripheral and posterior component, however, although now only receiving central facial palsy. Peripheral facial palsy affects superior input from the right hemisphere, is still able to allow the and inferior region of face. The main cause of peripheral temporal branch to sufficiently innervate the entire forehead. facial palsy is Bell’s palsy in which the cause remains This means that the forehead will not be paralyzed. The same unknown whereas the central facial palsy only affects the mechanism applies for an upper motor neuron lesion in the inferior area of the face1.Facial palsy is the weakness of right hemisphere. The left anterior facial motor nucleus 1 component no longer receives cortical motor input due to its musculature in the facial region with loss of sensation . The strict contralateral innervation, whereas the posterior facial muscles become weak and droop and it’s drawn across component is still sufficiently supplied by the left hemisphere. the opposite side of the face2. In partial facial palsy The result is paralysis of the left mid- and lower- face with an conditions, the lower part of the face is more affected. In unaffected forehead. The facial nerve is essential for severe facial palsy conditions the taste is affected over the communication and expression, and impairment of its function can severely disabling as speech, mastication and anterior 2/3rd of tongue. It may cause mild dysarthria and expression are heavily depend on these muscles that is difficulty in eating. The muscles of forehead escapes the controlled by the facial nerve. The facial palsy can affect the lesion and remains unaffected as uncrossed areas from the social wellbeing of the individual that demands treatment of ipsilateral and the supranuclear areas, movements in the facial nerve paralysis as a vital concern Electrical stimulation frontalis and upper orbicularis oculi are often spared in such is the use of electrical current to stimulate the paralysed type of lesion. Also, many patients voluntary muscle control muscle and facilitate the muscle contraction. Electrical of the face is lost but the muscles for spontaneous emotional stimulation therapy is mostly used in clinical settings to expressions remain unaffected.The causes for Upper Motor rehabilitate the muscles and facilitate the motor activity of the Neuron facial palsy is mostly due to stroke, tumors, Any muscle. Electrical stimulation has a two type of currents such lesion occurring within or affecting the corticobulbar tract . as galvanic and faradic type of current. The galvanic current is Lower motor neuron lesion involves lesion in branches. used to stimulate the individual muscles and the faradic Branches of the facial nerve leaving the facial motor nucleus 6, 7, 8 (FMN) for the muscles do so via both left and right posterior current used to stimulate the nerve trunks . Electrical (dorsal) and anterior (ventral) routes. The temporal branch stimulation helps in the recovery of the weak or paralysed travels out from the left and right posterior components. The facial muscles in facial palsy. Electrical stimulation promote inferior four branches do so via the left and right anterior regeneration and demyelination of injured facial nerve. It is components. The left and right branches supply their effective in functional recovery of facial expression muscles respective sides of the face. Accordingly, the posterior in facial nerve and facial symmetry. The mirror therapy was www.rsisinternational.org Page 9 International Journal of Research and Scientific Innovation (IJRSI) | Volume VI, Issue IX, September 2019 | ISSN 2321–2705 invented by vilayanur S. Ramachandran. Mirror therapy Centre, SRM Institute of science and technology, works on the principle of mirror neuron system and visual Kattankulathur feedback. Mirror therapy consist of a mirror box in which a INCLUSION CRITERIA mirror is attached to one side and the patient is asked to keep their affected limb inside the box and perform the movement Subjects with Upper Motor Neuron lesion Age group – 21to with the unaffected limb. This process gives visual feedback 50 years to the patient that the movement is occurred in affected limb. Gender - Both male and female It’s reduces the phantom limb pain, in which the patient still have pain in the limb even after having amputated.4,5.Neural Mini Mental status examination score >25 Subjects willing to Plasticity is considered to a main mechanism of Mirror participate Therapy in stroke patients, and it is generally considered to be EXCLUSION CRITERIA mediated by Mirror induced illusion. In 2012 cochrane review found that positive effects of Mirror therapy on motor Subjects with Lower Motor Neuron lesion Oral cancer function and activities of daily living. Facial exercises are Tempero mandibular joint fracture Recent tooth implantation proved to be for facial muscle activity, lip and tongue dysfunction. Facial exercises are done to restore the function Recent Head injury of the facial muscles. These include specific action exercises. PROCEDURE Then the patient is made to do active exercises in front of the mirror which prevents muscle atrophy and enhance muscle The subjects were selected based on the inclusion and function. Facial disability index questionnaire is used to exclusion criteria. Informed consent form was clearly measure the facial impairment and disability after facial explained to the subjects and it was obtained from the paralysis. These statements are subsequently grouped into 6 subjects. independent domains. A score is calculated from 0 (Worst) to The subjects are divided into two groups Group A and Group 100 (Best) by using a specific formula. The facial disability B. index (FDI) has been validated formally with respect to its ability to accurately and reliably measure these aspects of The facial disability index (FDI) questionnaire is given to the subjects and the questionnaire was filled by the subjects and facial paralysis9, 10. was used to assess the severity of the condition. Aim of the Study GROUPA The aim of the study was to evaluate the effect of mirror Group A subjects received electrical stimulation with galvanic therapy in facial palsy. current given for muscles and faradic current given for nerve Need for the Study trunks with duration of 15 to 20 minutes. Facial palsy is the condition affecting the motor functions of The electrical stimulation is given daily for 2 weeks. The the facial region. Orofacial exercises are generally used to facial palsy exercises are taught to the patient and they rehabilitate facial paresis in Upper Motor Nerve lesion, but followed the exercises daily for two weeks. After 2 weeks of few studies had proven the effectiveness, Moreover no other duration the post-test assessment was taken. effective therapies have yet been established and to our GROUP B knowledge no studies are available in mirror therapy in facial palsy in Upper Motor Nerve lesions to improve the motor Group B subjects received electrical stimulation in galvanic activity and to find out the better Protocol for facial palsy. current given for muscles and faradic current given for nerve Therefore this study will add growing body of knowledge that trunks with duration of 15 to 20 minutes. this techniques yield outcomes which should be ideal choice The electrical stimulation is given daily for 2 weeks. The for treatment in facial palsy.
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