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Physical Therapy for Facial Paralysis: A Tailored Treatment Approach

JS Brach, PT, GCS, is Clinical Assistant Professor, Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260 (USA) (jsbst6+{at}pitt.edu), and Doctoral Student, Department of Epidemiology, University of Pittsburgh. She was Staff Physical Therapist, Facial Nerve Center, CORE Network, LLC, Pittsburgh, Pa, at the time of this study. Address all correspondence to Ms Brach
JM VanSwearingen, PhD, PT, is Assistant Professor, Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, and Director of Rehabilitation, Facial Nerve Center, CORE Network, LLC

Background and Purpose. Bell palsy is an acute facial paralysis of unknown etiology. Although recovery from Bell palsy is expected without intervention, clinical experience suggests that recovery is often incomplete. This case report describes a classification system used to guide treatment and to monitor recovery of an individual with facial paralysis. Case Description. The patient was a 71-year-old woman with complete left facial paralysis secondary to Bell palsy. Signs and symptoms were assessed using a standardized measure of facial impairment (Facial Grading System [FGS]) and questions regarding functional limitations. A treatment-based category was assigned based on signs and symptoms. Rehabilitation involved muscle re-education exercises tailored to the treatment-based category. Outcomes. In 14 physical therapy sessions over 13 months, the patient had improved facial impairments (initial FGS score=17/100, final FGS score=68/100) and no reported functional limitations. Discussion. Recovery from Bell palsy can be a complicated and lengthy process. The use of a classification system may help simplify the rehabilitation process.

Key Words: Bell palsy • Classification system • Facial neuromuscular re-education • Facial paralysis

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Todd Henkelmann, Jessie M VanSwearingen, and Jennifer S Brach
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