Department of Rehabilitation Medicine, Hallym University College of Medicine, Dong-tan Sacred Heart Hospital, Hwaseong-si, Korea.
Department of Otorhinolaryngology, Hallym University College of Medicine, Dong-tan Sacred Heart Hospital, Hwaseong-si, Korea.
Clin Rehabil. 2023 Nov;37(11):1510-1520. doi: 10.1177/02692155231166216. Epub 2023 Mar 27.
To explore whether early physical interventions, including neuromuscular retraining therapy, can minimize excessive movement or any unwanted co-contraction after a severe Bell's palsy.
From March 2021 to August 2022, the therapist treated Bell's palsy patients for the acute (<3 months, Group A), subacute (3-6 months, Group B) and chronic (> 6 months, Group C) stages of the condition.
We explored whether early physical interventions, including neuromuscular retraining therapy, can minimize facial synkinesis after a severe episode of Bell's palsy. Each patient was informed about the potential for synkinesis and the therapist explained that the main purpose of neuromuscular retraining therapy is to learn new patterns to minimize synkinesis. The facial function of Group A was compared to that of Groups B and C using the 'Synkinesis' scale of the Sunnybrook Facial Grading System.
The final facial function score after neuromuscular retraining therapy was significantly associated with both the initial electroneuronographic degeneration rate and initial facial function. Early therapy did not prevent synkinetic movement in 84.7% of the patients. But, there was a significant difference between patients who started early neuromuscular retraining therapy and other groups in final facial function.
Synkinesis in Bell's palsy patients can be minimized if physiotherapy commences before synkinesis develops; appropriate neuromuscular retraining therapy timing is essential. A patient with sudden severe Bell's palsy should receive oral steroids as soon as possible, along with physical therapy (including neuromuscular retraining therapy) within 3 months, to minimize synkinesis just before synkinesis onset.
探索早期物理干预措施，包括神经肌肉再训练疗法，是否可以最小化严重贝尔面瘫后的过度运动或任何不期望的协同收缩。
从 2021 年 3 月至 2022 年 8 月，治疗师治疗贝尔面瘫患者的急性（<3 个月，A 组）、亚急性（3-6 个月，B 组）和慢性（>6 个月，C 组）阶段的疾病。
我们探讨了早期物理干预措施，包括神经肌肉再训练疗法，是否可以最小化严重贝尔面瘫后面部运动障碍。每位患者都被告知可能出现面肌痉挛，并告知治疗师神经肌肉再训练疗法的主要目的是学习新的模式以最小化面肌痉挛。使用 Sunnybrook 面部分级系统的“面肌痉挛”量表比较 A 组患者的面部功能与 B 组和 C 组患者的面部功能。
神经肌肉再训练疗法后的最终面部功能评分与初始电神经电图变性率和初始面部功能显著相关。早期治疗并不能预防 84.7%的患者出现协同运动。但是，在开始早期神经肌肉再训练疗法的患者与其他组之间，最终面部功能存在显著差异。
如果在面肌痉挛发展之前开始物理治疗，可以最小化贝尔面瘫患者的面肌痉挛；适当的神经肌肉再训练疗法时机至关重要。患有突发性严重贝尔面瘫的患者应尽快接受口服类固醇治疗，并在 3 个月内进行物理治疗（包括神经肌肉再训练疗法），以在面肌痉挛发作前最小化面肌痉挛。
