The Mirror Effect Plus Protocol for acute Bell’s palsy: a randomised and longitudinal study on facial rehabilitation

Abstract

Background

Small but interesting evidences suggest that facial rehabilitation for acute Bell Palsy (BP) could improve facial outcomes in patients who benefited from optimal medication, but whose symptoms are still severe two weeks after BP’s onset.

Aims

This study aimed to provide preliminary evidence of the long-term effects of a new facial retraining based on motor imagery and mirror therapy, the Mirror Effect Plus Protocol (MEPP).

Material and methods

Twenty BP patients received the standard medication for acute BP and were then randomly allocated to the treatment (MEPP) or control group, if their palsy was still at least moderate-to-severe at 14 days post onset. Three blind independent assessors graded the patients’ evolution until 6 months after onset.

Results

Significant differences between the groups were not found for any measured variable; however, a trend toward better recovery was found in the treatment group for every measured variable. This trend grew bigger for patients with severe or total BP.

Conclusions

This study suggests a promising effect of the MEPP on acute severe to total BP but requires further investigation with a larger number of participants.

Significance

Facial rehabilitation should be considered as an adjunct to medication for acute and most severe degrees of BP.

Chinese abstract

背景：少量但有趣的证据表明, 对于受益于最佳药物治疗但在BP发病两周后症状仍很严重的患者, 急性贝尔麻痹（BP）的面部康复可以改善面部效果。

目的：本研究旨在为一种新的面部再训练的长期影响提供初步证据。这种面部再训练以运动图像和镜像疗法为基础, 称为镜像效果增强协定（MEPP）。

材料和方法：20名BP患者接受了急性BP标准药物治疗。如果他们的麻痹症在发病后14天仍至少为中度至重度, 则将其随机分配至治疗组（MEPP）或对照组。由三位盲人独立评估者对患者的进展进行分级, 直到发病后6个月。

结果：对于任何测量变数, 两组之间均未发现显著差异。但是, 在治疗组中, 对于每个测量变数, 都发现有恢复较好的趋势。对于具有严重或完全BP的患者, 这种趋势变得更大。

结论：这项研究表明MEPP对急性重度至完全BP有效应, 但需要对更多的参与者进行进一步调查。

意义：面部康复应被视为急性和最严重的BP的药物治疗的辅助手段。

Keywords:

• Bell Palsy
• facial nerve paralysis
• rehabilitation
• mirror effect

Acknowledgements

The authors thank Khawla Karra, Laurence Gascon, and Nadim T. Saddy and those who participated in this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by a REPAR-OOAQ grant to S.M., A.R., and K.M. S.M. holds a doctoral training scholarship and K.M. holds a research scholar (Junior 1) both from the ‘Fonds de Recherche du Québec – Santé’.