PARALISIA FACIAL ARTIGO

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<p>Full Terms & Conditions of access and use can be found at</p><p>http://www.tandfonline.com/action/journalInformation?journalCode=yptr20</p><p>Download by: [Australian Catholic University] Date: 20 September 2017, At: 00:02</p><p>Physical Therapy Reviews</p><p>ISSN: 1083-3196 (Print) 1743-288X (Online) Journal homepage: http://www.tandfonline.com/loi/yptr20</p><p>Effectiveness of electrical stimulation for</p><p>rehabilitation of facial nerve paralysis</p><p>Katie A Fargher & Susan E Coulson</p><p>To cite this article: Katie A Fargher & Susan E Coulson (2017): Effectiveness of electrical</p><p>stimulation for rehabilitation of facial nerve paralysis, Physical Therapy Reviews, DOI:</p><p>10.1080/10833196.2017.1368967</p><p>To link to this article: http://dx.doi.org/10.1080/10833196.2017.1368967</p><p>Published online: 31 Aug 2017.</p><p>Submit your article to this journal</p><p>Article views: 12</p><p>View related articles</p><p>View Crossmark data</p><p>1DOI 10.1080/10833196.2017.1368967 Physical Therapy Reviews 2017</p><p>© 2017 Informa UK Limited, trading as Taylor & Francis Group</p><p>Effectiveness of electrical stimulation for</p><p>rehabilitation of facial nerve paralysis</p><p>Katie A Fargher, Susan E Coulson</p><p>Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, Sydney, Australia</p><p>Background: Despite no significant advantage being demonstrated for its use and no standardization of treatment</p><p>guidelines, electrical stimulation is still applied by therapists to treat facial paralysis. The aim of this investigation</p><p>was to determine whether electrical stimulation therapy for patients with acute or chronic facial nerve paralysis</p><p>improves time to, and rates of full recovery and facial function compared with no intervention.</p><p>Method: A systematic review of randomized and quasi-randomized controlled trials through Scopus, Medline,</p><p>PEDro, Embase, CINAHL, Pubmed, and Cochrane Library search engines for studies published up until August</p><p>2016. Reference lists were reviewed for further studies. Review Manager was used to extract data and review</p><p>quality of the studies. Studies were assessed for randomization of participants, allocation concealment, blinding</p><p>of participants, assessors and physiotherapists, presence and reporting of outcome data.</p><p>Results: Five studies were included for analysis – four during acute recovery and one in chronic facial nerve</p><p>paralysis. In acute facial nerve paralysis, two studies found no benefit of electrical stimulation and two studies</p><p>found improvement. A meta-analysis on changes in the House–Brackmann Score after treatment, rates of full</p><p>recovery and time to full recovery showed no statistically significant difference between intervention and control</p><p>groups. In chronic facial nerve paralysis, one study found improvements after extensive electrical stimulation on</p><p>the Facial Paralysis Recovery Profile.</p><p>Conclusions: There is no evidence to support the use of electrical stimulation during the acute phase of recovery</p><p>after Bell’s palsy and there is low-level evidence for patients with chronic symptoms. Furthermore, there is no</p><p>evidence available on the use of electrical stimulation for other causes of facial nerve paralysis.</p><p>Keywords: Bell palsy, Facial nerve, Electrical stimulation therapy, Facial paralysis, Physiotherapy, Rehabilitation</p><p>Introduction</p><p>Facial nerve paralysis (FNP) affects social interaction,</p><p>communication, and self-esteem, leading to long-lasting</p><p>negative impacts on daily life.1 Idiopathic Bell’s palsy</p><p>accounts for 75% of all cases, with trauma and Herpes</p><p>Zoster Oticus the next most common causes.2,3 There is a</p><p>variable degree of recovery after FNP without intervention</p><p>and this is dependent on the severity, cause, and location</p><p>of the nerve damage.4 With neuropraxia, or partial degen-</p><p>eration of the nerve, clinically observable facial move-</p><p>ment usually begins within a few weeks.4 When complete</p><p>degeneration of the nerve occurs, as with axonotmesis or</p><p>neurotmesis, movement only begins after the nerve regen-</p><p>erates.2,5 The nerve grows at a rate of 0.5 to 3 mm per day6</p><p>and reinnervation may be disordered due to scar tissue</p><p>and disruption of nerve fibers.5 Regeneration can lead to</p><p>altered patterns of muscle contraction, salivation, and tear-</p><p>ing (motor and autonomic synkinesis).7 Earlier recovery of</p><p>function indicates a milder injury with better prognosis.2</p><p>All patients with Bell’s palsy experience some recovery,</p><p>with 71% achieving full recovery. Outcomes after surgery</p><p>and trauma vary depending upon the site and severity of</p><p>the injury.</p><p>Along with pharmacology8 and surgery, physiotherapy</p><p>is undertaken after FNP to improve function. Patients are</p><p>referred to physiotherapists during acute and chronic</p><p>phases of recovery. Electrical stimulation has been used</p><p>since the 1950s with the goal of improving facial function</p><p>and minimizing sequelae.9 The aim of electrical stimula-</p><p>tion is to encourage nerve regeneration,10 and to main-</p><p>tain muscle bulk and contractile properties.10–12 In animal</p><p>studies, the quality of the muscle reinnervation is also</p><p>examined on a cellular level, with electrical stimulation</p><p>aiming to minimize polyinnervation, collateral branching,</p><p>interstitial fibrosis,13 Wallerian degeneration and demyeli-</p><p>nation.14 The types of electrical stimulation that have been</p><p>used by therapists include galvanic,9 eutrophic,15 mono-</p><p>phasic,11 biphasic,12 subthreshold,13 and contraction level.11</p><p>A systematic review in 200316 concluded that using</p><p>electrical stimulation was beneficial, however it included</p><p>case studies and case series which do not control for nat-</p><p>ural recovery. A Cochrane Review in 201117 addressed</p><p>multiple physiotherapy modalities for acute Bell’s palsy</p><p>and concluded no benefits of electrical stimulation at</p><p>Correspondence to: Susan E Coulson, Discipline of Physiotherapy Faculty</p><p>of Health Sciences, University of Sydney, Sydney, Australia. Email: susan.</p><p>coulson@sydney.edu.au</p><p>D</p><p>ow</p><p>nl</p><p>oa</p><p>de</p><p>d</p><p>by</p><p>[</p><p>A</p><p>us</p><p>tr</p><p>al</p><p>ia</p><p>n</p><p>C</p><p>at</p><p>ho</p><p>lic</p><p>U</p><p>ni</p><p>ve</p><p>rs</p><p>ity</p><p>]</p><p>at</p><p>0</p><p>0:</p><p>02</p><p>2</p><p>0</p><p>Se</p><p>pt</p><p>em</p><p>be</p><p>r</p><p>20</p><p>17</p><p>Fargher and Coulson A systematic review and meta-analysis of the literature</p><p>Physical Therapy Reviews 20172</p><p>6 months post onset. This review aims to address the</p><p>question ‘Does electrical stimulation therapy for patients</p><p>with acute or chronic FNP improve time to full recovery,</p><p>rates of full recovery and facial function compared to no</p><p>intervention?’.</p><p>Method</p><p>Identification and selection of studies</p><p>Literature searches were completed on Scopus, Medline,</p><p>PEDro, Embase, CINAHL, Pubmed, and Cochrane Library</p><p>search engines. Search terms used were ‘facial nerve’,</p><p>‘facial paralysis’, ‘facial palsy’, ‘Bell$ palsy’, ‘electrical</p><p>stimulation’, ‘electrotherapy’, ‘physical therapy’, ‘physi-</p><p>otherapy’, and ‘rehab*’. Reference lists of retrieved arti-</p><p>cles were also reviewed for further relevant studies. All</p><p>searches were completed between 26 May 2015 and 19</p><p>August 2016 by KF. Screening of titles and abstracts for</p><p>inclusion was completed by KF and SC. Disagreement</p><p>was resolved by discussion.</p><p>Wide inclusion criteria were necessary to draw con-</p><p>clusions relevant to variable etiologies and different</p><p>phases of rehabilitation (Figure 1). Only human studies</p><p>were included. Electrical stimulation delivered through</p><p>acupuncture needles was excluded. Randomized control</p><p>trials and quasi-randomized control trials were included</p><p>for analysis. Articles were excluded if electrical stimu-</p><p>lation was combined with another intervention that the</p><p>comparison group did not receive. Only published work</p><p>available in English through the document search were</p><p>used. Studies were excluded if they did not meet one of</p><p>the inclusion criteria.</p><p>Assessment of study characteristics and data</p><p>analysis</p><p>Variables sought from the studies are listed in Table 1. The</p><p>information was extracted by KF and reviewed by SC. The</p><p>risk of bias analysis was completed in Review Manager</p><p>(RevMan version 5.3; Copenhagen, Denmark: The Nordic</p><p>Cochrane Centre, The Cochrane Collaboration, 2014)18</p><p>and addressed randomization of participants,</p><p>allocation</p><p>concealment, blinding of participants, assessors and phys-</p><p>iotherapists, presence and reporting of outcome data. The</p><p>summary is presented in Figure 2. The PRISM-A state-</p><p>ment was followed during data extraction.19 Data analysis</p><p>was completed in Review Manager (RevMan version 5.3;</p><p>Copenhagen, Denmark: The Nordic Cochrane Centre, The</p><p>Cochrane Collaboration, 2014)18 using mean difference</p><p>and odds ratios with 95% confidence intervals. Kim and</p><p>Choi10 were the only paper to include a standard deviation</p><p>in their pre-treatment data. As it was calculated from a</p><p>large population (n = 60), it was the best estimate availa-</p><p>ble and was used across the studies to allow the pooling</p><p>of data.</p><p>Results</p><p>Included studies</p><p>Twenty-one papers were reviewed. Eight studies were</p><p>excluded for being case series20–27, two for a lack of rand-</p><p>omization28,29 and one for comparing ES to an alternative</p><p>therapy with no control group.30 Four reviews16,31–33 and</p><p>one retrospective chart review3 were also excluded. Five</p><p>studies were found to meet final criteria – four in acute</p><p>phase of recovery and one in chronic phase (Figure 3).</p><p>Characteristics of studies</p><p>Two randomized9,11 and two quasi-randomized controlled</p><p>trials10,12 applied electrical stimulation during acute phases</p><p>of recovery and one quasi-randomized controlled trial15 in</p><p>chronic phase. The dominant etiology was Bell’s palsy.</p><p>Full details of included studies are in Table 2. The quality</p><p>of each study was assessed using individual domains of</p><p>selection, performance, detection, attrition, and reporting</p><p>bias. A lack of blinding of the participants impacted on all</p><p>study outcomes. This would likely bias participants in their</p><p>compliance with therapy and home programs, as they are</p><p>aware that they are in the active therapy group. Conclusions</p><p>of some studies were considered with respect to low partic-</p><p>ipant numbers in treatment and control groups. No study</p><p>used intention-to-treat analysis. The risk of selection bias</p><p>was high in three studies,10,12,15 unclear in one,9 and low</p><p>in one.11 The impact of selection bias in unclear. Results</p><p>may have been affected by participants being preferen-</p><p>tially allocated to treatment or control groups depending</p><p>on their prognosis. Blinding of assessors was only clearly</p><p>stated in one study.11 This places the other studies at high</p><p>risk of bias toward the predispositions of the researchers.</p><p>Electrical stimulation parameters</p><p>In the acute studies, three used similar therapy parameters</p><p>to maintain muscle properties (Table 2).9,11,12 The program</p><p>started between two- and four-week post injury and was</p><p>administered by a therapist. Minimal muscle contractions</p><p>were used during sessions. The frequency of treatment var-</p><p>ied from 1 day per week12 to 5 days per week.11 Electrical</p><p>stimulation was continued for a variable length of time</p><p>from 3 weeks11 to 3 months.12</p><p>Kim and Choi10 used electrical parameters that were</p><p>different to the other studies. Stimulation was at a Figure 1 Inclusion criteria.</p><p>D</p><p>ow</p><p>nl</p><p>oa</p><p>de</p><p>d</p><p>by</p><p>[</p><p>A</p><p>us</p><p>tr</p><p>al</p><p>ia</p><p>n</p><p>C</p><p>at</p><p>ho</p><p>lic</p><p>U</p><p>ni</p><p>ve</p><p>rs</p><p>ity</p><p>]</p><p>at</p><p>0</p><p>0:</p><p>02</p><p>2</p><p>0</p><p>Se</p><p>pt</p><p>em</p><p>be</p><p>r</p><p>20</p><p>17</p><p>Fargher and Coulson A systematic review and meta-analysis of the literature</p><p>Physical Therapy Reviews 2017 3</p><p>subthreshold level, and applied continuously for the first</p><p>2 months of recovery to limit Wallerian degeneration of</p><p>the nerve. The electrodes were placed near the mastoid</p><p>process instead of the muscles and the equipment was</p><p>applied by the participant.</p><p>Like the majority of the acute studies, participants in the</p><p>chronic stages were instructed to use electrical stimulation</p><p>at the muscle contraction threshold with the aim being to</p><p>maintain muscles and encourage return of structure and</p><p>function.15 The intervention was used for much longer</p><p>durations in the chronic population (see Table 2).</p><p>Outcome measures</p><p>The outcomes considered were the length of time to full</p><p>recovery, rates of full recovery, improvements in facial</p><p>function, and rates of complications. The outcomes used in</p><p>the studies included the House–Brackmann Facial Nerve</p><p>Grading System, the Facial Paralysis Recovery Profile</p><p>(FPRP), the Facial Paralysis Recovery Index (FPRI),</p><p>Facial Disability Index, and Sunnybrook Facial Grading</p><p>System. Video-based motion analysis and various point</p><p>rating systems to grade motion were also used.</p><p>Length of time to full recovery</p><p>In Mosforth and Taverner’s study,9 participants were</p><p>divided into two subgroups: those with and without</p><p>nerve degeneration as assessed by EMG data. They</p><p>reported no difference in the length of time to full recov-</p><p>ery between groups for participants without denerva-</p><p>tion (treatment group mean 43 days, range 14–90 days;</p><p>control group mean 39 days, range 14–134 days). For</p><p>participants with denervation, time to initial movement</p><p>return in the intervention group was 53 days (range</p><p>10–104 days) compared with 66 days (14–90 days) in</p><p>the control group. The inclusion of infrared radiation as</p><p>part of the intervention protocol, however, confounds</p><p>this study’s findings.</p><p>Kim and Choi10 included only participants with</p><p>less severe forms of Bell’s palsy (House–Brackmann</p><p>score</p><p>e-</p><p>S</p><p>ne</p><p>at</p><p>h</p><p>G</p><p>ro</p><p>up</p><p>s:</p><p>c</p><p>on</p><p>tr</p><p>ol</p><p>a</p><p>nd</p><p>e</p><p>le</p><p>ct</p><p>ric</p><p>al</p><p>s</p><p>tim</p><p>ul</p><p>at</p><p>io</p><p>n.</p><p>S</p><p>es</p><p>si</p><p>on</p><p>s:</p><p>3</p><p>s</p><p>et</p><p>s</p><p>of</p><p>3</p><p>0</p><p>co</p><p>nt</p><p>ra</p><p>ct</p><p>io</p><p>ns</p><p>B</p><p>ot</p><p>h</p><p>gr</p><p>ou</p><p>ps</p><p>: s</p><p>el</p><p>f-</p><p>m</p><p>as</p><p>sa</p><p>ge</p><p>d</p><p>ai</p><p>ly.</p><p>S</p><p>es</p><p>si</p><p>on</p><p>s</p><p>pe</p><p>r</p><p>w</p><p>ee</p><p>k:</p><p>3</p><p>Th</p><p>re</p><p>sh</p><p>ol</p><p>d:</p><p>m</p><p>in</p><p>im</p><p>al</p><p>c</p><p>on</p><p>tr</p><p>ac</p><p>tio</p><p>n</p><p>Le</p><p>ng</p><p>th</p><p>o</p><p>f i</p><p>nt</p><p>er</p><p>ve</p><p>nt</p><p>io</p><p>n:</p><p>v</p><p>ar</p><p>ia</p><p>bl</p><p>e,</p><p>u</p><p>p</p><p>to</p><p>1</p><p>ye</p><p>ar</p><p>.</p><p>K</p><p>im</p><p>a</p><p>nd</p><p>C</p><p>ho</p><p>i (</p><p>20</p><p>16</p><p>)</p><p>Ye</p><p>s</p><p>D</p><p>ia</p><p>gn</p><p>os</p><p>is</p><p>: B</p><p>el</p><p>ls</p><p>p</p><p>al</p><p>sy</p><p>; n</p><p>=</p><p>6</p><p>0;</p><p>H</p><p>ou</p><p>se</p><p>–B</p><p>ra</p><p>ck</p><p>m</p><p>an</p><p>n</p><p>G</p><p>ra</p><p>de</p><p>le</p><p>ss</p><p>th</p><p>an</p><p>IV</p><p>A</p><p>dm</p><p>in</p><p>is</p><p>tr</p><p>at</p><p>io</p><p>n:</p><p>s</p><p>el</p><p>f</p><p>D</p><p>ur</p><p>at</p><p>io</p><p>n:</p><p>1</p><p>0</p><p>m</p><p>s</p><p>Fr</p><p>eq</p><p>ue</p><p>nc</p><p>y:</p><p>2</p><p>0</p><p>H</p><p>z</p><p>Lo</p><p>ca</p><p>tio</p><p>n:</p><p>c</p><p>at</p><p>ho</p><p>de</p><p>o</p><p>n</p><p>m</p><p>ai</p><p>n</p><p>br</p><p>an</p><p>ch</p><p>es</p><p>o</p><p>f</p><p>fa</p><p>ci</p><p>al</p><p>n</p><p>er</p><p>ve</p><p>, a</p><p>no</p><p>de</p><p>o</p><p>n</p><p>m</p><p>as</p><p>to</p><p>id</p><p>p</p><p>ro</p><p>ce</p><p>ss</p><p>.</p><p>Vo</p><p>lta</p><p>ge</p><p>: 2</p><p>0</p><p>M</p><p>V</p><p>–1</p><p>0</p><p>V</p><p>Le</p><p>ng</p><p>th</p><p>o</p><p>f i</p><p>nj</p><p>ur</p><p>y:</p><p>rank). Using</p><p>the House–Brackmann scale, Kim and Choi10 reported</p><p>a significantly higher change in facial function in the</p><p>intervention group compared to control group at all data</p><p>collection visits except for 4, 10, and 12 weeks post</p><p>symptom onset. The Sunnybrook Facial Nerve Grading</p><p>System scores were not significantly different between</p><p>Figure 4 Forest plot of length of time to full recovery.</p><p>Figure 5 Forest plot of rate of full recovery.</p><p>D</p><p>ow</p><p>nl</p><p>oa</p><p>de</p><p>d</p><p>by</p><p>[</p><p>A</p><p>us</p><p>tr</p><p>al</p><p>ia</p><p>n</p><p>C</p><p>at</p><p>ho</p><p>lic</p><p>U</p><p>ni</p><p>ve</p><p>rs</p><p>ity</p><p>]</p><p>at</p><p>0</p><p>0:</p><p>02</p><p>2</p><p>0</p><p>Se</p><p>pt</p><p>em</p><p>be</p><p>r</p><p>20</p><p>17</p><p>Fargher and Coulson A systematic review and meta-analysis of the literature</p><p>Physical Therapy Reviews 20176</p><p>recovery, however, there is variation in frequency of treat-</p><p>ment from one to five days per week.9,11,12 The other study</p><p>in the acute phase used continuous subthreshold stimula-</p><p>tion and placed the electrodes over the main branch of the</p><p>facial nerve rather than the muscles.10</p><p>Electrical stimulation does not alter the speed or rate</p><p>of full recovery, nor does it improve facial function in the</p><p>acute phase. In the chronic phase of recovery, there is low</p><p>quality evidence in one study 15 that extensive electrical</p><p>stimulation may have a positive impact on facial function.</p><p>Reasons for this may include extrapolation of study results</p><p>from other areas of the body to the facial region, giving</p><p>the impression of movement to the patient, and equip-</p><p>ment manufacture. There is no evidence that electrical</p><p>stimulation will result in full recovery when used with</p><p>chronic FNP.</p><p>There are potential negative outcomes from using</p><p>electrical stimulation. Complications after FNP such as</p><p>reinforcing synkinesis34 have been reported in the liter-</p><p>ature for human subjects. In studies examining facial</p><p>nerve regeneration in rats, no change in polyinnervation</p><p>or collateral branching was found with axonal projec-</p><p>tion disorganized in the electrical stimulation and sham</p><p>stimulation groups.13 Additionally, the number of motor</p><p>endplates in the facial muscles was reduced to 24% of</p><p>the value of the sham stimulation group,13 leading to</p><p>partial innervation instead of complete, which would</p><p>detrimentally impact on return of facial function. Animal</p><p>studies using electrical stimulation in other areas of the</p><p>body have also demonstrated a halt in growth cone</p><p>advancement,35 prevention of terminal sprouting,36,37</p><p>limiting growth of axons and terminal Schwann cells,38</p><p>and decreased reinnervation.39</p><p>This current metanalysis provides no clear evidence</p><p>of benefit to support patients spending time and money</p><p>on electrical stimulation following facial nerve paraly-</p><p>sis. There is, however, evidence of effective interventions</p><p>which are currently used following FNP such as mime</p><p>therapy,40 video self-modeling,41 and tailored facial exer-</p><p>cises.17 An animal model study has also demonstrated</p><p>support for manual stimulation in favor of electrical stim-</p><p>ulation for improving outcomes.42</p><p>Implications for clinicians</p><p>This review found no evidence to support the use of</p><p>electrical stimulation in the acute stages of Bell’s palsy</p><p>Complications</p><p>The rate of development of contracture after FNP was not</p><p>altered by the use of electrical stimulation.9 One study</p><p>reported contact dermatitis in four out of thirty participants</p><p>in the electrical stimulation group.10 ‘No indications of any</p><p>adverse response to the treatment’ was reported in one</p><p>study12 however overall there was not a comprehensive</p><p>and standardized reporting of complications.</p><p>Discussion</p><p>The main goal of this review is to examine the efficacy</p><p>of electrical stimulation on recovery after FNP. In the</p><p>acute phase of recovery, there are two randomized9,11 and</p><p>two quasi-randomized controlled trials.10,12 Alakram and</p><p>Puckree12 found no benefit in facial function with Tuncay11</p><p>presenting positive findings in the electrical stimulation</p><p>group. Kim and Choi10 found improvements in length of</p><p>time and rates of return to facial function by adding elec-</p><p>trical stimulation while Mosforth and Taverner9 reported</p><p>no difference. Three studies did not use true randomization</p><p>techniques instead using alternate enrollment,12 division</p><p>by specialist,10 or unclear list methods.9 There was also no</p><p>attempt to blind assessors in three studies placing them at</p><p>high risk of bias of the predisposition of the researchers,</p><p>likely in favor of active intervention.9,10,12 Tuncay et al.11</p><p>was the only study to include randomization for group</p><p>selection and blinding of assessors. The lack of blinding</p><p>of participants potentially biases the intervention group.</p><p>When the studies were combined for meta-analysis, there</p><p>was no statistically significant difference between treat-</p><p>ment and control groups for improvement in function,</p><p>time to full recovery and achievement of full recovery</p><p>(Figures 4–6).</p><p>The participants with chronic FNP in Farragher’s</p><p>study who were initially enrolled in the control group,</p><p>all received electrical stimulation when they crossed over</p><p>into the treatment group, therefore they could not be post-</p><p>tested to compare with the intervention group.15 As noted</p><p>by Tuncay et al., by losing the control group, it is difficult</p><p>to assess whether the positive impacts are due to electri-</p><p>cal stimulation or intensive attention from a therapist.11</p><p>Additionally, there was a greater than 50% decline in par-</p><p>ticipants reported in the results after 18 weeks.</p><p>The included studies used a variety of intervention</p><p>protocols (Table 2). Three studies used similar muscle</p><p>contraction electrical stimulation in the acute phase of</p><p>Figure 6 Forest plot of improvement in House–Brackmann Score.</p><p>D</p><p>ow</p><p>nl</p><p>oa</p><p>de</p><p>d</p><p>by</p><p>[</p><p>A</p><p>us</p><p>tr</p><p>al</p><p>ia</p><p>n</p><p>C</p><p>at</p><p>ho</p><p>lic</p><p>U</p><p>ni</p><p>ve</p><p>rs</p><p>ity</p><p>]</p><p>at</p><p>0</p><p>0:</p><p>02</p><p>2</p><p>0</p><p>Se</p><p>pt</p><p>em</p><p>be</p><p>r</p><p>20</p><p>17</p><p>Fargher and Coulson A systematic review and meta-analysis of the literature</p><p>Physical Therapy Reviews 2017 7</p><p>PubMed PMID: 111313094. Language: English. Entry Date: 20151207.</p><p>Revision Date: 20160428. PublicationType: Article. Journal Subset:</p><p>Allied Health</p><p>11 Tuncay F, Borman P, Taşer B, Ünlü I, Samim E. Role of electrical</p><p>stimulation added to conventional therapy in patients with idiopathic</p><p>facial (bell) palsy. Am J Phys Med Rehabil. 2015;222–8. doi:10.1097/</p><p>PHM.0000000000000171</p><p>12 Alakram P, Puckree T. Effects of electrical stimulation on house-</p><p>brackmann scores in early Bells palsy. Physiother Theory Pract.</p><p>2010;26(3):160–6. doi:10.3109/09593980902886339</p><p>13 Sinis N, Horn F, Genchev B, Skouras E, Merkel D, Angelova SK, et al.</p><p>Electrical stimulation of paralyzed vibrissal muscles reduces endplate</p><p>reinnervation and does not promote motor recovery after facial</p><p>nerve repair in rats. Ann AnaT. 2009;191(4):356–70. doi:10.1016/j.</p><p>aanat.2009.03.004</p><p>14 Kim J, Han SJ, Shin DH, Lee WS, Choi JY. Subthreshold continuous</p><p>electrical stimulation facilitates functional recovery of facial nerve</p><p>after crush injury in rabbit. Muscle Nerve. 2011;43(2):251–8.</p><p>doi:10.1002/mus.21840</p><p>15 Farragher D, Kidd G, Tallis R. Eutrophic electrical stimulation for</p><p>Bell’s palsy. Clin Rehabil. 1987;1:265–71.</p><p>16 Quinn R, Cramp F. The efficacy of electrotherapy for Bell’s palsy: a</p><p>systematic review. Phys Ther Rev. 2003;8:151–64.</p><p>17 Teixeira LJ, Valbuza JS, Prado GF. Physical therapy for Bell’s</p><p>palsy (idiopathic facial paralysis). Cochrane Database Syst Rev.</p><p>2011;12:CD006283. doi: 10.1002/14651858.CD006283.pub3</p><p>18 Review Manager (RevMan). 5.3 ed. Copenhagen: The Nordic</p><p>Cochrane Centre, the Cochrane Collaboration; 2014.</p><p>19 Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew</p><p>M, et al. Preferred reporting items for systematic review and meta-</p><p>analysis protocols (prisma-p) 2015: elaboration and explanation.</p><p>BMJ. 2015;349. doi:10.1136/bmj.g7647</p><p>20 Wilson CMR SL. Rehabilitation postfacial reanimation surgery after</p><p>removal of acoustic neuroma: a case study. J Neurol Phys Ther.</p><p>2010;34(1):41–9. doi:10.1097/NPT.0b013e3181cfc324</p><p>21 Shrode LW. Treatment of facial muscles affected by Bell’s palsy with</p><p>high-voltage electrical muscle stimulation. J Manipulative Physiol</p><p>Ther. 1993;16(5):347–52.</p><p>22 Weiss MH. Case report: successful treatment of Bell’s palsy. Dent</p><p>Surv. 1976;52(8):32–3.</p><p>23 Frach JP, Osterbauer PJ, Fuhr AW. Treatment of Bell’s palsy by</p><p>mechanical force, manually assisted chiropractic adjusting and high-</p><p>voltage electrotherapy. J Manipulative Physiol Ther. 1992;15(9):596–</p><p>8.</p><p>24 Targan RS, Alon G, Kay SL. Effect of long-term electrical stimulation</p><p>on motor recovery and improvement of clinical residuals in patients</p><p>with unresolved facial nerve palsy. Otolaryngol Head Neck Surg.</p><p>2000;122(2):246–52. PubMed PMID: 10652399.</p><p>25 Hyvarinen A, Tarkka IM, Mervaala E, Paakkonen A, Valtonen H,</p><p>Nuutinen J, et al. Cutaneous electrical stimulation treatment in</p><p>unresolved facial nerve paralysis: an exploratory study. Am J Phys</p><p>Med Rehabil. 2008;87(12):992–7. PubMed PMID: 18787496.</p><p>26 Gittins J, Martin K, Sheldrick J, Reddy A, Thean L. Electrical</p><p>stimulation as a therapeutic option to improve eyelid function</p><p>in chronic facial nerve disorders. Invest Ophthalmol Vis Sci.</p><p>1999;40(3):547–54. PubMed PMID: 10067956.</p><p>27 Paniora L. The treatment of Bell’s palsy using the Respond unit. New</p><p>Zealand J Physiother. 1994;22(3):30–2.</p><p>28 Guzelant AYS, AB, Saraçoğlu, GV, Can, I, ünal, A. Impact of</p><p>electrical stimulation on rehabilitation process in peripheral facial</p><p>paralysis. Acta Medica Mediterranea. 2014;30(6):1375–9.</p><p>29 Narin S, Barutçu A. Treatment of prolonged facial paralysis with</p><p>temporalis myoplasty and electrical stimulation. J Neurol Sci.</p><p>2012;28(4):513–9.</p><p>30 Manikandan N. Effect of facial neuromuscular re-education on facial</p><p>symmetry in patients with Bell’s palsy: a randomized controlled trial.</p><p>Clin Rehabil. 2007;21(4):338–43. doi:10.1177/0269215507070790</p><p>31 de Almeida JR, Guyatt GH, Sud S, Dorion J, Hill MD, Kolber MR,</p><p>et al. Management of Bell palsy: clinical practice guideline. CMAJ.</p><p>2014;186(12):917–22. doi:10.1503/cmaj.131801</p><p>32 Murray JAM. Ancilliary aids in the treatment of facial paralysis. Facial</p><p>Plast Surg. 1992;8(2):127–30.</p><p>33 Buttress S, Herren K. Electrical stimulation and Bell’s palsy. Emerg</p><p>Med J. 2002;19(5):428.</p><p>34 Diels HJ. Facial paralysis: is there a role for a therapist? Facial Plast</p><p>Surg. 2000;16(4):361–4. PubMed PMID: 11460303.</p><p>35 Cohan CS, Kater SB. Suppression of neurite elongation and growth</p><p>cone motility by electrical activity. Science. 1986;232(4758):1638–40.</p><p>as it has not been shown to improve either the rate of</p><p>recovery or the quality of facial function. In the chronic</p><p>stage, one study reported low-level evidence of limited</p><p>beneficial changes in facial function following large</p><p>quantities of electrical stimulation. No studies reported</p><p>complete recovery. Although there is some suggestion in</p><p>animal studies that axon regeneration may be accelerated</p><p>by brief periods of electrical stimulation,43 this review</p><p>concludes that there is no evidence in human studies to</p><p>support electrical stimulation in the acute phase of facial</p><p>nerve paralysis.</p><p>Implications for future research</p><p>Quality randomized control trials of humans are needed in</p><p>the area of chronic FNP of various etiologies using inter-</p><p>nationally recognized outcome measures, consideration</p><p>of potential safety concerns in study design, standardized</p><p>electrical stimulation programs and consistent follow-up.</p><p>An objective and systematic recording of complications</p><p>should be included in all studies.</p><p>Notes on contributors</p><p>Katie Fargher, BAppSc, is a clinical physiotherapist, and</p><p>research interests are in both pediatrics and in rehabilita-</p><p>tion of facial nerve disorders.</p><p>Susan Coulson, PhD (Physio); MAppSc(Ex & Sport Sc);</p><p>BAppSc(Physio), is a lecturer discipline of Physiotherapy,</p><p>Faculty of Health Sciences, The University of Sydney.</p><p>Her research interest is in rehabilitation of facial nerve</p><p>disorders.</p><p>ORCID</p><p>Susan E Coulson http://orcid.org/0000-0002-3586-2562</p><p>References</p><p>1 Coulson SE, O’Dwyer NJ, Adams RD, Croxson GR. Expression of</p><p>emotion and quality of life after facial nerve paralysis. Otol Neurotol.</p><p>2004;25(6):1014–9. Epub 2004/11/18 PubMed PMID: 15547436.</p><p>2 Peitersen E. Bell’s palsy: the spontaneous course of 2,500 peripheral</p><p>facial nerve palsies of different etiologies. Acta Otolaryngol Suppl.</p><p>2002;122:4–30. Epub 2002/12/17 PubMed PMID: 12482166.</p><p>3 Hohman MH, Hadlock TA. Etiology, diagnosis, and management</p><p>of facial palsy: 2000 patients at a facial nerve center. Laryngoscope.</p><p>2014;124(7):E283–E93. doi:10.1002/lary.24542;10.1001/jamafacial.</p><p>2013.1382</p><p>4 May M. The facial nerve. New York, NY: Thieme; 1986.</p><p>5 Sunderland S. Nerves and nerve injuries. 2nd ed. New York, NY:</p><p>Churchill Livingstone; 1978.</p><p>6 Ross MH, Pawlina W. Histoloy: a text and atlas. 5th ed. Baltimore,</p><p>MD: Lippincott Williams & Wilkins; 2006.</p><p>7 May M. Facial paralysis, peripheral type: a proposed method of</p><p>reporting. (Emphasis on diagnosis and prognosis, as well as electrical</p><p>and chorda tympani nerve testing). Laryngoscope 1970;80(3):331–90.</p><p>8 Madhok V, Gagyor I, Daly F, Somasundara D, Sullivan M, Gammie</p><p>F, et al. Corticosteroids for Bell’s palsy (idiopathic facial paralysis).</p><p>Cochrane Database Syst Rev. 2016;7.</p><p>9 Mosforth J, Taverner D. Physiotherapy for Bell’s palsy. Br Med J.</p><p>1958;2(5097):675–7.</p><p>10 Kim J, Choi JY. The effect of subthreshold continuous electrical</p><p>stimulation on the facial function of patients with Bell’s palsy. Acta</p><p>Otolaryngol. 2016;136(1):100–5. doi:10.3109/00016489.2015.1083121</p><p>D</p><p>ow</p><p>nl</p><p>oa</p><p>de</p><p>d</p><p>by</p><p>[</p><p>A</p><p>us</p><p>tr</p><p>al</p><p>ia</p><p>n</p><p>C</p><p>at</p><p>ho</p><p>lic</p><p>U</p><p>ni</p><p>ve</p><p>rs</p><p>ity</p><p>]</p><p>at</p><p>0</p><p>0:</p><p>02</p><p>2</p><p>0</p><p>Se</p><p>pt</p><p>em</p><p>be</p><p>r</p><p>20</p><p>17</p><p>Fargher and Coulson A systematic review and meta-analysis of the literature</p><p>Physical Therapy Reviews 20178</p><p>Appendix A. Detailed search strategy – Medline</p><p>Medline, Scopus, Medline, Embase, CINAHL, Pubmed: three</p><p>topic areas combined with ‘AND’</p><p>(1) Subject headings: Bell Palsy, Facial Paralysis, Facial</p><p>Nerve. Keyword search: facial paralysis, facial nerve,</p><p>Bell$ palsy, Bell$ paralysis, facial palsy.</p><p>(2) Subject headings: Physical Therapy Modalities,</p><p>Rehabilitation. Keyword search: physical therapy, phys-</p><p>iotherapy, rehab*</p><p>(3) Subject headings: Electric Stimulation, Electric</p><p>Stimulation Therapy. Keyword search: electrical stimu-</p><p>lation, electrotherapy.</p><p>(4) English</p><p>PEDro and cochrane library:</p><p>(1) Facial nerve</p><p>(2) Facial paralysis</p><p>(3) Facial palsy</p><p>(4) Bell’s palsy</p><p>(5) Bell’s paralysis</p><p>36 Brown MC, Holland RL, Ironton R. Nodal and terminal sprouting</p><p>from motor nerves in fast and slow muscles of the mouse. J Physiol.</p><p>1980;306:493–510. PubMed PMID: 7463373.</p><p>37 Tam SL, Archibald V, Jassar B, Tyreman N, Gordon T. Increased</p><p>neuromuscular activity reduces sprouting in partially denervated</p><p>muscles. J Neurosci. 2001;21(2):654–67. PubMed PMID: 11160444.</p><p>38 Love FM, Son YJ, Thompson WJ, Love FM, Son Y-J, Thompson WJ.</p><p>Activity alters muscle reinnervation and terminal sprouting by reducing</p><p>the number of schwann cell pathways that grow to link synaptic sites. J</p><p>Neurobiol. 2003;54(4):566–76. PubMed PMID: 12555269.</p><p>39 Hennig R. Late reinnervation of the rat soleus muscle is</p><p>differentially suppressed by chronic stimulation and by ectopic</p><p>innervation. Acta Physiol Scand. 1987;130(1):153–60. PubMed</p><p>PMID: 3591386.</p><p>40 Beurskens CHG, Heymans PG. Mime therapy improves facial</p><p>symmetry in people with long-term facial nerve paresis: a randomised</p><p>controlled trial. Aust J Physio. 2006;52(3):177–83.</p><p>41 Coulson SE, Adams R, O’Dwyer N, Croxson GR. Physiotherapy</p><p>rehabilitation of the smile after long-term facial nerve palsy using</p><p>video self-modeling and implementation intentions. Otolaryngol Head</p><p>Neck Surg. 2006;134:48–55.</p><p>42 Angelov DN. Physical rehabilitation of paralysed facial muscles:</p><p>Functional and morphological correlates. Adv Anat Embryol Cell</p><p>Biol. 2011;210:1–153.</p><p>43 Gordon T, Borschel GH. The use of the rat as a model for studying</p><p>peripheral nerve regeneration and sprouting after complete and partial</p><p>nerve injuries. Exp Neurol. 2017;287:331–47.</p><p>D</p><p>ow</p><p>nl</p><p>oa</p><p>de</p><p>d</p><p>by</p><p>[</p><p>A</p><p>us</p><p>tr</p><p>al</p><p>ia</p><p>n</p><p>C</p><p>at</p><p>ho</p><p>lic</p><p>U</p><p>ni</p><p>ve</p><p>rs</p><p>ity</p><p>]</p><p>at</p><p>0</p><p>0:</p><p>02</p><p>2</p><p>0</p><p>Se</p><p>pt</p><p>em</p><p>be</p><p>r</p><p>20</p><p>17</p>