Received: 17-Mar-2023, Manuscript No. aeb-23-92042; Editor assigned: 20-Mar-2023, Pre QC No. aeb-23-92042 (PQ); Reviewed: 22-Mar-2023, QC No. aeb-23-92042 (Q); Revised: 25-Mar-2023, Manuscript No. aeb-23-92042 (R); Published: 30-Mar-2023
Background: Facial palsy in pediatrics is very rare, and it doesn’t have any identifiable cause. Usually, exercises, massage, and taping are suggested. Since it is one of the rarest conditions and there is no optimal treatment recommended. The purpose of the study is to identify the effect of neuromuscular facilitation training in pediatric facial palsy.
Methodology: This is a Case series done with five children with facial palsy, and all underwent neuromuscular facilitation training and video-guided exercises. All patients were managed with conventional physiotherapy which includes, massage and facial movements. The conventional treatment was given for five days. Since the lockdown was proposed due to Covid 19, the parents and the children were called and taught neuromuscular facilitation training to the parents; along with that, a handout was also given to them. The video call was made to the parent by the therapist and did exercises video-assisted. The initial two weeks it was video-guided, and later, the parents were doing the exercises, and the therapist monitored them through video. The improvement was measured using the House-Brackmann scale.
Result: Three males and two female children were involved with an average of 6.2 years, and the duration of the symptoms is five days on average. On application of the neuromuscular facilitation training, a significant difference was obtained, and all the children become normal at the 7th week.
Conclusion: Neuromuscular facilitation training plays an essential role in stimulating the weakened facial muscles by the principle of irradiation. It shows better than traditional therapy in pediatric facial palsy.
Facial palsy, Pediatrics, Neuromuscular training, House-Brackmann scale, Exercises
Facial palsy is the seventh nerve palsy acknowledged since olden times by Romans, Greeks, Egyptians, and various other native cultures . Usually, facial nerve paralysis is idiopathic, and its annual incidence is about 15 cases-30 cases per 1 00 000 population around the globe . Facial palsy raises significant aesthetic and psychological issues because it expresses emotions by controlling the eyebrows, mouth, nostrils, and speech . Apart from that, facial palsy causes difficulty in eating, and speaking, corneal drying, altered taste, facial muscle spasm, and synkinesis.
Facial paralysis in children is very uncommon compared to adults, and the improvements are much better in children than in adults . Diagnosing pediatric facial palsy requires a detailed history collection. It is mandatory to investigate the onset of the paralysis and the improvements . The prognosis of pediatric facial palsy is similar to that of adults with facial paralysis. However, the assessment of the forecast is challenging. Every child got full functional recovery in the previous kinds of literature cited. Evaluation of facial paralysis is by the house brackman’s index in adults, which is one of the best outcome measures. Still, it does not possess high validity in pediatric facial palsy .
Standard management recommended for this is usually oral corticosteroids, preferably within three days from onset. There is no harmony in managing pediatric facial palsy, and it was typically managed with physiotherapy and multivitamins . Physiotherapy management for an adult includes exercises, electrical stimulation, taping, massage, mime therapy, and PNF . Studies have identified that Neuromuscular Facilitation Training (NMFT) has more effective than no exercises . Since there are no clinical guidelines available to manage pediatric facial paralysis, it can’t be managed like adults. Electrical stimulation is not strongly advised in pediatric facial palsy. The main line of management focuses only on exercises and massage. Since the exercises are recommended in management this study tries to identify the effect of neuromuscular facilitation training. So, this study aimed to investigate the effect of Neuromuscular Facilitation Training (NMFT) on pediatric facial palsy
The case series includes pediatric patients from March 2020 to June 2021. Five pediatrics were referred from the department of pediatrics to the outpatient department of physiotherapy with facial paralysis and recommended for exercises. Initially, a 7-year-old child has been referred to physiotherapy with complaints of facial weakness, and a comprehensive assessment and treatment protocol was developed. The treatment plan were Exercises, Massage, and Taping. A home program was advised, which includes balloon blowing, straw sucking, and facial massage. The child was treated at the department for five days, and the lockdown was enforced in March 2020. We invited the child and the parent and taught NMFT to the facial muscles, and also supervised how they are doing it. After two days telephone call was made by the therapist to assist in the NMFT exercises. The parents have requested to do the exercises while the therapist does video guidance. Following two weeks of video-guided therapy on alternate days the parent was comfortable with applying the NMFT and the therapist did video supervision. Subsequently, alternate days of video-guided exercises were conducted, and identified his progress. Within ten days, another child at the age of 6 years, came with idiopathic facial paralysis, and the same protocol was followed along with video-guided exercises.
Neuromuscular facilitation training includes relaxation techniques, which was used to relax the facial muscles. NMFT starts with asking the child to lift eyebrows, look up and wrinkle the forehead against the resistance of the parent using their fingertips to stimulate the frontalis, Ask the child to frown, the resistance applied just above the lateral direction to facilitate corrugator Supercilli, ask the child to close the eyelid against resistance to stimulate orbicularis oculi, Ask the child to wrinkle the nose against resistance diagonally down to stimulate procerus, ask the patient to purse the lips and say prunes against resistance to encourage orbicularis oris and ask the child to wrinkle the chin to stimulate mentalis. All the exercises were done in front of a mirror, exercises were done only for 5 repetitions-10 repetitions to avoid muscle fatigue, and the whole session is for 40 minutes twice daily .
Every month one new pediatric facial palsy visited the department, and the same protocol was followed. Four cases were treated from March 2020 to July 2020 and in May 2021. We follow the same video-guided exercises. Following the activities, all the child’s parents were requested to take a video of the child. This video was used to assess the child’s progress, and the progression is calculated using the House-Brackmann Scale.
In this case series, three male children and two female children were scanned with a mean age of 6.2 years, and the duration of the symptoms is five days. The questionnaire was developed using a Likert scale on the treatment progression, treatment satisfaction, and treatment methods. All the children and their parents were delighted with all the components. The house-Brackmann scale was used to investigate the improvement, and still, as the participants are significantly fewer, the values are not quantifiable. Table 1 shows the clinical analysis of the onset of recovery and the duration of rehab. It has demonstrated that an average of 6 weeks is required for complete healing.
|Age in years||Sex||Grade of presentation (House Brackmann) & Side of presentation||Recovery onset in days||Duration of complete recovery in weeks|
|7||Male||IV (Right side)||Day 8||7th week|
|6||Female||III (Left side)||Day 6||6th week|
|5||Male||III (Right side)||Day 7||5th week|
|6||Male||IV (Left side)||Day 5||7th week|
|7||Female||III (Left side)||Day 8||5th week|
The purpose of the case series is to evaluate the effect of neuromuscular facilitation training on pediatric facial paralysis. Similar studies on facial palsy show that around 89.3% of children with facial palsy recovered completely, and the recovery happened with 90% [3,11]. Exercise is the most commonly used method for the rehabilitation of facial palsy . Physiotherapy with neuromuscular retraining is much helpful in managing facial nerve palsy . NMFT benefits in correct movement patterns and improves facial movements and exercise programs . NMFT helps in stimulating the weakened facial muscles by the principle of irradiation, and it shows better than traditional therapy in paediatric facial palsy . NMFT affects the cutaneous muscle distributed over the face, contributing to early improvements .
NMFT emphasizes the accuracy of facial movement patterns and improves isolated muscle control. It prevents exercises that promote mass contraction of the muscles related to more than one facial expression. Similar studies showed that participants who perform self-exercises at home show more significant improvement, and analysis done by Beursken et al. also showed a considerable improvement even in chronic cases. He concluded that structural home exercises produce many benefits [16-18].
The major limitation of this study is a case series design, and this study has done with five children. More participants are needed to explore more on this treatment perspective. The effectiveness of the neuromuscular exercises was not quantifiable in the smaller sample.
The prognosis of all the children has been good, and all have a higher recovery rate. This study concludes that the application of neuromuscular exercises and frequent video-guided exercises aids in the recovery of pediatric facial paralysis.