Methodology:
Study type: experimental Design: Controlled clinical research, single blind (hybrid).
Universe: all people with peripheral facial paralysis or Bell's palsy in the City of
Corrientes.
Units of analysis: each person with peripheral facial paralysis or Bell's palsy who
attends the UNNE University Kinesiology Service. This center is taken as a reference,
since it is a reference place for the referral of patients with this diagnosis, it is
open to the general public and free of charge.
Sampling: a probabilistic sampling will be carried out. Sample size (n): 152 patients
Expected loss ratio (R): 15% Loss-adjusted sample: 179 patients
The following inclusion criteria will be taken into account:
-Patients with a medical referral that indicates as a diagnosis: peripheral facial
paralysis, Bell's palsy, frigori facial paralysis, idiopathic facial paralysis, who have
NOT received prior kinesic treatment.
Patients with central facial paralysis (facial paralysis associated with stroke), with
peripheral facial paralysis of more than 6 months' duration, will be excluded from the
study. Patients who present dermal lesions that interfere with the application of
electrical currents (open wounds, lacerations or burns) and/or who attend with a medical
prescription that advises against the use of electrostimulation in writing.
Two groups will be defined:
Control: Patients with peripheral facial paralysis who will receive standard kinesic
treatment (facial muscle reeducation without selective muscle electrostimulation)
Study: Patients with peripheral facial paralysis who will receive standard kinesic
treatment (with muscle reeducation) and selective muscle electrostimulation.
The assignment of patients to each group will be carried out in a systematic random
manner.
People who voluntarily attend the University Kinesiology Service in the indicated period
will be selected based on the aforementioned inclusion and exclusion criteria. Patients
will be assigned to each group in a systematic random manner. A characteristic of
controlled clinical trials is double blinding, a condition that will be resigned since it
is impossible for the kinesiologist to ignore what treatment is assigned to the patient,
since he himself is the one who applies it. On the other hand, it is worth mentioning
that the blinding that will be included will be the initial and final evaluation of the
people included in the study, that is; A group of professionals trained in facial
evaluation scales will receive the initial and final videos of the patients without
knowing the treatment they received.
study variables:
Functional recovery from facial paralysis dimension:
-Specific muscle function: - Ability to close eyes completely and symmetrically.
Mouth occlusion at the beginning and end of treatment -Value: Does not occlude: 0 -
Occludes: 1 Capacity to contain liquids and air. VALUE: Does not contain: 0 Contains: 1
-Functional recovery time. Number of treatment sessions carried out until the person's
kinesic discharge.
VALUE: Short term: up to 7 sessions -Medium term: up to 15 sessions -Long term:
greater than 15 sessions
Facial symmetry: The correspondence between the size, shape and location of facial
features on one side with respect to the opposite side. Present: 1 Absent: 0
Laterality of paralysis Side of peripheral facial paralysis Right: 1 Left:2
Individual characteristics of people with peripheral facial paralysis
Days of evolution of the PFP: Number of days of evolution of the paralysis before
starting treatment -Short term: less than 7 days -Medium term: up to 15 days -Long term:
greater than 15 days
previous pathological history
presence of synkinesis
Facial function assessment scales: House Brackman and Sunnybrook
Registration method
To record the data obtained, the following is done: filming, photographic recording of
facial muscle functions with a NIKON DSC COOLPIX B500® camera; For the written record, a
daily monitoring sheet is used that includes: anamnesis, clinical evaluation, functional
evaluation, electrostimulation parameters and re-education.
Position of the patient for taking photographic and videographic records: the patients
are seated in front of the camera, placed on a tripod, focusing on the face in the
foreground, taking an imaginary biclavicular lower line as the frame limit, with a clear
background. . In this way, the initial evaluation, evolution and final assessment of each
patient was documented.
Filming and photographic records were carried out without zoom to avoid distortions in
the image or defects in its resolution.
DESCRIPTION OF THE TREATMENT APPLIED TO EACH GROUP FACIAL REEDUCATION Protocol Muscle
re-education: Symmetrical facial movements are requested, activating the muscles of the
affected side, avoiding the participation of the unaffected side. We work with the
patient sitting in front of a mirror, asking him to perform the following actions or
gestures: raise his eyebrows, frown, close his eyes (tightly and blink), smell an
unpleasant odor, show his fangs, blow a kiss, blow , fake smile (lip corner pulled back
horizontally), frank smile (lip corner pulled back and up, showing teeth), kiss and
"pout". The functional capacity of the mouth was trained, inflating the cheekbones and
moving air from one side to the other, avoiding compensations.
Depending on the degree of facial dysfunction and its condition, the kinesiologist
performs irradiation, stretch reflex, movement facilitation and/or its inhibition. Three
series of five repetitions of each gesture described were done.
Selective muscle electrostimulation protocol for the study group:
Each patient underwent an "electroevaluation" with an exponential current generating
device (NEUROMATIC 700 brand Meditea®) which consisted of a test using facial stimulation
with different pulse widths (in milliseconds) and intensities (in milliamps) with
current. exponential. It was observed in which parameters a frank, visible and selective
contraction was achieved, avoiding muscle fatigue. This procedure was performed daily,
allowing selective muscle stimulation and a dosed application of the physical agent used.
Technique for applying selective muscle electrostimulation: a direct technique was used
with a dispersive electrode in the patient's cervical spine and an active punctal
electrode in the facial muscles.
Ethical considerations:
The process of reading, understanding, accepting and signing the informed consent was
carried out in a prior interview, before starting the treatment. This document included
the treatment methods used, the objectives of the study, the free follow-up, the
commitment of both parties, as well as the formal dissemination mechanisms used regarding
the results of the work to each participating patient. The risks inherent to kinesic
practice were detailed and the patient was informed of the mechanisms used to ensure the
quality of care provided.