Acute Management

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Early Stage (Acute Management)

Before starting treatment the therapist must ensure that the cause of the weakness has been established and with that, the time course and degree of expected recovery.

History of presenting condition

Identification of any other risk factors

Treatment and investigations to date – past, present and planned

Past medical history

Functional & psychosocial difficulties

Current level of facial function – including both subjective and objective assessment tools

Patient’s level of understanding of their condition, including patient’s expectations from treatment

Before starting treatment the therapist must ensure that the cause of the weakness has been established and with that, the time course and degree of expected recovery.

Early Stage Management - Flaccid Stage

  • Eye Care – See Eye Care leaflet. Teach manual blinks, taping eye shut etc, emphasise the importance of eye lubrication and protection of the cornea
  • Oral Hygiene – regular teeth brushing and hygienist visits are recommended at this stage as a dry mouth increases the risk of dental problems.
  • Eating and drinking – the use of a special cup, straw or fine china may make drinking easier.
  • Speech – supporting the cheek whilst speaking and speaking slowly and clearly can help at this stage.
  • Check on patient’s understanding of their condition
  • Patients are often very frightened and need time to express how they feel
  • Attempting exercises at this stage is counter productive
  • Relaxation of the unaffected side is more important so that the patient is able to achieve and feel facial symmetry at rest.
  • When movement starts to return – practice small movements which centre the face -quality is better than quantity
  • Assisted movements (help in the direction of the movement)
  • Advise the patient to avoid fatigue of the facial muscles as this will lead to frustration
  • Can use sEMG to help relax the unaffected side
  • See facial exercise leaflet
  • Massage will improve blood circulation to the facial muscles as well as aid lymphatic drainage
  • It will increase sensory input and increase facial muscle awareness
  • It can also be used to aid relaxation of the unaffected side

Most patients with Bells Palsy recover spontaneously and as such need no treatment other than reassurance and acute care management as described above.

Video link for patient use:
https://www.facialpalsy.org.uk/support/self-help-videos/management-of-flaccid-facial-paralysis-floppy-face/