Kabat Technique and Neuromuscular Effect in Patients With Bell's Palsy

March 18, 2021 updated by: Riphah International University

Effects of Kabat Technique and Neuromuscular Re-Education in Patients With Bell's Palsy

Bell's palsy is the sudden one-sided peripheral weakness of seventh cranial nerve (Facial nerve), represents 50% to 75% of all etiologies with a rate of 58.2 to 8 new cases per 1 million per year. The objective is to compare the effects of Kabat techniques and Neuromuscular Re-Education on facial disability and synkinesis in patients with bell's palsy. A Randomized Control Trial was conducted on 20 participants, equally allocated in Kabat and PNF training group from February-2020 until December- 2020. Participants were selected according to inclusion and exclusion criteria on purposive sampling technique and randomization was done by sealed envelope method. The assessment was done after taking consent before the first and last session. The tools included Facial disability index, Sunnybrook facial grading system and synkinesis assessment questionnaire. Data were analyzed using SPSS v.20.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Bell's palsy is the sudden one-sided peripheral weakness of seventh cranial nerve (Facial nerve), represents 50% to 75% of all etiologies with the rate of 58.2 to 8 new cases per 1 million per year. It can be either a complete palsy or weakness of facial nerve. This condition may start with pain over half of face especially mastoid region with other symptoms like decreased sensation over half of face, decrease lacrimation, hyperacusis, pain and numbness over half of face. Bell's palsy patients may show signs of absent/decrease facial creases, positive bells phenomenon and forehead folds, associated with other disabilities like contracture in facial muscles and synkinesis due to which patient cannot close his eye.The cause of bell's palsy is unknown therefore it is also called idiopathic facial palsy but recent studies claim that "herpes simplex virus" can be a cause of bell's palsy.Other causes such as tooth extraction, removal of the tumour, local anaesthesia, TMJ surgery, ischemic neuropathy, facial fracture can also be considered. Different studies were carried out on the incidence, risk factors and treatments methods of bell's palsy.The most common risk factors for bell's palsy, reported by a study, is diabetes, and hypertension. A study reported that patients with diabetes are 4 to 5 times more likely to have Bell's palsy.Men and women are equally affected by this disorder.There are different treatment methods for Bells palsy i.e. medical management, physical therapy management, surgical management etc.Although Physical therapy management is not considered to be treatment of choice in treating bell's palsy but there is several clinical studies which claims the benefits of rehabilitation if applied in early stage. Physical therapy managements include different techniques, namely Proprioceptive neuromuscular facilitation, Kabat rehabilitation, Kinisio taping, cryotherapy, massage therapy biofeedback, muscular reeducation.As claimed in a study in 2013, Kabat technique is quite effective in treating the facial disabilities if the therapist is trained. In this study different Kabat techniques namely "rhythmic initiation on those patients who did not perform any movement, repeated stretch was used at the start and also through full ROM in case of muscular weakness, isotonic were used when patients had voluntary movement control, were used on three patients .A study claimed in a case report in 2017 that PNF techniques are very effective in improving functional outcomes in Childs with "bell's palsy".Several studies were done on effects of "Kabat rehabilitation" in "Bell's Palsy". As another conducted a study in 2017.Two groups of Bell's palsy were compared after application of two different treatment protocols. Participants of group A was given Kabat exercises with electrical stimulation and kinesio taping while group B was given electrical stimulation plus home exercises. Study reported that Kabat exercise is quite effective in improving facial asymmetry in bell's palsy.A study was done in 2015 in Islamabad compare the effects of Kabat exercises and Taping in reducing facial synkinesis and disability.The study reported that Kabat exercises are more effective in reducing facial synkinesis and disability.A study was done in 2007, Comparing Neuromuscular reeducation techniques with conventional physical therapy in treating Bell's palsy. This study was done in manipal, India in which he reported that neuromuscular reeducation techniques are more effective in improving facial asymmetry in patients with bell's palsy .The previous studies showed that clinician have worked either with Neuromuscular Re-Education or with kabat in treating Bell's palsy. There is no study done which compare the effects of Neuromuscular Re-Education vs. Kabat in treating Bell's palsy. So the aim of this study is to determine the effect of Kabat and Neuromuscular Re-Education on facial disability and synkinesis and to compare both treatments effects.Kabat Exercises rehabilitation of the facial nerve, 3 fulcrums are found, whose muscles can be stimulated. Upper fulcrum: includes the frontalis, corrugator and orbicularis muscles of the eye.Intermediate fulcrum: Includes the common elevator muscle of the upper lip and wing of nose, the dilator naris and the multiform. Lower fulcrum includes the zygomaticus major, the zygomaticus minor, the risorius, the orbicularis, the triangular of the lower lip, buccinator, chin muscle and square muscle of the chin.

Study Type

Interventional

Enrollment (Actual)

24

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
      • Islamabad, Pakistan, 44000
        • Riphah International University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

20 years to 50 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Diagnosed cases of bell's palsy
  • Non traumatic onset ( conditions like infectious, hypertensive patients, diabetic patients

Exclusion Criteria:

  • • History of significant psychiatric illness

    • Upper motor neuron disease ( stroke, TBI, tumor)
    • Non co-operative patients
    • Post-surgical case

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Kabat Technique's
Kabat exercises on Upper fulcrum, Intermediate fulcrum and lower fulcrum
Other: Kabat Technique's

As with all cranial nerves, some specific techniques can also be applied on the facial nerve to enhance responses and improve recovery; the most important are: The rhythmic start: shows and guides the subject into the movements and the scheme; agonist investigation utilizes sequential concentric and eccentric contractions; The inversion of the antagonist: reinforces responses through the induction phenomenon; Repeated contractions: calls for a response with repeated stretching that briefly enables movement; Isometric contractions: for stabilizing and reinforcing the response.

Conventional therapy exercises
Experimental: Neuromuscular Re-Education:
For initiation, Facilitation, Movement control and movement control
Other: Neuromuscular Re-Education

After the baseline assessment, the participant in the control will receive Neuromuscular Re-Education. The duration of session will be 45 minutes.Neuromuscular Re-Education: For initiation (acute phase): Active-assisted exercise,Massage and stretch for affected side.For Facilitation ,Active-assisted exercise.For Movement control:Massage and stretching for facial retraction,Assisted and active exercises on involved side.

For Relaxation,Thermotherapy,Relaxation exercises,Alternating rhythmic movements.

Conventional therapy exercises

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
SunnyBrook Facial Grading System
Time Frame: 4 weeks
the tool is used to assess changes from baseline to 4 weeks The Sunnybrook scale is a regional weighted scale based on evaluation of different regions including resting symmetry, symmetry of voluntary movement and severity of Synkinesis to form one single composite score from 0 to 100. It was devised and established at the Sunnybrook Health Sciences Centre in Toronto having an intraclass correlation coefficient (ICC) of 0.890. The Facial Grading System is a tool used for clinical evaluation of Facial Nerve function. It is intended to use on peoples with facial nerve weaknes.
4 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Facial Disability Index
Time Frame: 4 weeks
the tool is used to assess changes from baseline to 4 weeks The Facial Disability Index (FDI) is a condition-specific scale that is proposed to be used to help clinicians in making decisions about individual patients and to differentiate among individuals with different levels of disability and to evaluate change within a person over time. It have 2 domains, i.e. physical function and social wellbeing. It have total 10 questions, 5/domain. Each item is rated on a 6-point scale, ranging from severe disability to absence of disability. Both subscales are transformed to a score on a 100-point scale, with 100 indicating unimpaired physical or social/well-being function.
4 weeks

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Synkinesis Assessment Questionnair:
Time Frame: 4 weeks
the tool is used to assess changes from baseline to 4 weeks The Synkinesis Assessment Questionnaire (SAQ) is a valid, reliable, and easily administered instrument for the self-assessment of synkinesis in patients with facial palsy. This instrument was developed and validated in the Facial Nerve Center at the Massachusetts Eye and Ear Infirmary (Boston, USA) in 2007. The questionnaire consists of nine items. Total scores range from 0 (no synkinesis) to 100 (severe synkinesis, all the time). The SAQ is a reliable and valid tool having the Cronbach alpha for the final SAQ was 0.859
4 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Riphah International University

Investigators

  • Principal Investigator: Dr Aruba Saeed, PHD*, Riphah International University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

November 15, 2020

Primary Completion (Actual)

December 15, 2020

Study Completion (Actual)

December 30, 2020

Study Registration Dates

First Submitted

December 21, 2020

First Submitted That Met QC Criteria

March 18, 2021

First Posted (Actual)

March 19, 2021

Study Record Updates

Last Update Posted (Actual)

March 19, 2021

Last Update Submitted That Met QC Criteria

March 18, 2021

Last Verified

March 1, 2021

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • REC/00659 Muhammad Kashif

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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