Combined Effects of Proprioceptive Neuromuscular Facilitation (PNF) and Neural Mobilization on Improving Facial Symmetry in Patients With Bells Palsy

September 11, 2026 updated by: Foundation University Islamabad
Bell's palsy is an acute,unilateral facial paresis that significantly affects patient's facial symmetry,motor function and quality of life.The primary goal of this randomized controlled trial is to determine if integrating the targeted neural mobilization with proprioceptive neuromuscular facilitation improves facial symmetry and motor function more effectively than using pnf alone.participants allocated to either experimental group receiving neural mobilization and pnf or control group receiving pnf alone.after approval from ERC FUSH, participants are assessed using housebrackman scale and sunnybrook facial grading system(scales to asses the degree of severity of facial paralysis) at first and fourth week of intervention application.data will be analysed using spss v.22.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Bell's palsy is an acute lower motor neuron facial nerve paralysis caused by dysfuntion in facial nerve (cranial nerve 7), leading to impairements in facial expression,speech, eating and psychological wellbeing, ultimatemately affecting the quality of life. Despite the individual benefits of rehabilitation techniques like facial proprioceptive neuromuscular facilitation and neural mobilization,there is limited evidence about the combined effects of these two verses pnf alone in the rehabilitation of bell's palsy. This randomized controlled trial is conducted in foji foundation hospital ,rwp, for the duration of one year after approval including a sample size of 36 patients. Sampling technique would be purposive.After ethical approval from ERC FUSH ,eligible participants will be allocated in two groups via coin toss method.the participants would be assessed through house brackman scale and sunny brook facial grading system (scales to asses the degree of severity of facial paralysis) at fisrt and forth week of intrvention application (3 sessions per week,30-45 minutes per seesion, for consecutive four weeks).

Study Type

Interventional

Enrollment (Estimated)

38

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 Contact

Study Locations

  • Pakistan
      • Islamabad, Pakistan, 44000
        • Recruiting
        • Foundation University College of Physical Therapy
        • Contact:

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

  • Child
  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Age 15-60 years.
  • Both male and female.
  • Patient diagnosed with bells palsy by neurologist or relevant specialist.
  • Patients with moderate to severe Bell's palsy evaluated by Modified House-Brackman SCALE
  • Patient without exposure to any other rehabilitation program
  • Patients within the acute or subacute phases (within 6 months of onset)

Exclusion Criteria:

  • Patients with a history of recurrent Bell's palsy or other neurological disorders (e.g., stroke, multiple sclerosis)
  • Patients with pacemakers, metal implants or other contraindications for electrical muscle stimulation.
  • Presence of facial trauma or surgical interventions that might interfere with rehabilitation outcomes.
  • Co-existing medical conditions (e.g., diabetes mellitus, infections, or malignancies) that might impair nerve recovery or affect study outcomes

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: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: pnf and neural mobilization
  1. Gentle facial nerve mobilization applied within pain free range (10-12 min/session, 6-10 repetition/technique,30-60 seconds/glide).
  2. rhythmic initiation and resisted voluntary movements(3-5 rep/movement, 3-4 sets /session)
Procedure: GROUP A COMBINED THERAPY GROUP

Receives proprioceptive neuromuscular facilitation (pnf), neural mobilization and conventional therapy.

DESCRIPTION

  • PNF using rhythmic initiation and resisted voluntary movements directed at the frontalis, orbicularis oculi, zygomaticus major and minor, orbicularis oris and buccinator; three to five repetitions per pattern, three to four sets per session. Progression governed as tolerated with resistance and repetitions increased as recovery allowed.
  • Gentle facial nerve mobilization within a pain-free range, ten to twelve minutes per session; six to ten repetitions per technique or thirty to sixty seconds per glide, advancing glide range as tolerated.
  • Conventional therapy; clinic-based facial expression exercises with interrupted galvanic stimulation (rectangular waveform, 100 ms, 3 sets × 30 contractions), 2-3 sessions weekly, 15-20 minutes; plus daily home facial exercises with mirror feedback (smiling, blinking, puckering), 10-15 minutes.
Active Comparator: pnf alone
Rhythmic initiation and resisted voluntary movements(3-5 rep/movement, 3-4 sets /session).
Procedure: GROUP B PNF GROUP

Receives proprioceptive neuromuscular facilitation and conventional therapy. DESCRIPTION

  • Proprioceptive neuromuscular facilitation, using rhythmic initiation and resisted voluntary movements. Progression governed by the participant's tolerance and motor control, with resistance and repetitions increased as recovery allowed.
  • Conventional therapy: clinic-based facial expression exercises with interrupted galvanic stimulation (rectangular waveform, 100 ms, 3 sets × 30 contractions), 2-3 sessions weekly, 15-20 minutes; plus daily home facial exercises with mirror feedback (smiling, blinking, puckering), 10-15 minutes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Symmetry of face
Time Frame: 4 weeks
It is measured by Sunnybrook facial Grading system (SFGS) SFGS Score = (Voluntary Movement Score) - (Synkinesis Score) - (Resting Symmetry Score) Minimum value: 0 (Complete paralysis) Maximum value: 100 (Normal facial function) Higher scores indicate a better outcome
4 weeks
Severity of facial paralysis
Time Frame: 4 weeks

It is measured by the House-Brackmann scale. Patients graded IV-VI show severe impairment, and patients graded I-III have mild-to-moderate dysfunction.

Minimum value: I (Normal facial function) Maximum value: VI (Total paralysis) Outcome interpretation: Higher scores indicate a worse outcome
4 weeks

Collaborators and Investigators

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

Sponsor

Foundation University Islamabad

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)

September 14, 2025

Primary Completion (Estimated)

December 10, 2026

Study Completion (Estimated)

January 10, 2027

Study Registration Dates

First Submitted

August 6, 2026

First Submitted That Met QC Criteria

August 6, 2026

First Posted (Actual)

August 11, 2026

Study Record Updates

Last Update Posted (Actual)

September 15, 2026

Last Update Submitted That Met QC Criteria

September 11, 2026

Last Verified

September 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • FUI/FUCP/CTR/Neuro/Mahnoor

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

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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