Bell's Palsy Step-by-Step Massage Therapy Protocols

Table of content 1- Definition of Bell's Palsy ? 2- Pathophysiology ? 3- Sign and Symptoms 4- some practical questions ? 5- Contraindications and Cautions? 6- Step-by-Step Protocol for ? 7- Home work Exercises

Definitions

Bell's palsy is also known as “acute facial palsy of unknown cause.” It’s a condition in which the muscles on one side of your face become weak or paralyzed. It affects only one side of the face at a time, causing it to droop or become stiff on that side.

The facial nerve, or cranial nerve VII. The facial nerve travels from the brain to a wide area of muscles in the face, and controls movements of the eyelids, the muscles around the mouth, and the muscles for tearing (eyes), chewing, and facial expression, among other actions. .

Pathophysiology

 The facial nerve, which is affected by Bell’s palsy, travels from the brain to a wide area of muscles in the face . This nerve controls the movement of the eyelids, the muscles around the mouth, and the muscles for tearing (eyes), chewing, and facial expression, among other actions.

 Paralysis of the facial nerve is believed to result from either edema (swelling) or ischemia (temporary reduced blood fl ow), both of which compress the nerve against bony areas in the base of the skull where it travels from the brain to the muscles of the face. The reason for the presence of edema and/or ischemia continues to be the subject of debate.

 There are usually no warning signs or symptoms. However, similar symptoms may be caused by a stroke or tumor. Therefore, the fi nal appropriate diagnosis of Bell’s palsy must be made by a physician to rule out more serious conditions.

Sign and Symptoms :-

Self-discovery upon waking: wet pillow from salivation (drooling), a drooping eyelid, sagging mouth, crooked smile, and an inability to completely close the eyelid

• Weakness or paralysis of one entire side of the face

• Pain around the ear on the affected side

• Inability to taste foods or a disturbance in normal taste

• Acute sensitivity to sound

• Inability to create normal facial expressions of eyebrow crinkling, smiling, squinting, and pursing lips

• Decreased tearing; susceptibility to corneal abrasion and dryness of the eye

• Drooling from decreased control of the muscles inside, outside, and around the mouth

Note :- Before the therapist begins working on the face and eyes of any client, she must ask herself some practical questions:

• Does she wear contact lenses?

• Does she have dentures?

• Does she have any facial implants or internal fixations that should not be massaged directly?

The massage for Bell’s palsy, although it begins lightly, ultimately moves “to the bone” with deep work that is highly stimulating.

Therapist must be sure the client’s face can safely tolerate the work. Since the face often represents a person’s sense of self-esteem and privacy, and can carry a history of abuse, it is important at the beginning of the therapeutic relationship to build trust with the client. During the initial interview, the therapist might ask:

• How do you feel about this change in your face?

• May I ask if you will be able to tolerate therapy on your face for about 30 minutes?

• Do you understand this is usually a temporary condition and that it will pass?

• Do you understand that we’ll take this therapy at your pace, and we’ll sit back and relax at any time?

• Do you think you’ll be comfortable massaging your own face and helping me along in this process?

Contraindications and Cautions: • Do not proceed with this therapy until stroke and tumor have been ruled out by a physician. • Do not proceed with this therapy until stroke and tumor have been ruled out by a physician. • Bell’s palsy clients experience good days and bad days based on swelling, discomfort, acute hearing, lack of sleep, eye pain or discomfort, side effects of medications, and self-image. Do not perform therapy if the face is extremely sensitive or if the client is experiencing pain. As in all massage therapies, “no pain, no gain” is not our motto, and it certainly applies to work on the face. • Do not apply deep pressure near the styloid or mastoid processes at the lateral bases of the skull during the scalp massage or when positioning the client’s head; allow the client’s head to rest in mid line, with little pressure to the base of the skull for most of the treatment.

Roll the head from side to side only when absolutely necessary. The facial nerve exits the brain at a small hole near the base of the skull behind the earlobe, and pressure on this area can further infl ame or compress an most of the treatment.

Step-by-Step Protocol :-

1- Place your hands on either side of the client’s face as if to embrace it. Rest here for a moment before beginning your therapy. No pressure, just simple presence.

2- Compression, light pressure, using your whole hand (Both sides of the face).

3- Digital kneading, medium pressure, circling clockwise and counterclockwise.

4- Digital kneading, medium pressure, circling toward the chest; small, slow circles.

5- Digital kneading, medium pressure; tiny, slow circles performed with fi nger pads, not fingertips.

6- Digital kneading; slow, small circles; medium-to-deep pressure (This is the fi rst time “deep” pressure is applied: “go for the bone” to the client’s tolerance; this work must be deep to be effective.)

7- Digital kneading, using finger pads; slow, small circles.

• Maxilla region below the nose (the mustache ridge).

• Do not invade the nose or the mouth or touch the upper lip.

8- Digital kneading, using finger pads; slow, larger circles; medium to-deep pressure.

9- Stop a moment. Stroke the entire face using both open hands simultaneously, moving from the mid line of the face to the lateral hairline. Finish this resting period with soft compression of the entire face. Ask the client how she is doing. Reconfirm comfortable positioning.

10- Digital kneading, a little faster but still very smooth; larger, deeper circles on the entire surface of the face.

12- Pin cement or plucking. Quick, light, careful but thorough enough to displace more than superficial tissue.

• Start at the mandible.

• Use the procedure on every part of the face that allows you to grasp a little muscle or skin; even try to engage the small thin muscles of the forehead.

• Do not use pin cement around the eyes or nose.

13- ROM and gentle resistance of all facial muscle actions

• Ask the client to wrinkle her forehead by raising her eyebrows; return to normal.

• Place your fingertips along the superior ridge of the forehead just below the hairline.

• While providing very gentle resistance against the movement of the frontal muscle, ask the client to wrinkle her .

forehead again and gently push against her movement. Return to normal. Repeat 5 times.

14- Ask the client to close her eyes; ever so gently place two fingertips on her closed eyelids. Apply no pressure to the eyeball. (Make sure she is not wearing contact lenses.)

• Ask her to try to open her eyelids while you apply the gentlest of resistance pressure, not allowing the eyelids to open completely, not applying any pressure to the eyeball.

15- Ask the client to grimace, teeth gritted, mouth slightly open, pulling the platysma (superficial muscle of the neck) very tight.

• Massage the entire mandibular ridge with deep, large circles on the bone, while she holds this position.

16- Allow the client to rest from these exercises, and gently massage the face with large, slow, progressively deeper circles. Stroke the face when the therapy is finished. Massage the superficial muscles of the neck lightly and massage the superior trapezius.

(Remember to apply no pressure to the occipital ridge; a contraindication for this work.) You are taking focus away from the face for a moment and allowing the client to take a break.

17- Scalp massage, deep to tolerance, digital kneading of all muscles of the scalp (being careful not to apply pressure behind the earlobes). End with “scrubbing” the hair by using quick

“washing” movements of the entire surface covered by hair. Be careful not to tug the hair.

18- Sit the client up on the side of the table and stand in front of her.

• Demonstrate (or review) the AEIOU exercises you want her to perform several times throughout the day.

• Teach (or review) how to deeply and thoroughly massage every bony ridge of her face and all major muscles.

• Teach (or review) the plucking (pin cement) of all the muscles of her face.

• Teach (or review) how to massage the muscles of her neck.

19- Inform the client that the therapeutic face work has ended, and ask her which area of her body she would like to have massaged, simply for relaxation.

Home Work Exercises :- • Remember when you learned the vowels A E I O U in school? I want you to over enunciate each one very slowly while stretching every single muscle in your face and holding the position for several seconds at a time. (At this point, you demonstrate, so she can see how humorous the exercise can be. Exaggerate each move.) • Open your eyes and mouth wide for the “AAAAAAAA.” • Grimace to the point of (feigned) horror and show all your teeth for the “EEEEEEE.” • Open your mouth and eyes wide for the “IIIIIIIIII.” • Furrow your brow, pull the muscles tight over your cheekbones, and open your eyes wide for the “OOOOOOOO.” • Purse your lips, thrust your jaw forward, and look devilish for the “UUUUUUU.”