A Comparative Study on the Effectiveness of Rood’s Approach Versus Combined Rood’s Approach and Facial Proprioceptive Neuromuscular Facilitation (PNF) in Patients with Bell’s Palsy
Keywords:
Bell’s palsy, Facial PNF, Rood’s Approach, House-Brackmann Grade, physiotherapy, facial paralysis rehabilitationAbstract
Background:Bell’s palsy is an acute idiopathic facial nerve paralysis that affects the seventh cranial nerve, causing sudden unilateral facial muscle weakness. While Rood’s Approach and Facial Proprioceptive Neuromuscular Facilitation (PNF) are both recognized in physiotherapeutic management, there is limited evidence comparing their individual and combined effectiveness in facial palsy rehabilitation.
Objective:To compare the effects of Rood’s Approach alone versus its combination with Facial PNF in improving facial muscle function in Bell’s palsy patients using the House-Brackmann (HB) grading system.
Methodology: A comparative interventional study was conducted on 30 patients diagnosed with Bell’s palsy. Participants were randomly divided into two groups: Group A received Rood’s Approach alone, while Group B received Rood’s Approach combined with Facial PNF. Interventions were provided over an 8-week period, and outcomes were assessed pre- and post-treatment using the HB grading system. Data were analyzed using paired and independent t-tests with significance set at p < 0.05.
Results: Both groups showed significant improvements post-treatment. Group A improved by a mean of 2.67 HB grade points, while Group B showed greater improvement with a mean change of 3.40. Although the between-group difference was not statistically significant, the clinical outcomes favored the combined approach, suggesting enhanced neuromuscular recovery.
Conclusion: Both interventions were effective in improving facial function in Bell’s palsy patients. However, the combination of Rood’s Approach with Facial PNF provided superior clinical benefits, supporting its recommendation as a more effective rehabilitation protocol.
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Ton G, Lee LW, Ng HP, et al.: Efficacy of laser acupuncture for patients with chronic Bell's palsy: a study protocol for a randomized, double-blind, sham-controlled pilot trial. Medicine (Baltimore). 2019, 98:e15120.
Bosco D, Plastino M, Bosco F, et al.: Bell's palsy: a manifestation of prediabetes? . Acta Neurol Scand. 2011, 123:68-72
Aditya V: LMN facial palsy in pregnancy: an opportunity to predict preeclampsia-report and review . Case Rep Obstet Gynecol. 2014, 2014:626871. 10.1155/2014/626871 4.
Peng KP, Chen YT, Fuh JL, Tang CH, Wang SJ: Increased risk of Bell palsy in patients with migraine: a nationwide cohort study. Neurology. 2015, 84:116-24. 10.1212/WNL.0000000000001124
Khateri M, Cheraghi S, Ghadimi A, Abdollahi H: Radiation exposure and Bell’s palsy: a hypothetical association. J Biomed Phys Eng. 2018, 8:337-40.
Bell’s Palsy Recovery . (2009). Accessed: August 31, 2021: https://www.news-medical.net/health/Bells-PalsyRecovery.aspx.
Sajadi MM, Sajadi MR, Tabatabaie SM: The history of facial palsy and spasm: Hippocrates to Razi Neurology. 2011, 77:174-8. 10.1212/WNL.0b013e3182242d23 8.
Zandian A, Osiro S, Hudson R, Ali IM, Matusz P, Tubbs SR, Loukas M: The neurologist's dilemma: a comprehensive clinical review of Bell's palsy, with emphasis on current management trends. Med Sci Monit. 2014, 20:83-90
EVISTON TJ, CROXSON GR, KENNEDY PGE, ET AL BELL'S PALSY: AETIOLOGY, CLINICAL FEATURES AND MULTIDISCIPLINARY CARE JOURNAL OF NEUROLOGY, NEUROSURGERY & PSYCHIATRY 2015;86:1356-1361
PEITERSEN,E. BELL'S PALSY; THE SPONTANEOUS COURSE OF 2,500 PERIPHERAL FACIAL NERVE PALSIES OF DIFFERENT ETIOLOGIES. ACTA OTO-LARYNGOLOGICA. SUPPLEMENTUM 2002;549:4-30
Holland NJ, Weiner GM. Recent developments in Bell's Palsy. BMJ 2004; 329(7465):553-7
Murakami, S. et al. Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann. Intern. Med. 124, 27–30 (1996).
Moran LB, Graeber MB. The facial nerve axotomy model. Brain Res Rev 2004;44(2–3):154–78.
Rhoton AL., Jr. Afferent connections of the facial nerve. J Comp Neurol 1968;133(1):89–100
Myckatyn TM, Mackinnon SE. A review of facial nerve anatomy. Semin Plast Surg 2004;18(1):5–11.
Oliver Z. Essentials of Physical Medicine and Rehabilitation. Academic Page; 2021.
Nshimiyimana J, Uwihoreye P, Muhigirwa JC, Niyonsega T. Neurofunctional Intervention Approaches. Neurorehabilitation and Physical Therapy: IntechOpen; 2023.
Niethamer L, Myers R. Manual therapy and exercise for a patient with neck-tongue syndrome: A case report. journal of orthopaedic & sports physical therapy. 2016;46(3):217-24.
Neville C, Beurskens C, Diels J, MacDowell S, Rankin S. Consensus Among International Facial Therapy Experts for the Management of Adults with Unilateral Facial Palsy: A Two-Stage Nominal Group and Delphi Study. Facial Plastic Surgery & Aesthetic Medicine. 2023
Glinkowski WM, Tomasik P, Walesiak K, Głuszak M, Krawczak K, Michoński J, Czyżewska A, Żukowska A, Sitnik R, Wielgoś M. Posture and low back pain during pregnancy - 3D study. Ginekol Pol. 2016;87(8):575-80.
Susanti NY, Madhav N. Exercise for Pregnancy and Pregnant Women Back Pain. STRADA JurnalIlmiah Kesehatan. 2022 May 30;11(1):15-9.
Rasyid PS, Igirisa Y. The Effect of Birthball Training to Back Pain in Third Trimester Pregnant Women in Kabila Community Health Center. Health Notions. 2019 Apr 6;3(4):173-7.
TOa, A., EAa, O. and ADa, A., 2023. Effect Of Lumbar Stabilisation on Pain Intensity and Anxiety Levels of Pregnant Women with Low Back Pain.
Mulati TS, Wahyuni T, Kuswati K, Susilowati D. Factors That Affect Back Pain In Second And Third Trimester Pregnant Women. JurnalKebidanan dan Kesehatan Tradisional. 2022 May 24:30-41.
Kisner, C. and Colby, L.A. (2012) Therapeutic Exercise: Foundations and Techniques. F.A. Davis Company, Philadelphia.
Saori Morino1,2* , Mika Ishihara3, Fumiko Umezaki3, Hiroko Hatanaka3, Hirotaka Iijima1,2, Mamoru Yamashita3, Tomoki Aoyama4 and Masaki Takahash Low back pain and causative movements in pregnancy: a prospective cohort study Morino et al. BMC Musculoskeletal Disorders (2017) 18:416 DOI 10.1186/s12891-017-1776-x
Morino S, Ishihara M, Umezaki F, Hatanaka H, Iijima H, Yamashita M, Aoyama T, Takahashi M. Low back pain and causative movements in pregnancy: a prospective cohort study. BMC Musculoskeletal Disorders. 2017 Dec;18(1):1-8.
Rabiee M, Sarchamie N. Low back pain severity and related disability in different trimesters of pregnancy and risk factors. International Journal of Womens Health and Reproduction Sciences. 2018 Oct 15;6(4).
Singh N, Desai OP. PREVENTION AND MANAGEMENT OF LOW BACKACHE IN PREGNANT WOMEN THROUGH THE USE OF EXERCISE PROGRAM AND EDUCATION BOOKLET. Indian Journal of Occupational Therapy (Indian Journal of Occupational Therapy). 2007 Dec 1;39(3).
Conder R, Zamani R, Akrami M. The biomechanics of pregnancy: A systematic review. Journal of Functional Morphology and Kinesiology. 2019 Dec 2;4(4):72.
Tampubolon E, Fransysca H. Effect of Pregnancy Exercise on Lower Back Pain in Pregnant Women in The Village of The Working Area of Medan Public Health Center. International Journal of Clinical Inventions and Medical Sciences. 2022 Mar 29:4(1):11-6.
Koukoulithras Sr 1, Stamouli A, Kolokotsios S, Plexousakis Sr M. Mavrogiannopoulou C. Koukoulithras 1, Plexousakis M. The effectiveness of non- pharmaceutical interventions upon pregnancy-related low back pain: a systematic review and meta-analysis. Cureus. 2021 Jan 30;13(1).
Kokic IS, Ivanisevic M. Uremovic M, Kokic T, Pisot R, Simunic B. Effect of therapeutic exercises on pregnancy-related low back pain and pelvic girdle pain: Secondary analysis of a randomized controlled trial. Journal of rehabilitation medicine. 2017 Feb 7,49(3):251-7.
Barakat R. Pelaez M, Montejo R, Luaces M. Zakynthinaki M. Exercise during pregnancy improves maternal health perception. a randomized controlled trial. American journal of obstetrics and gynecology. 2011 May 1,204(5).402-el
Saptyani PM, Suwondo A, Runjati R. Utilization of Back Movement Technique to Intensity of Low Back Pain in Third Trimester Pregnant Women. STRADA JurnallImiah Kesehatan. 2020 Nov 1;9(2):535-42.
Ashraf F. Kanwal R, Inam I, Kanwal M, Mahreen M, Rehman T. Comparison of Normal Vaginal Delivery with or without Antenatal Exercise in Primigravida Presenting in A Tertiary Care Hospital. Pakistan Journal of Medical & Health Sciences. 2022;16(11):721-.
Davidson M & Keating J (2001) A comparison of five low back disability questionnaires: reliability and responsiveness. Physical Therapy 2002;82:8-24.
Dehghan, F.; Haerian, B.S.; Muniandy, S., Yusof, A; Dragoo, J.L.; Salleh, N. The effect of relaxin on the musculoskeletal system. Scand. J. Med. Sci. Sports 2014, 24, e220-e229.
Amru DE, Umiyah A, Yastirin PA, Susanti NY, Ningsih DA. Effect of Deep Breathing Techniques on Intensity of Labor Pain in The Active Phase. tijossw [Internet]. 2021Dec.29 [cited 2023Jun.5];3(2):359-64.
Mohamed AS, Khedr NF, Elsherbiny EA. Effect of Practicing Sitting Pelvic Tilt Exercise on the Intensity of Pregnancy-related Lumbopelvic Pain. Int. J. Nurs. 2020 Dec;7:121-8.
Manyozo, S. D., Nesto, T., &Muula, A. S. (2019). Low back pain during pregnancy: Prevalence, risk factors and association with daily activities among pregnant women in urban Blantyre, Malawi. 31(March), 71-76.
Bryndal A, Majchrzycki M, Grochulska A, Glowinski S, Seremak-Mrozikiewicz A. Risk factors associated with low back pain among A group of 1510 pregnant women. Journal of personalized medicine. 2020 Jun 15:10(2):51.
Mota MJ, Cardoso M, Carvalho A, Marques A, Sá-Couto P, Demain S. Women's experiences of low back pain during pregnancy. Journal of back and musculoskeletal rehabilitation. 2015 Jan 1,28(2):351-7.
Shiri R, Coggon D, Falah Hassani K. Exercise for the prevention of low back and pelvic girdle pain in pregnancy: A meta-analysis of randomized controlled trials. European Journal of Pain. 2018 Jan;22(1):19-27
Öztürk G, GelerKülcü D, Aydoğ E, Kaspar Ç, Uğurel B. Effects of lower back pain on postural equilibrium and fall risk during the third trimester of pregnancy. The Journal of Maternal-Fetal& Neonatal Medicine. 2016 Apr s17;29(8):1358-62.
Gutke A, Boissonnault J, Brook G, Stuge B. The severity and impact of pelvic girdle pain and low-back pain in pregnancy: a multinational study. Journal of women's health. 2018 Apr 1;27(4):510-7.
Casagrande D, Gugala Z, Clark SM, Lindsey RW. Low back pain and pelvic girdlepain in pregnancy. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2015 Sep 1;23(9):539-49.
Haakstad LA, Bø K. Effect of a regular exercise programme on pelvic girdle and low back pain in previously inactive pregnant women: a randomized controlled trial. Journal of rehabilitation medicine. 2015 Mar 5;47(3):229-34.
Biviá-Roig G, Lisón JF, Sánchez-Zuriaga D. Effects of pregnancy on lumbar motion patterns and muscle responses. The Spine Journal. 2019 Feb 1;19(2):364-71.
Gutke A, Betten C, Degerskär K, Poousette S, Olsén MF. Treatments for pregnancy- related lumbopelvic pain: a systematic review of physiotherapy modalities. Acta ObstetGynecolScand 2015; 94: 1156-1167
Arif A, Shahid G, Siddique MA, Aziz K, Fahim MF. Effects of exercises on pregnancy related low back pain: a quasi experimental study. Journal of Bahria University Medical and Dental College. 2018;8(3):163-7.
Pangaribuan IK, Lubis K, Yanti S, Sibarani L. Pregnancy Exercises on Reducing Lower Back Pain In Pregnant Women Trimester II and III. Journal of Maternal and Child Health Sciences (JMCHS). 2023 Dec 31;3(2):95-100.
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