The "Mirror Effect Plus Protocol" for acute Bell's palsy: A randomized controlled trial with 1-year follow-up

Abstract

Objective: To study the effects of the "Mirror Effect Plus Protocol" (MEPP) on global facial function in acute and severe Bell's Palsy.

Design: Single blind and randomized controlled trial to compare the effects of basic counseling (control group) versus MEPP (experimental group) over one year.

Setting: Outpatient clinic following referrals from Emergency or Otorhinolaryngology Departments.

Subjects: 40 patients (n = 20 per group) with moderately severe to total palsy who received standard medication were recruited within 14 days of onset. Baseline characteristics were comparable between the groups.

Interventions: The experimental group received the MEPP program (motor imagery + manipulations + facial mirror therapy) while the control group received basic counseling. Both groups met the clinician monthly until 6 months and at one-year post-onset for assessments.

Outcome measures: Facial symmetry, synkinesis, and quality of life were measured using standardized scales. Perceived speech intelligibility was rated before and after therapy by naïve judges.

Results: Descriptive statistics demonstrated improvements in favor of the MEPP for each measured variable. Significant differences were found for one facial symmetry score (House-Brackmann 2.0 mean (SD) = 7.40 (3.15) for controls versus 5.1 (1.44) for MEPP), for synkinesis measures (p = 0.008) and for quality-of-life ratings (mean (SD) score = 83.17% (17.383) for controls versus 98.36% (3.608) for MEPP (p = 0.002)). No group difference was found for perceived speech intelligibility.

Conclusion: The MEPP demonstrates promising long-term results when started during the acute phase of moderately severe to total Bell's Palsy.

Keywords: Bell palsy; facial nerve diseases; facial paralysis; mirror therapy; rehabilitation; synkinesis.

Figure 1.

CONSORT 2010 Flow Diagram of this controlled randomized longitudinal trial.

Figure 2.

Longitudinal changes in (a) median House-Brackmann 2.0 (FNGS 2.0) and (b) SB synkinesis scores, according to the treatment group for the complete cohort (n = 40). Legend: House-Brackmann 2.0 or FNGS 2.0 synkinesis scores: 4 = severe synkinesis; 0 = no synkinesis. Sunnybrook synkinesis scores: 15 = severe synkinesis; 0 = no synkinesis Assessment times: Flaccid phase = 10–14 days post-onset; paretic phase: 1-, 2-, and 3- months post onset; Synkinetic phase: 4-, 5-, and 6-months post-onset; chronic phase: 1-year post-onset; Black line: MEPP participants; Dash line: Controls. SB: Sunnybrook; MEPP: Mirror Effect Plus Protocol; FNGS: Facial Nerve Grading Scale.