Does electrical stimulation improve motor recovery in patients with idiopathic facial (Bell) palsy?

The purpose of “Evidence in Practice” is to illustrate how evidence is gathered and used to guide clinical decision making. This article is not a case report. The examination, evaluation, and intervention sections are purposely abbreviated. A 35-year-old woman was referred to our clinic with the diagnosis of Bell palsy, a unilateral facial palsy of unknown etiology. The patient reported that she first noticed the problem when she awoke 2 days ago and saw that her face “was distorted and deviated towards the right side.” She stated that she was recovering from a recent respiratory tract infection and that the evening before the facial symptoms appeared, she experienced pain in the mastoid region. Upon observing the facial asymmetry, the patient was concerned that she was having a stroke. The patient saw her primary care physician who diagnosed her as having Bell palsy after having ruled out a tumor, stroke, and Lyme disease by physical examination, magnetic resonance imaging studies, and laboratory tests including blood work. The physician prescribed acyclovir and prednisolone and suggested a consultation with a physical therapist for management of her facial muscle weakness. Upon arrival in our clinic, the patient expressed great concern that her facial weakness would interfere with her work as a lawyer and indicated that she was willing to adhere to any treatment regimen that would enhance her chances of early and optimal recovery. Our examination of the patient's vital signs revealed a heart rate of 76 bpm and blood pressure of 126/80 mm Hg. The neurologic examination revealed facial asymmetry at rest with drooping of the corner of the mouth and some accumulation of saliva on the left side of the mouth and a decrease in the prominence of the nasal labial fold. Sensation over the left side of the face was intact; …