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Effectiveness of Electrical Stimulation with Mime Therapy Versus Electrical

Stimulation with Motor Imagery Technique in Patients with Bell's Palsy: A
Comparative Study

Article  in  International Journal of Science and Research (IJSR) · September 2021

DOI: 10.21275/SR21327101533

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 International Journal of Science and Research (IJSR)
ISSN: 2319-7064
SJIF (2019): 7.583

Effectiveness of Electrical Stimulation with Mime

Therapy Versus Electrical Stimulation with Motor
Imagery Technique in Patients with Bell’s Palsy: A
Comparative Study
Preksha Prajapati1, Shivani Patel2
1
Intern, Nootan College of Physiotherapy, Sankalchand Patel University, Visnagar, India
Email ID: prekshaprajapati1998[at]gmail.com,
2
Tutor, Nootan College of Physiotherapy, Sankalchand Patel University, Visnagar, India
Email ID: dr.srp12345.sp[at]gmail.com

Abstract: Background: Bell’s palsy is an acute-onset Peripheral facial pathology and is the commonest explanation for lower motor nerve
fiber facial palsy. The physical therapy treatment for Bell’s palsy includes Electrical stimulation of affected facial muscle and mime therapy.
Aim: To seek out whether there is any significant difference between effectiveness of electrical stimulation with Mime therapy and electrical
stimulation with motor imagery technique in patients with Bell’s Palsy. Objective: To improve motor function and strength of facial muscles.
Methodology: On the premise of inclusion and exclusion criteria 30 participants were elect. They were treated with Electrical stimulation
with Mime therapy and electrical stimulation with motor imagery technique for 5 days / week for 6 weeks, subsequently that re-assessment
was infatuated HBS, MMT and SD curve. Results: using SPSS Version 26.Parametric test was used. In Group A improvement was seen The
data was analyzed. Conclusion: Electrical stimulation with mime therapy is effective to improve strength and motor function in patients with
Bell’s Palsy.

Keywords: Bell’s Palsy, Electrical Stimulation, Mime Therapy, Motor Imagery Technique, Facial Muscles

1. Introduction In Electrical stimulation, the stimulation is given to the

paralyzed muscles that are dennervated and to the nerve trunks
Bell’s palsy can be defined as unilateral paralysis of the facial or branches till the voluntary movement returns.[9] The nerve
muscles resulting from an intrinsic lesion of the facial nerve.[1] impulses to the muscles are blocked due to the lesion in facial
Bell’s palsy is an acute-onset of Peripheral facial neuropathy nerve, by giving electrical stimulation the external stimulus
and is the commonestreason for lower motor neuron facial can produce electric impulses which helps in restoring the
palsy. [2] The term Bell’s palsy was coined by sir Charles Bell muscle properties. [9]
in 1774-1842. [3]It affects males and females equally , and has
a slightly higher incidence in middle and later life, but Mime therapy is a type of physiotherapy. It was created to
certainly occurs across all age ranges.[4] help patients who had limited or restricted facial movement or
a lack of facial muscle control.[10]The aim of mime therapy is
The causes can be compression of facial nerve along the nerve to promote symmetry of the face at rest and through
course, herpes infection, exposure to cold air, middle ear movement.[10] Components of Mime therapy include:-
infections, traumatic injuries or post surgeries of dental and 1) Anamnesis, patient information about treatment and
ear, nose or throat.[6] prognosis.
2) Self massage of face and neck.
The common features are loss of forehead wrinkles and 3) Breathing and relaxation exercises.
inability to close frown, Droopy eyebrow and inability to raise 4) Specific exercises to co-ordination both facial halves and
eyebrow, Inability to close the eye fully or blink, Watery eye to decrease synkinesis.
(crocodile tears), Inability to squint, Painful eye with 5) Eye and lip closure exercises.
symptoms of grittiness or imitation, sensitivity to light, 6) Expression exercises.[10]
drooling from the weak corner of your mouth, excess or
reduced salivation (dry mouth), Inability to flare nostril, Loss Motor imagery can be defined as a dynamic state during which
of taste in anterior 2/3rd of the tongue, Hyperacusis.[7] an individual Mentally stimulates a physical action. This kind
of extraordinary expertise implies that the subject feels
The physiotherapy treatment for Bell’s palsy includes themselves that performing the action.[11]Motor imagery can
Electrical stimulation of affected facial muscle and mime act as a substitute for the imagined behavior, producing
therapy.[8] similar effects on cognition and behavior.[12]
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Licensed Under Creative Commons Attribution CC BY
Paper ID: SR21327101533 DOI: 10.21275/SR21327101533 1669
 International Journal of Science and Research (IJSR)
ISSN: 2319-7064
SJIF (2019): 7.583
2. Methodology  Blow your cheeks

Participants of male and female with the age was between 20 3rd week :-
to 40 years of age, having Bell’s palsy,Clinically diagnosed a) Electrical stimulation
patients of Bell’s palsy, and who were willing to be a part of b) Mime Therapy :- (Infront of Mirror)
the study were included in the study. These individuals were  Facial massage following the muscular fiber direction
informed about the study and the procedure was clearly (only during the session)
explained to all. An informed and written consent was  Frowning
obtained from the subjects those who agreed to be a part of the  Smile
study that was to be conducted.The participants which were  Close eyes without support
selected were then randomly assigned in to 2 groups A and B.  Fish face
Thirty subjects with mean age of 32.6 ± 6.25(mean ± SD)  Eyebrow raising
became a part of the study. The participants underwent a  Breathing exercises
detailed pre-evaluation. The pre-evaluation included an  Blow your cheeks
Neurological assessment which obtained information about  Mouth opening and closing
demographic details, medical history, personal history,
functional scale, muscle strength and Motor function of the 4th week :-
subjects.Subjects who fulfilled the selection criteria were a) Electrical stimulation
informed about the study and requested to sign written b) Mime Therapy:- (Infront of Mirror)
informed consent forms.In this study SD curve, House-
 Facial massage following the muscle fiber direction
Brackmann facial paralysis scale and MMT of facial muscle
(only during the session)
were used as outcome measures. Experiments were conducted
 Frowning
on 15 subjects in Group A, 15 subjects in Group B. Group A
was treated with Electrical stimulation with Mime therapy and  Close eyes
Group B was given Electrical stimulation with Motor imagery  Smile
technique. The treatment protocol consisted of 5  Fish face
sessions/week for 6 weeks.After 6 weeks of treatment the  Eyebrow raising
participants of both groups underwent post-evaluation and the  Breathing exercises
pre and post- treatment data were noted.  Moving lips side to side
 Mouth opening and closing
3. Intervention  Chewing exercise
 Blow a candle
Group A: Electrical Stimulation With MIME Therapy  Nasal flaring

1st week:- 5th week :-

a) Electrical stimulation:- 30 contraction, 3 set, 100 duration a) Electrical stimulation
b) Mime Therapy:-(Infront of mirror) b) Mime Therapy:- (Infront of Mirror)
 Facial massage following the muscular fiber direction.  Close eyes with resistance
(only during the session)  Smile with resistance
 Frowning (passive)  Frowning
 Close eyes (passive)  Eyebrow raising
 Smile(passive)  Fish face
 Fish face (passive)  Moving lips side to side
 Eyebrow raising (passive)  Nasal flaring
 Breathing exercises  Blow a candle
 Sucking air with help of straw
2nd week  Chewing exercise
a) Electrical stimulation  Breathing exercises
b) Mime Therapy:- (Infront of Mirror)  Rinse mouth
 Facial massage following the muscular fiber direction.  Speaking vowels
(only during the session)
 Frowning (passive) 6th week:-
 Close eyes (passive) a) Electrical stimulation
 Smile, 3 times with digit support and 3 times without digit b) Mime Therapy :- (Infront of Mirror)
support.  Close eye with resistance
 Fish face (passive)  Smile with resistance
 Eyebrow raising (passive)  Frowning with resistance
 Breathing Exercises
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Licensed Under Creative Commons Attribution CC BY
Paper ID: SR21327101533 DOI: 10.21275/SR21327101533 1670
 International Journal of Science and Research (IJSR)
ISSN: 2319-7064
SJIF (2019): 7.583
 Eyebrow raising with resistance  Then ask the patient to relax the all parts of the body.
 Fish face  Then ask the patient to take a deep breath and exhale
 Rinse mouth slowly.
 Nasal flaring  Then ask the patient to imagine that ―you are showing
 Fill mouth with water (30-45 sec) your angary face‖, ―you are closing and open your eyes‖,
 Fill rubber balloon ―you are smiling‖, ―you are pouting‖, ―you are raising your
 Chewing exercise eyebrows‖, ―you are blowing your cheeks‖, ―you are
 Sucking water with help of straw opening and closing your mouth‖.
 Speaking vowels
 Breathing exercises Week:-4th
a) Electrical stimulation
b) Motor imagery technique:- (perform in a silent room)
Group B: Electrical Stimulation With Motor Imagery
Technique  First ask the patient to sleep on the plinth and close the
eyes.
Week:- 1st+  Then ask the patient to relax the all parts of the body.
a) Electrical stimulation :- 30 contraction, 3 set, 100 duration  Then ask the patient to take a deep breath and exhale
b) Motor imagery technique:- (perform in a silent room) slowly.
 First ask the patient to sleep on the plinth and close the  Then ask the patient to imagine that ―you are showing
eyes. your angary face‖, ―you are closing and open your eyes‖,
 Then ask the patient to relax the all parts of the body. ―you are smiling‖, ―you are pouting‖, ―you are raising your
 Then ask the patient to take a deep breath and exhale eyebrows‖, ―you are blowing your cheeks‖, ―you are
slowly. opening and closing your mouth‖. ―you are doing nasal
flaring‖, ―you are blowing the candle‖, ―you are deviating
 Then ask the patient to imagine that ―you are raising your
your lips side to side‖, ―you are chewing something‖.
eyebrows", "you are showing your angary face‖, ―you are
closing and open your eyes‖, ―you are smiling", "you are
pouting‖. Week:- 5th and 6th
a) Electrical stimulation
b) Motor imagery technique:- (perform in a silent room)
Week:- 2nd
a) Electrical stimulation  First ask the patient to sleep on the plinth and close the eyes.
b) Motor imagery technique:- (perform in a silent room)  Then ask the patient to relax the all parts of the body.
 First ask the patient to sleep on the plinth and close the  Then ask the patient to take a deep breath and exhale
eyes. slowly.
 Then ask the patient to relax the all parts of the body.  Then ask the patient to imagine that ―you are raising your
 Then ask the patient to take a deep breath and exhale eyebrows‖, ―you are showing your angary face‖, ―you are
slowly. closing and open your eyes‖, ―you are doing nasal flaring‖,
―you are blowing air from your mouth‖, ―you are drinking
 Then ask the patient to imagine that ―you are showing your
angary face‖, ―you are closing and open your eyes‖, ―you water with the help of straw‖, ―you are blowing the
candle‖, ―you are smiling‖, ―you are deviating your lips
are smiling‖, ―you are pouting‖, ―you are raising your
side to side‖, ―you are pouting‖, ―you are chewing
eyebrows‖, ―you are blowing your cheeks‖.
something‖, ―you are speaking vowels‖.
Week:- 3rd
a) Electrical stimulation  I will give 15-20 seconds in between each instruction, to the
b) Motor imagery technique:- (perform in a silent room) patients to imagine the movement.
 First ask the patient to sleep on the plinth and close the
eyes.

Electrical stimulation for facial muscles Mime therapy Infront of Mirror

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Paper ID: SR21327101533 DOI: 10.21275/SR21327101533 1671
 International Journal of Science and Research (IJSR)
ISSN: 2319-7064
SJIF (2019): 7.583

Motor Imagery Technique

4. Result Table 1: Pre and Post treatment values of Group A

Pre-Treatment Post-Treatment
Group A
Pre and post-treatment data of the participants of both groups Mean ± SD Mean ± SD
were noted. All statistical analysis was done using SPSS 26 HBS 1.9 ± 0.79 5 ± 0.5
MMT 1.5 ± 0.0 1.92 ± 0.19
software for windows. Descriptive analysis was obtained by
using mean & standard deviation. The intergroup comparison
between Group A and B of pre-treatment and post-treatment Table 2: Pre and Post Treatment values of Group B
Pre-Treatment Post-Treatment
of House-Brackmann scale was done by paired t-test and Group B
Mean ± SD Mean ± SD
Manual Muscle Testing was done byWilcoxson sign ranked HBS 2.46 ± 0.79 3.3 ± 0.74
test.The intragroup comparison of pre-treatment and post- MMT 1.5 ±0.0 1.58 ± 0.054
treatment of House-Brackmann scale within Group A and
Group B was done by unpaired t-test and Manual Muscle
Testing within Group A and Group B was done by Mann-
Whitney U test.

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Licensed Under Creative Commons Attribution CC BY
Paper ID: SR21327101533 DOI: 10.21275/SR21327101533 1672
 International Journal of Science and Research (IJSR)
ISSN: 2319-7064
SJIF (2019): 7.583

Similar graphs of SD curve were found in other subjects that and maintains muscle properties. Visual feedback has shown
were a part of the study. to manage muscle activities in facial muscle. Also miming
demands extraordinarily refined sense of body and muscle
The results found in this study disclosed that after a six-week control. mime therapy has shown to create new growth and
treatment program, both groups, Group A, who received increase production of collagen and connective tissue in facial
Electrical stimulation with Mime therapy and Group B who muscles and restore facial muscle action.
received Electrical stimulation with Motor imagery technique
attained a significant improvement in the strength and motor In group A, improvement in facial function could be because
function of facial muscles. But statistically greater significant of Mime therapy and Electrical stimulation could be a
improvement was seen in Group A as compared to Group B (p combination of an active movement with simultaneous passive
value < 0.05). stimulation that helps in fast restoration of facial function.
Mime therapy found to be effective by neuro physiological
5. Discussion mechanism of production of extremely refined sense of muscle
control. This treatment technique produces a complete and
The results found throughout this study disclosed that when a immediate recovery of facial function.
six-week treatment program, eachgroup, Group A, who
received Electrical stimulation with Mime therapy and Group Teresa Paolucci (2019) declared that Motor imagery
B who received Electrical stimulation with Motor imagery technique is effective in improving facial physical function
technique attained a significant improvement in the strength and that they contained psycho-emotional distress and
and Motor function of Facial muscles. improved quality of life that is also linked to emotional and
communicative aspects of mimic expressions. It’s necessary to
Electrical Stimulation is one of the most important emphasis however, particularlywithin the early stages of the
components of rehabilitation programmes for patients with treatment and through the primary rehabilitative amount, to
Bell’s palsy. avoid synkinesis, the exercise respect to the myofascial facial
maneuvers is performed passively, and the patient is not
Sharvani Belle Praveen Kumar (2018) declared that Mime required to recruit any muscles.
therapy is beneficial because massage improves circulation
Volume 10 Issue 3, March 2021
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Paper ID: SR21327101533 DOI: 10.21275/SR21327101533 1673
 International Journal of Science and Research (IJSR)
ISSN: 2319-7064
SJIF (2019): 7.583
Lotzs and Cohen (2006) declared that Motor imagery is a [5] Kennedy PG. Herpes simplex virus type 1 and Bell’s
cognitive process in which a subject imagines that he=she palsy—a current assessment of the controversy. Journal
performs a movement without actually performing the of neurovirology. 2010 Jan 1;16(1):1-5.
movement and while not even tensing the muscles. It is a [6] Peitersen E. Bell's palsy: the spontaneous course of
dynamic state throughout that the illustration of a particular 2,500 peripheral facial nerve palsies of different
motor action is internally activated with none motor output. In etiologies. Acta Oto-Laryngologica. 2002 Jan
other words, motor imagery needs the aware activation of 1;122(7):4-30.
brain regions that also are concerned in movement preparation [7] Rowland L, Merritt H. Merritt's neurology. Philadelphia:
and execution, accompanied by a voluntary inhibition of the Lippincott Williams & Wilkins; 2005.
particular movement. [8] Singh, J., n.d. Textbook Of Electrotherapy.
[9] Nelson, R., Hayes, K. and Currier, D., 2005. Clinical
This study was conducted on thirty subjects with mean age of Electrotherapy. Taipei: Pearson Education Taiwan
32.6 ± 6.25 mean ± SD). The subjects were divided into two [10] Beurskens CH, Devriese PP, Van Heiningen I,
groups; Group A received Electrical stimulation with Mime Oostendorp RA. The use of mime therapy as a
therapy and Group B received Electrical stimulation with rehabilitation method for patients with facial nerve
motor imagery technique for 1 session/day and 5 days/week paresis. International Journal of Therapy and
for 6 weeks. during this study SD curve, House-Brackmann Rehabilitation. 2004 May;11(5):206-10. Available
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outcome measures. The results showed a significant https://www.researchgate.net/publication/225026704_Th
improvement in the outcome measures in post-treatment stage e_use_of_mime_therapy_as_a_rehabilitation_method_fo
as compared to the pre-treatment stage. r_patients_with_facial_nerve_paresis.
[11] Decety J. Do imagined and executed actions share the
A significant improvement was found after treatment in Group same neural substrate?. Cognitive brain research. 1996
A in case of HBS Score as compared to Group B. A Mar 1;3(2):87-93.
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in case of MMT compared to Group B. substitute for experience. Social and Personality
Psychology Compass. 2016 Jul;10(7):405-20.
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Head Neck Surg. 1985;93:184-93.
In the experimental conditions used in the study, both the [14] Hislop, H. and Montgomery, J., 2007. Daniels And
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function of facial muscles. The use of Electrical stimulation Saunders / Elsevier.
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greater improvement in Strength and Motor function of facial patterns of idiopathic facial paralysis: a 16-year study.
muscles when compared to Electrical stimulation with motor Otolaryngol Head Neck Surg 1999;120:269–71
imagery technique ( Group B).

7. Limitations
1) Long term follows up of the patients was not taken.
2) The study includes treatment period of 6 weeks only.
3) The study involves small sample size.

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