Rehabilitation team approach for the treatment in facial palsy in a multicentric clinical practice. Consensus guide

Introduction/Background The treatment for facial palsy is complex and requires specialized units as well as a multidisciplinary team to assess the patient globally and respond to the problems of each phase. To unify criteria and define the best treatment for each phase of the facial palsy, to improve facial function and quality of life. Material and method Both doctors and physical therapists from the Facial Palsy Units from the Rehabilitation Services of two university hospitals in Barcelona, Spain, got together to revise scientific articles, share clinical experiences and introduce new technique for facial palsy management. Afterwards, a consensus document was created as a protocol for both medical centers. Results Consensus on best treatment for each phase was achieved, as follows: – hypotonic phase: neurosensory stimulation through Perfetti method, proprioceptive and cognoscitive activities with neurosensory feedback, and movement induction by neuromuscular training (ill side). Treatment with botulinum toxin helps diminish hypercontractility of the sound side; – initiation of movement: neuromuscular training and Perfetti's neuromuscular stimulation; – synkinetic phase: neuromuscular retraining with dissociated movements of the synkinetic muscles. Relaxation treatment of the maintained muscle contractures. Treatment with botulinum toxin helps control aberrant movements and induces facial symmetry. Myofascial techniques (dry needling and mesotherapy) may help diminish maintained muscular contraction. After dynamic surgery, treatment must be based on the physiology of the reconstruction implemented, inducing movement according to the given nervous stimuli. In congenital/obstetric palsies, treatment will be similar to that of adults’ Bell's palsy, adjusting treatment to patient's age. Conclusion We believe this consensus will allow for a better clinical practice, to offer the patient the best treatment to improve functionally, mentally and socially, thus improving quality of life.