Bell's palsy is an acute,unilateral facial paresis that significantly affects patient's facial symmetry,motor function and quality of life.The primary goal of this randomized controlled trial is to determine if integrating the targeted neural mobilization with proprioceptive neuromuscular facilitation improves facial symmetry and motor function more effectively than using pnf alone.participants allocated to either experimental group receiving neural mobilization and pnf or control group receiving pnf alone.after approval from ERC FUSH, participants are assessed using housebrackman scale and sunnybrook facial grading system(scales to asses the degree of severity of facial paralysis) at first and fourth week of intervention application.data will be analysed using spss v.22.
Age 15-60 years.
Both male and female.
Patient diagnosed with bells palsy by neurologist or relevant specialist.
Patients with moderate to severe Bell's palsy evaluated by Modified House-Brackman SCALE
Patients with a history of recurrent Bell's palsy or other neurological disorders (e.g., stroke, multiple sclerosis)
Patients with pacemakers, metal implants or other contraindications for electrical muscle stimulation.
Presence of facial trauma or surgical interventions that might interfere with rehabilitation outcomes.
Co-existing medical conditions (e.g., diabetes mellitus, infections, or malignancies) that might impair nerve recovery or affect study outcomes
Parallel
GROUP A COMBINED THERAPY GROUP
Procedure/SurgeryReceives proprioceptive neuromuscular facilitation (pnf), neural mobilization and conventional therapy. DESCRIPTION * PNF using rhythmic initiation and resisted voluntary movements directed at the frontalis, orbicularis oculi, zygomaticus major and minor, orbicularis oris and buccinator; three to five repetitions per pattern, three to four sets per session. Progression governed as tolerated with resistance and repetitions increased as recovery allowed. * Gentle facial nerve mobilization within a pain-free range, ten to twelve minutes per session; six to ten repetitions per technique or thirty to sixty seconds per glide, advancing glide range as tolerated. * Conventional therapy; clinic-based facial expression exercises with interrupted galvanic stimulation (rectangular waveform, 100 ms, 3 sets × 30 contractions), 2-3 sessions weekly, 15-20 minutes; plus daily home facial exercises with mirror feedback (smiling, blinking, puckering), 10-15 minutes.
GROUP B PNF GROUP
Procedure/SurgeryReceives proprioceptive neuromuscular facilitation and conventional therapy. DESCRIPTION * Proprioceptive neuromuscular facilitation, using rhythmic initiation and resisted voluntary movements. Progression governed by the participant's tolerance and motor control, with resistance and repetitions increased as recovery allowed. * Conventional therapy: clinic-based facial expression exercises with interrupted galvanic stimulation (rectangular waveform, 100 ms, 3 sets × 30 contractions), 2-3 sessions weekly, 15-20 minutes; plus daily home facial exercises with mirror feedback (smiling, blinking, puckering), 10-15 minutes.
Symmetry of face
It is measured by Sunnybrook facial Grading system (SFGS) SFGS Score = (Voluntary Movement Score) - (Synkinesis Score) - (Resting Symmetry Score) Minimum value: 0 (Complete paralysis) Maximum value: 100 (Normal facial function) Higher scores indicate a better outcome
Severity of facial paralysis
It is measured by the House-Brackmann scale. Patients graded IV-VI show severe impairment, and patients graded I-III have mild-to-moderate dysfunction. Minimum value: I (Normal facial function) Maximum value: VI (Total paralysis) Outcome interpretation: Higher scores indicate a worse outcome
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