Facial Paralysis & Bell’s Palsy Rehabilitation

Experiencing acute facial paralysis can be scary as one might suspect it's a stroke, but unless you experience paralytic symptoms in the arms and legs, and speech slur, it's not a stroke, neither is it life-threatening.

A simple pneumonic can help you spot a stroke and respond in a better way.

F - Facial drooping
A - Arms weakness
S - Speech difficulty
T - Time to call 911

Even if the symptoms are limited to your face, you must see a doctor for early diagnosis and treatment. Rehabilitation for facial paralysis depends on the extent of damage to your facial nerve and how long it has been since. Truwell Physical Therapy provides PT and speech therapy for facial paralysis by our trained and qualified team of professionals.

Let's discuss the usual course of the disease.

Facial paralysis is the weakness of your facial muscles due to an insult to the facial nerve. It is either injured at the level of brain, which is in case of a stroke, leading to paralysis of lower half of the face (forehead is not affected). Or, it is damaged somewhere in the lower region, which leads to paralysis of a complete half of the face. The former is called central facial palsy while the latter is called peripheral facial palsy.

Causes of Peripheral Facial Palsy include:


  • Herpes Zoster Infection can lead to Ramsay Hunt Disease, which affects the facial nerve. It is often accompanied by a rash and damage to hearing and balance. The recovery period is extensive, owing to complications due to infection.
  • Tick-borne infection i.e., Lyme Disease is another cause of facial paralysis in 10% of patients, 25% of which may suffer from bilateral facial paralysis.


  • Fractures of the skull near the jaw and ear region may cause damage to the facial nerve and lead to paralysis.
  • Surgical interventions for the above-mentioned fractures may also cause facial paralysis as the nerve may be accidentally damaged during the procedure.


Compression by a tumor or an injury to the facial nerve sustained during the surgical removal of the tumor can cause facial paralysis.

Idiopathic Facial Paralysis - Bell's Palsy

There's no known underlying reason for bell's palsy, which is the most common cause of acute facial paralysis. The risk factors include pregnancy, diabetes, obesity, ear infection, stress, and so on.

Signs and Symptoms of Facial Palsy

  • Droopiness of the affected side of the face
  • Pain in the inner ear
  • Altered sense of taste
  • Dryness of eye
  • Lack of proper blinking in the affected eye
  • Drooling due to an inability to close the mouth completely
  • Improper speech due to weak lip movement and loss of lip seal leading to difficulty in sounding certain alphabets like m, b, p, etc.
  • Difficulty eating
  • Sensitivity to loud noises

Facial Palsy Treatment

Treatment of Facial Palsy is based on the underlying causes that we discussed earlier. The course of treatment and disease prognosis is clarified after standardized medical tests such as blood work, imaging, ENT screening, and EMG until the physician reaches a diagnosis.

The general treatment options include:

  • Course of antibiotics
  • Localized steroid injections
  • Surgical repair of the nerve
  • Physiotherapeutic rehabilitation of nerve and muscle weakness

Over 70% of individuals regain full function within six months of the paralysis while some individuals may sustain some loss of function for the rest of their lives.

Bell's Palsy Treatment

Bell's Palsy is a condition in which the underlying cause of facial paralysis is unknown even after all medical tests. The condition may only be treated with a conservative therapeutic regime. A similar approach is used for facial palsy alongside the disease-specific treatment.

Dry Eye Care

The loss of blinking movement in the droopy eye and reduced tearing cause dryness of the eye, which may last from weeks to months. This causes a risk of corneal ulcer and vision damage, which is why appropriate eye care should be started as soon as possible. This includes:

  • Managing hydration with a healthy water intake (8 glasses per day).
  • Regular use of lubricating eye drops.
  • Use of lubricating ointment and taping the eye shut, during sleep.
  • Protection from wind and air-conditioning.
  • Use of humidifiers at home and at the workplace.
  • Use of scleral lenses.

In chronic cases, blinking deficiency of the eye is corrected surgically.

Dry Mouth Care

Improper lip seal and reduced production of saliva lead to dry mouth in individuals with Bell's Palsy. This can lead to a number of problems.

  • Saliva is important for gum health and prevents tooth decay. It is recommended to maintain good hygiene and use special toothpaste and mouthwash that doesn't have alcohol content, which can act as a drying agent.
  • Lack of saliva means loss of lubrication in the mouth. Keeping a water bottle handy and frequently sipping water is helpful. Add gravy and sauces to your meals to compensate for the lack of lubrication.
  • Avoid smoking, alcohol, and caffeine.

Drinking and Eating

Facial palsy can make it difficult to eat or drink with a dysfunctional lip seal and there might be a lot of mess while doing so. Here are a few steps that make help prevent that:

  • Have a soft chewable diet and avoid hard and excessively chewy foods.
  • Avoid foods with mixed consistency such as milk and cereal.
  • Avoid dry, crumbly foods, as they may trigger a cough.
  • Use a Kapi-cup for water so you don't have to tip your head back while drinking water, as that may lead to coughing or choking.
  • After meals, clear out food bits with your finger, for better hygiene.
  • Your food intake will reduce, so adding dietary supplements will be a wiser step for maintaining good health.


  • Talk slowly, while facing the listener so they can understand you through lip reading.
  • Support your floppy cheek with your palm while you're talking.
  • Frequently sip water during presentations to prevent dry mouth.

Physical Therapy for Bell's Palsy

PT for Bell's Palsy includes retraining the neuromuscular function through exercises and electrical modalities. It includes:

  • Massage therapy: to improve blood flow in the affected area and induce relaxation of muscles.
  • Relaxation and Breathing Exercises: to prevent muscle twitch or spasms due to stress.
  • Assisted Exercise: to help initiate movement and retrain the muscle for certain movements.
  • Active Movement: so the muscle learns to perform controlled movements.
  • Resisted Exercise: to increase the strength and endurance of the muscles, so they can function for longer durations without fatigue.
  • Task-Specific Movements such as:
    • Blowing through a straw
    • Pouting while sucking your cheeks in
    • Tongue spread over the teeth
    • Smiling
    • Looking up or down

Your therapist will guide you through the rehabilitation regime, and prescribe home exercises to retain progress.

Remember, consistency is the key here, for a quicker recovery. But your focus should be on the quality of movement, not the number of repetitions.

NOTE: Forcing or overworking the paralyzed muscles can lead to faulty rewiring of the nerve function, called synkinesis. This means that your intentional action and the resultant action of the muscle will not be coordinated. It is a common problem about which your therapist will also guide you. If you develop Synkinesis, there's a special therapy designed for its rehabilitation that goes on for over a year. It is known as Mime Therapy.

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