Journal of Novel Physiotherapies
Open Access

EMS: Electrical Muscle Stimulation; SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2; RT-PCR: Real- Time reverse transcription-Polymerase Chain Reaction; COVID-19: Coronavirus Disease 2019; MRI: Magnetic Resonance Imaging; HSV: Herpes Simplex Virus.

Bell’s palsy is an acute disorder of the facial nerve, which produces full or partial loss of movement on one side of the face. The ongoing COVID-19 pandemic has affected millions of people worldwide and revealed several neurological syndromes related to this infection. Acute facial nerve palsy commonly occurs in clinical practice [1]. Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is a newly discovered coronavirus that presents with a multitude of different symptoms and signs. The most described presentation is when the virus infects the cells using the angiotensin-converting enzyme 2 (ACE2) receptor, leading to respiratory compromise of varying degrees. However, the clinical picture of coronavirus disease 2019 (COVID-19) infection varies widely and SARS-CoV-2 has been implicated in a number of different signs and symptoms that were found to cause widespread systemic infections, of which respiratory complications similar to SARS-CoV-2 were most recognizable. Nervous system manifestations, including dizziness, headache, muscle damage, ischemic, and hemorrhage stroke, were also commonly reported [2]. Bell’s palsy is a neuromuscular disorder that is treated by physiotherapists. In addition to the range of modalities that are used to either promote recovery or prevent degeneration in the nerve and muscles [3]. Seventh cranial nerve paralysis arises from a variety of causes involving upper or lower motor neuron lesions. The prognosis depends on the type of lesion. Lower motor neuron problems arising from viral disorders or Bell’s palsy can show spontaneous recovery, although there may be some residual weakness. Seventh cranial nerve damage affects all the muscles of facial expression. Clinically, the most important consequence is paralysis of the upper eyelid on the affected side [4]. The degree of facial nerve recovery depends on patient’s age, lesion type, nerve nurturing, neuromuscular involvement and physiotherapy [5].

To evaluate the effects of physiotherapy management with EMS, and taping for bell’s palsy

Case Presentation

A 55-year-old male with past medical history of hypertension presented with complaint of left facial drooping and unable to closing left eye and weakness of two weeks duration. He did not have any other contributory past medical, surgical, social, or family history, however no fever, runny nose, cough and other symptoms. On physical examination showed left peripheral facial paralysis without herpes zoster, which did not reveal findings that explained the weakness in his bilateral upper and lower extremities. Brain magnetic resonance imaging (MRI) showed no abnormality. The results of consecutive realtime reverse transcription-polymerase chain reaction (RT-PCR) tests were positive for SARS-CoV-2 RNA through nasal and throat swabs. The blood routine test and C-reactive protein level were both normal. He was eventually diagnosed with confirmed COVID-19 positive complicated with Bell’s palsy. Therefore treatment was started. The patient completed a course of physiotherapy with EMS and tapping 45 days 90 sessions. The patient maintained independent respiratory integrity and his muscle function improved. The physiotherapy started after 14 days of home quarantine with proper precaution mask and gloves (Figures 1-14).

The results show that the physiotherapy sessions obtained the effect of physiotherapy management with EMS, taping in the treatment of Bell’s palsy, highly respondents to recovery (Tables 1 and 2).

Table 1: Patient Characteristic.

Table 2: Pre- & Post-intervention Mean ± SD, Mean Difference (95% CI), p values & Effect Size data of both groups.

We are in the exponential phase of learning about COVID-19, an emerging infectious disease, which has caused an ongoing global pandemic. Facial nerve palsy can be associated with infections, most commonly HSV and HIV, Lyme disease, and Mycobacterium tuberculosis. The exact pathogenesis of acute facial nerve palsy remains unclear, but in association with neurotropic herpesviruses (HSV), it is thought to be related to axonal spread and viral replication leading to inflammation and demyelination [6].

The rapid expansion of COVID-19 pandemics led to the development of a growing number of neurological syndromes. Our study shows that facial palsy can occur during the clinical course of COVID-19 or anticipate other typical manifestations such as fever and respiratory symptoms [1].

The effect of physiotherapy management with Electrical Muscle Stimulation (EMS) and taping for Bell’s palsy outcome improved. Facial exercises can help to improve facial function, mainly for people with facial paralysis acute and chronic cases, early physiotherapy management with EMS may improve functional recovery.

The study recommends that the physiotherapists and patients should use the physiotherapy sessions with follow-up that include EMS and facial exercise complete all sessions of treatment.

Conflict of interest - The authors declare that they have no conflict of interest.