Effects of exercises on Bell's palsy: Systematic review of randomized controlled trials

Objective: This study examined the effects of facial exercises associated either with mirror or electromyogram (EMG) biofeedback with respect to complications of delayed recovery in Bell's palsy. Patients: Patients with unilateral idiopathic facial palsy were included in this review. Interventions: Facial exercises associated with mirror and/or EMG biofeedback as treatment. Main Outcome Measure: Report of facial symmetry, synkinesis, lip mobility, and physical and social aspects. Results: Four studies of 132 met the eligibility criteria. The studies described mime therapy versus control (n = 50), mirror biofeedback exercise versus control (n = 27), "small" mirror movements versus conventional neuromuscular retraining (n = 10), and EMG biofeedback + mirror training versus mirror training alone. The treatment length varied from I to 12 months. Conclusion: Because of the small number of randomized controlled trials, it was not possible to analyze if the exercises, associated either with mirror or EMG biofeedback, were effective. In summary, the available evidence from randomized controlled trials is not yet strong enough to become integrated into clinical practice.