Role of Kabat rehabilitation in facial nerve palsy. a randomised study on severe cases of Bell's palsy

The treatment of Bell's palsy (BP), based on steroids and/or antiviral drugs, may still leave a certain percentage of affected subjects with disfiguring sequels due to an incomplete recovery. The different procedures of physical rehabilitation have not proved to play a favorable role for this disorder. The aim of the present study was to compare the functional outcome of severe cases of Bell's palsy when treated by steroids alone or by steroids accompanied by Kabat physical rehabilitation. A prospective study has included 94 subjects who showed sudden facial nerve (FN) palsy with House-Brackmann grade IV or V and who were divided into two groups on the ground of the therapeutical approach: one group (a) has been treated by steroids, the other one (b) has received steroids in combination with a physical rehabilitation. The medical treatment consisted in the administration of steroids, at a dosage of 60 mg per day for 15 days; the physical rehabilitative treatment consisted in the proprioceptive neuromuscular facilitation according to Kabat, and was administered to one of the two groups of subjects. Recovery rate, degree of recovery and time for recovery were compared between the two study groups, by using the Mann-Whitney test and the univariate logistic regression statistical test (Ward test). The Kabat patients (group b) had about 20 times the odds of improving by three HB grades or more (OR= 17.73, 95%CI= 5.72 to 54.98, p< 0.001) in respect to the patients who did not receive physical treatment (group a). The mean speed of recovery in group b was the half of that recorded for group a (non Kabat subjects). No difference was instead observed in the incidence of synkineses between the two study groups. Steroid treatment could provide a better and faster recovery in the severe cases (HB IV and V) of BP when complemented with the Kabat physical rehabilitation