Motor Imagery and Mirror Therapy on Synkinesis, Facial Asymmetry, Facial Function and QoF in Bell's Palsy Patients.

Bell's palsy is a condition that causes sudden weakness in the muscles on one side of the face. The weakness makes half of the face appear to droop, difficulty in closing eyes and synkinesis. These symptoms significantly impact facial symmetry and quality of life. Mirror therapy and Motor imagery have shown promise in improving motor function and overall well-being. The primary objective of this study is to compare the effects of the Mirror therapy and Motor Imagery on facial symmetry, synkinesis and quality of life in patients with Bell's palsy. This randomized clinical trial will be carried in 10 months after the approval of synopsis. Total number of 36 participants meeting the inclusion criteria will be included in this study through a non-probability convenience sampling technique. Participants will be randomly assigned into 2 groups using computer generated randomization method. Group A and Group participants will receive Motor Imagery and Mirror therapy, respectively. All the groups will receive interventions for five days a week for 8 weeks. Total treatment time will be 35 minutes. The outcome measuring scales used will be facial Clinometric Scale (FaCE), Synkinesis Assessment Scale and Sunnybrook facial grading system to assess facial symmetry, synkinesis and facial movements. The data will be analyze using SPSS version 28 for windows. Assessment will be carried out at baseline and four weeks, after discontinuation of treatment.

Inclusion criteria

• Age 18 years and above.
• Both genders male and female will be included.
• Patients diagnosed with Bell's palsy with relevant diagnostic criteria, including history. (tick bite, erythema migraine, pain), neurological examination including inspection of ear and infection of HIV, Herpes virus.
• Patient having asymmetry in face (Sunnybrook Facial Grading Scale SFGS, use to check asymmetry in both sides of face).
• Appearance of synkinesis on affected side (Synkinesis Assessment Scale)
• Onset of symptoms must be first week.
• Patient having sufficient, physical, and mental ability to understand instructions and cooperate throughout the session.

Exclusion criteria

• Patients diagnosed with other than Bell's palsy (e.g., facial nerve trauma) (25).
• Patients with severe co-morbidities (e.g., uncontrolled hypertension, diabetes, cardiovascular diseases).
• Patients with significant cognitive impairment or communication difficulties who have undergone previous facial nerve surgery or interventions.
• Patients with severe psychiatric conditions affecting compliance or participation and on psychiatric medications.
• Patients with central nervous system tumor.