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Effect of Integrated Yoga and Naturopathy therapies in the

Management of Bell’s palsy – A Case Report

Indira Devi S1, Prashanth S2, Krithika C3

1Reader, H.O.D. 2Assistant medical officer/Lecturer Grade 2, Department of Yoga Philosophy,

3PG Scholar, Department of Acupuncture and Energy medicine,

Govt. Yoga and Naturopathy Medical College, Chennai, Tamil Nadu, India

ABSTRACT:
Bell's palsy is a type of facial paralysis that is unilateral in 70% of cases. Here, we report a case
of unilateral facial nerve palsy, which was diagnosed as Bell’s palsy and showed a good response
to yoga and naturopathy interventions. A 31-year-old man with Bell’s palsy on the right side
with an unknown etiology was admitted to integrated yoga and naturopathy management in
our hospital for 3 weeks. The facial grading system (FGS) for facial movement and the facial
disability index (FDI) scale for facial disability was assessed before and after the intervention.
After 3 weeks of yoga and naturopathy interventions, patients showed positive improvement in
FGS composite score from Grade VI (FGS score 46) to Grade I (FGS score 4). FDI score also
showed notable improvement in physical function (from 50 to 95), Social/Well-being subscale
(from 75 to 100) after the intervention. The findings of the present study suggest integrated
yoga and naturopathy interventions for the effective management of facial movements and
facial disability in bell’s palsy.

KEYWORDS: Bell’s palsy, Disability. Naturopathy, Yoga.

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Received: 19.10.2022 Revised: 01.12.2022 Accepted: 10.12.2022 Published: 20.12.2022
______________________________________________________________________________________________________________

Quick Response code *Corresponding Author:

Dr. Indira Devi S
Reader, H.O.D., Department of Yoga Philosophy,
Govt. Yoga and Naturopathy medical college, Chennai
Tamil Nadu, India.
E-mail [email protected]

INTRODUCTION: Although the etiology is unknown, the

Bell’s palsy is an acute ipsilateral facial Herpes simplex virus (HSV) is commonly
nerve paralysis with an unknown etiology implicated in causing bell’s palsy by causing
that can result in weakness of the muscles acute inflammation and edema of the facial
of facial expression.[1] Facial palsy is caused nerve, thereby entrapment of the nerve in
by a disruption in the nerve pathway at any the bony canal, which leads to compression
of the facial nerve segments [2] and most and ischemia. This leads to neuropraxia or
commonly occurs between the ages of 15 degeneration of the facial nerve [4]. Yoga and
and 60 years, with 15 to 44-year-olds Naturopathy is a drugless system of
experiencing the highest incidence [3]. Its medicine that is effective in the
onset is sudden, with facial muscle management of various diseases, which is
weakness progressing over hours to days. safe and reported to have no adverse effects.

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Therefore, this case report aimed to the use of five standard expressions:
examine the effect of integrated yoga and eyebrow raise, eye closure, open mouth
naturopathy in the management of bell’s smile, lip pucker, and snarl/show teeth. All
palsy. the above items are evaluated on point
scales, and a cumulative composite score is
CASE REPORT: calculated. [5]
A 31-year-old man who was diagnosed with Facial Disability Index (FDI)- It is intended
unilateral Bell’s palsy on the right side came to provide for the patient's disability as well
to our In-Patient department on November as related social and emotional well-being.
24, 2021. The patient reported that his The FDI consists of two subscales; physical
facial paralysis had happened suddenly on function (items 1–5) and social wellbeing
November 16, 2021, while he got up from (items 6–10). The scores range from 0
bed in the early morning. He had the (complete paralysis) to 100 (normal facial
complaint of dry eyes for a week, he function). The FDI has been shown to be
consulted with a neurologist and reliable and valid as a clinical instrument
ophthalmologist and they prescribed lubrex and has been shown to accurately
carboxy-methycellulose eye drops six times demonstrate the relationship between
a day. The etiology was unknown, and it impairments, disability, and psychosocial
was associated with pain over the left status. [6]
shoulder. His resting facial posture revealed
severe asymmetry with a right-sided droop. THERAPEUTIC INTERVENTION:
Voluntary movement of the right-sided An Integrated Yoga and Naturopathy
facial musculature was barely visible, intervention has been given for a period of
whereas the uninvolved left-sided facial 3 weeks. The details of the yoga and
musculature was clearly intact. Due to Naturopathy intervention provided to the
unsatisfactory results, he visited the subject are given in Table 1 and 2.
integrated yoga &Naturopathy department.
Written informed consent was obtained RESULTS AND OUTCOME:
from the patient after a verbal explanation After 3 weeks of yoga and naturopathy
of the interventions. intervention, the patients showed
improvement in FGS composite score, FDI
ASSESSMENT CRITERIA: score, and its subscales. Added to this
The Facial Grading System [FGS]- It is a tool patient’s physical function and social/well-
used in the clinical evaluation of facial nerve being also improved (Table 3).
function. It scores range of movement of the
facial muscles as a percentage - full range FOLLOWUP:
movement is scored as 100 percent. The To further understand the long-term
FGS comprises three areas of evaluation. advantages of yoga and naturopathy
Evaluation of resting symmetry; degree of interventions in Bell’s palsy, we intend to
voluntary excursion of facial muscles; continue monitoring the patient. After six
degree of synkinesis associated with months of monitoring, the patient reported
specific voluntary movement. The regions no reoccurrence of symptoms.
of the face are evaluated separately, with

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Table 1: A detail of the Naturopathy intervention given to the subject
Name of the Therapy Duration Frequency in
in mins 3 weeks

Hydrotherapy
Alternate compress to the right side of the face 5 min Every day
A facial steam with peppermint oil 10 min Every day
Neutral water enema - Once in a week
Massage
Partial massage to face with lavender oil 10 min Every day
Partial massage to head and spine 10 min Thrice a week
Physiotherapy
Facial exercises with Tongue involvement 20 min Every day
Temporomandibular joint exercise. 20 min Every day
Heliotherapy
Sun bath with yellow glass exposure to head 15 min Twice a week
Magneto therapy
Magnetic lead- 4 (Right hand and Right foot) 5 min Every day
Acupressure and Acupuncture
Stomach meridian massage Scalp 15 min Thrice a week
acupressure 15 min Every day
Acupressure to motor points of the face 15 min Every day
Acupuncture-Needling with electrical stimulation 20 min First 10days

Auriculo therapy
Shenmen point, Zero-point, Sympathetic area, Face and 20 min Every alternate
brain area days

Table 2: Yoga intervention given to the subject:

Intervention details Duration in
minutes per day
(60mins)
Asana Pawanamuktasana series-1 30mins
Supine series:
Uttanpadasana, Pawanamuktasana, Setu bandhasana
Prone series:
Bhujangasana, Tiryeka bhujangasana, Ardha
shalabasana
Sitting series:
Simhagarjasana, Marjariasana, Vyagrasana,
Shasangasana
Standing series:
Tadasana, Tiryeka tadasana, Katichakrasana, Ardha
katichakrasana

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Surya bhedana pranayama, Nadi shodana pranayama, 10 rounds of each
Pranayama Brahmari pranayama, Sheetkari pranayama, sheethali pranayama
pranayama, ujjayi pranayama - 20mins
Mudras Kechari mudra, Kaki mudra, Shambhavi mudra, 10mins
Shanmuki mudra
Relaxation Deep relaxation technique and Yoga nidra (on alternate 10-15mins
days)

Table: 3 Changes in the FGS and FDI score after the intervention
Variables Before Treatment After Treatment
FGS 46 (Grade-VI) 4 (Grade-I)
FDI (total) 125/200 195/200
Physical scale 50/100 95/100
Social well being 75/100 100/100

DISCUSSION: grading system [FGS] and facial disability

From the results of the study, integrated index (FDI) of Bell’s palsy patients.
yoga and naturopathy interventions
showed considerable improvement in FGS
and FDI scores in patients with Bell’s palsy. THE STRENGTH OF THE STUDY:
This case also strengthens the rising body of
scientific data supporting the use of yoga No adverse effects were reported by the
and naturopathy treatments for functional subjects. It is feasible, and safe for the
disability conditions like facial palsy. patient, and the patient was comfortable
Previous research suggested that yoga and with the treatment.
naturopathy are both safe and beneficial for
peripheral nervous system disorders [7, 8] LIMITATIONS OF THE STUDY:
and for reducing oxidative stress. The results may vary because of a single
Acupuncture reduces pain and case study. Hence, further well-planned
inflammation in the body through the clinical studies are suggested with a large
release of endogenous opioids and sample size to validate our results.
serotonin.[9] Hydrotherapy and massage
help in reducing pain, inflammation, stress, CONCLUSION:
anxiety, and depression and in improving The results suggest that yoga and
the quality of sleep and quality of life. naturopathy interventions are effective in
Regular exercise in the form of yoga has patients with Bell's palsy and have notable
been shown to improve both exogenous and changes in their facial movements and
endogenous antioxidant status in human disability. However, further clinical studies
studies. [10-11] The improvement in oxidative are recommended to validate the results of
stress and the reduction in inflammation the study.
might pave the way for better healing and
progress in overall health. Thus, a DECLARATION OF PATIENT CONSENT:
combination of these therapies might have The authors certify that they have obtained
significant improvement in the facial all appropriate patient consent forms. In the
form the patient(s) has/have given his

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images and other clinical information to be 8. Venugopal V, Venkateswaran ST,
reported in this journal. This patient Poornima R, Maheshkumar K.
understands that their names and initials Recommendation of yoga and
will not be published and due efforts will be naturopathy intervention for the
made to conceal their identity, but effective management of post covid
anonymity cannot be guaranteed. syndrome. Journal of Ayurveda and
Integrative Medicine.
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