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ABSTRACT Facial palsies have multiple etiologies, but have in common the negative impact not only on the functions of the stomatognathic system but also on the self-image and emotional expression. This article aimed to describe a case study of unilateral peripheral facial palsy caused by the Guillain-Barré Syndrome. Hence, it shares assessment and intervention experiences related to this type of change and presents its functional results. It also highlights the important role of the interdisciplinary team (which comprised a physiatrist, physical therapist, speech-language-hearing therapist, occupational therapist, and nurses) to catalyze the patient's evolution and the management of possible complications. Moreover, it is rather important to integrate the patients as members of the rehabilitation team, empowering them and giving them responsibility for the success of the intervention.
RESUMO As paralisias faciais podem ter uma multiplicidade de etiologias, contudo têm em comum o impacto negativo não só para as funções do sistema estomatognático, como também na autoimagem e expressão emocional. O presente artigo tem como objetivo a descrição de um estudo de caso relativo a uma paralisia facial periférica unilateral na sequência de Síndrome de Guillain-Barré. Pretende-se deste modo a partilha de experiência em termos de avaliação e intervenção neste tipo de alterações e a apresentação do respetivo resultado funcional. Ressalta-se, também, o importante papel da equipa interdisciplinar (composta por médico fisiatra, fisioterapeuta, fonoaudiólogo, terapeuta ocupacional e equipa de enfermagem) enquanto catalisador para a evolução e na gestão de eventuais intercorrências. Salienta-se, ainda, a importância da integração do paciente enquanto membro da equipa de reabilitação, empoderando-o e responsabilizando-o pelo sucesso da intervenção.
ABSTRACT
Objective To investigate the efficacy of transverse insertion of thick needles into the Du meridian in treating rat ischemic facial paralysis and preliminarily explore the possible mechanism by which it produces a therapeutic effect. Methods Sixty Wistar rats were randomly allocated to groups A (transverse insertion of thick needles), B (basic Western drugs), C (blank control) and D (sham operation), 15 rats each. A rat model of ischemic facial paralysis was made using a modified vascular occlusion method in all the rats. Facial nerve deficits were scored in every group of rats during treatment. At 1 day after model making, group A was treated by transverse insertion into point Shendao and 4-hour retention of needle, once daily, for a total of 14 days; group B was treated by an oral gavage of prednisone and intraperitoneal injection of vitamine B12, once daily, for a total of 14 days. Groups C and D were not treated. In 4 rats randomly chosen at 3, 7 or 14 days after model making, facial nerve concomitant intrinsic vascular tissue HIF-1αprotein was measured by an immunohistochemical method; serum NO, by enzyme-linked immunosorbent assay; serum ET content, by radioimmunoassay.Results After 7 days of treatment, the neurological deficit score increased gradually in groups A and B and there was a statistically significant difference compared with after model making in the two groups (P<0.01). After 7 days of treatment, there was a statistically significant difference in the neurological deficit score in groups A and B compared with groups C and D (P<0.05) and between groups C and D (P<0.05). After 14 days of treatment, there was a statistically significant difference in the neurological deficit score between group A or B and group C (P<0.05) and between group B or C and group D (P<0.05). In group A, there was a statistically significant difference in the neurological deficit score after 14 days of treatment compared with after 7 days of treatment (P<0.05). After 3, 7 and 14 days of treatment, there was a statistically significant difference in HIF-1αMOD value in groups A , B and C compared with group D (P<0.01). After 3 and 7 days of treatment, there was a statistically significant difference in HIF-1αMOD value between group A or B and group C (P<0.05). In groups A and B, there was a statistically significant difference in HIF-1αMOD value after 3 and 14 days of treatment compared with after 7 days of treatment (P<0.05). After 3 and 7 days of treatment, there was a statistically significant difference in serum NO content between group A or B and group D (P<0.01). In groups A and B, there was a statistically significant difference in serum NO content after 7 days of treatment compared with after 3 days of treatment (P<0.05). After 3 and 7 days of treatment, there was a statistically significant difference in serum ET content in groups A , B and C compared with group D (P<0.05). In groups A and B, there was a statistically significant difference in serum ET content after 7 days of treatment compared with after 3 days of treatment (P<0.05).Conclusions Transverse insertion of thick needles into the Du meridian can effectively promote rat’s recovery from ischemic facial paralysis. The mechanism by which it produces a therapeutic effect may be regulating the expression of tissue HIF-1α and the NO and ET contents of serum.