Sažetak

Uvod: Bellova kljenut akutna je idiopatska periferna neuropatija facijalnog živca koja uzrokuje poremećaj pokreta mimičke muskulature te može dovesti do značajnih funkcionalnih, estetskih i psihosocijalnih posljedica. U rehabilitaciji bolesnika s težim kliničkim oblicima sve se češće primjenjuju tehnike neuromišićne reedukacije, među kojima je i površinska elektromiografija uz biofeedback (sEMG biofeedback), iako su dokazi o njezinoj učinkovitosti još uvijek ograničeni. Cilj ovog rada bio je prikazati primjenu sEMG biofeedbacka u rehabilitaciji bolesnika s teškom Bellovom kljenuti te opisati klinički tijek i funkcionalni ishod rehabilitacije.

Prikaz slučaja: Prikazan je slučaj 82-godišnjeg bolesnika s teškom Bellovom kljenuti (House–Brackmann stupanj V), koja je perzistirala unatoč liječenju sistemskim kortikosteroidima i početnom ciklusu sEMG biofeedbacka. Zbog izostanka očekivanog oporavka nastavljen je individualizirani fizioterapijski program koji je uključivao sEMG biofeedback, edukaciju o zaštiti oka, kinesiotaping, samomasažu, primjenu toplih obloga te postupno uvođenje kućnog programa vježbi pred ogledalom. Tijekom sedmomjesečne rehabilitacije provedeno je ukupno 70 tretmana sEMG biofeedbacka pod neposrednim nadzorom fizioterapeuta.

Rezultati: Po završetku rehabilitacije postignut je oporavak do House–Brackmannova stupnja II, uz simetriju lica u mirovanju, potpuno zatvaranje oka, nestanak funkcionalnih poteškoća pri žvakanju i govoru te blagu sinkineziju pri maksimalnom zatvaranju oka. Zaostao je izostanak spontanog treptanja pri umoru, s posljedičnim isušivanjem oka i povremenim refleksnim suzenjem, zbog čega je prema preporuci oftalmologa u daljnjem tijeku liječenja moguće razmotriti ugradnju utega u gornju vjeđu.

Zaključak: Prikazani slučaj upućuje na moguću korist individualiziranog fizioterapijskog programa temeljenog na sEMG biofeedbacku, uz naglasak na selektivnu neuromišićnu reedukaciju i selektivnu kontrolu mimičkih pokreta, u bolesnika s teškom Bellovom kljenuti i odgođenim oporavkom. Potrebna su daljnja prospektivna istraživanja radi utvrđivanja učinkovitosti ovakvog pristupa i razvoja standardiziranih rehabilitacijskih protokola.

Ključne riječi: Bellova kljenut; sEMG biofeedback; neuromišićna reedukacija; selektivna kontrola pokreta.

Abstract

Introduction: Bell’s palsy is an acute idiopathic peripheral neuropathy of the facial nerve that impairs facial muscle movement and may result in significant functional, aesthetic, and psychosocial consequences. In patients with more severe clinical presentations, neuromuscular re-education techniques, including surface electromyography biofeedback (sEMG biofeedback), are increasingly used in rehabilitation despite the limited evidence regarding their effectiveness. The aim of this study was to present the application of sEMG biofeedback in the rehabilitation of a patient with severe Bell’s palsy and to describe the clinical course and functional outcome of rehabilitation.

Case presentation: We present the case of an 82-year-old patient with severe Bell’s palsy (House–Brackmann grade V) that persisted despite treatment with systemic corticosteroids and an initial course of sEMG biofeedback therapy. Owing to the lack of the expected recovery, an individualized physiotherapy program was continued, including sEMG biofeedback, education on eye protection, kinesiotaping, self-massage, warm compresses, and the gradual introduction of a home-based mirror exercise program. During the seven-month rehabilitation period, the patient underwent a total of 70 sEMG biofeedback sessions under the direct supervision of a physiotherapist.

Results: At the completion of rehabilitation, recovery to House–Brackmann grade II was achieved, with restoration of facial symmetry at rest, complete eye closure, resolution of chewing and speech difficulties, and only mild synkinesis during maximal eye closure. Persistent absence of spontaneous blinking during fatigue, accompanied by ocular dryness and occasional reflex tearing, remained; therefore, implantation of an upper eyelid weight was considered as a possible future treatment option following the ophthalmologist’s recommendation.

Conclusion: This case suggests that an individualized physiotherapy program based on sEMG biofeedback, with emphasis on selective neuromuscular re-education and selective control of facial movements, may be beneficial in patients with severe Bell’s palsy and delayed recovery. Further prospective studies are needed to determine the effectiveness of this approach and to develop standardized rehabilitation protocols.

Keywords: Bell’s palsy; sEMG biofeedback; neuromuscular re-education; selective motor control.