Exteroceptive Stimulation for Facial Palsy After Stroke

NCT07568769 | Completed

• 1 other identifier: TUF/EIRB/193/26
• Study Type: interventional
• Target: 36
• Locations: 1 country
• Sites: 1

Brief Summary

Stroke is a leading cause of long-term disability worldwide and frequently results in central facial palsy, which manifests as facial asymmetry, impaired muscle control, and reduced functional ability. These impairments can affect speech, emotional expression, and overall quality of life. Conventional physiotherapy is commonly used to manage post-stroke facial palsy; however, the additional benefit of sensory-based rehabilitation approaches remains insufficiently explored, particularly in clinical settings with limited resources. This study was conducted to evaluate whether the addition of exteroceptive stimulation to conventional physiotherapy leads to greater improvement in facial symmetry and functional outcomes compared to conventional physiotherapy alone. Exteroceptive stimulation aims to enhance sensory input and facilitate neuromuscular activation, potentially improving motor recovery in affected facial muscles. In this double-blind randomized controlled trial, a total of 36 participants diagnosed with post-stroke facial palsy were recruited and randomly allocated into two groups. The experimental group received exteroceptive stimulation in addition to conventional physiotherapy, while the control group received conventional physiotherapy alone. Both interventions were administered over a period of four weeks. Outcome measures were assessed at baseline and at the end of the intervention period. The primary outcome was lip angle deviation, used as an indicator of facial symmetry. Secondary outcomes included facial function and disability assessed using standardized tools such as the Facial Disability Index and the Synkinesis Assessment Questionnaire. The findings of this study aim to provide evidence on the effectiveness of integrating sensory-based techniques into routine rehabilitation programs for post-stroke facial palsy. The results may support the development of more comprehensive and effective rehabilitation strategies to improve patient outcomes.

Conditions

Stroke; Facial Palsy

Keywords

Stroke Rehabilitation; Facial Paralysis; Exteroceptive Stimulation; Neurorehabilitation; Synkinesis

Outcome Measures

Primary Outcomes (1)

• Change in Lip Angle Deviation

  Lip angle deviation was measured using standardized facial symmetry assessment techniques to evaluate improvement in facial alignment.

  Baseline and Week 4

Secondary Outcomes (2)

• Facial Disability Index (FDI)

  Baseline and Week 4

• Synkinesis Assessment Questionnaire (SAQ)

  Baseline and Week 4

Study Arms (2)

Exteroceptive Stimulation

EXPERIMENTAL

Exteroceptive stimulation was applied to the affected side of the face using structured sensory techniques, including light touch, stroking, tapping, and graded pressure over the perioral, cheek, and nasolabial regions. The intervention was delivered by a trained physiotherapist in a standardized sequence to enhance sensory input and facilitate neuromuscular activation.

Other: Exteroceptive Stimulation; Other: Conventional Physiotherapy

Conventional Physiotherapy

ACTIVE COMPARATOR

Conventional physiotherapy included a structured facial rehabilitation program comprising facial muscle exercises, facilitation techniques, and functional retraining aimed at improving symmetry and muscle coordination.

Other: Conventional Physiotherapy

Interventions

Exteroceptive Stimulation OTHER

Exteroceptive stimulation was applied to the affected side of the face using structured sensory techniques, including light touch, stroking, tapping, and graded pressure over the perioral, cheek, and nasolabial regions. The intervention was delivered by a trained physiotherapist in a standardized sequence to enhance sensory input and facilitate neuromuscular activation. Each session lasted approximately 30-40 minutes and was administered 5 days per week for 4 weeks in a clinical setting. This intervention was provided in combination with conventional physiotherapy.

Exteroceptive Stimulation

Conventional Physiotherapy OTHER

Conventional physiotherapy included a structured facial rehabilitation program comprising facial muscle exercises, facilitation techniques, and functional retraining to improve symmetry and coordination. Sessions were delivered by a qualified physiotherapist, lasting approximately 30-40 minutes, 5 days per week for 4 weeks. This intervention was provided alone in the control group and in combination with exteroceptive stimulation in the experimental group.

Conventional Physiotherapy; Exteroceptive Stimulation

Eligibility Criteria

• Age: 40 Years - 55 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Patients diagnosed with post-stroke facial palsy Age between 40 and 55 years Both male and female participants Acute onset of facial weakness within 1-3 weeks Non-traumatic onset of disease Commitment to comply with electrical stimulation treatment for 2 months, were included in this study.

You may not qualify if:

• Participation in other therapies for facial nerve, Presence of neoplastic tumor, Pregnancy, Cardiac, Excessive perspiration, Psychiatric illness or Mental impairment, Neurotmesis, Post-surgical cases of heart and brain surgery, Bilateral facial palsy due to demyelinating disease e.g. motor neuron disease, trigeminal neuralgia, Open wounds/ulcers, ENT impairment/Otitis Media, Repetitive previous history of stroke, Invasive cardiac instrumentation such as endarterectomy or stent placement within 30 days prior to admission in ICU were excluded

Sponsors & Collaborators

• University of Faisalabad: lead

Study Sites (1)

Tertiary Care Hospitals, Faisalabad, Pakistan

Faisalābad, Punjab Province, 3800, Pakistan

Location

Related Publications (1)

• 1. Albaret G, Domergue H. Stroke and stroke rehabilitation. Pathy's Princ Pract Geriatr Med. Published online February 18, 2022:619-634. doi:10.1002/9781119484288.CH48 2. Unnithan AKA, Das JM, Mehta P. Hemorrhagic Stroke. In Statpearls. Published online December 13, 2025:1-12. 3. Fulk GD., Chui KK. O'Sullivan & Schmitz's physical rehabilitation. Published online 2024:1337. 4. Choi JH, Kim BR, Han EY, Kim SM. The Effect of Dual-Task Training on Balance and Cognition in Patients With Subacute Post-Stroke. Ann Rehabil Med. 2015;39(1):81. doi:10.5535/ARM.2015.39.1.81 5. Junior VA dos S, Santos M de S, Ribeiro NM da S, Maldonado IL. Combining Proprioceptive Neuromuscular Facilitation and Virtual Reality for Improving Sensorimotor Function in Stroke Survivors: A Randomized Clinical Trial. J Cent Nerv Syst Dis. 2019;11. doi:10.1177/1179573519863826 6. Hashmi M, Khan M, Wasay M. Growing Burden of Stroke in Pakistan: A Review of Progress and Limitations. Int J Stroke. 2013;8(7):575-581. doi:10.1111/J.1747-4949.2012.00827.X 7. Schimmel M, Voegeli G, Duvernay E, Leemann B, Müller F. Oral tactile sensitivity and masticatory performance are impaired in stroke patients. J Oral Rehabil. 2017;44(3):163-171. doi:10.1111/JOOR.12482 8. Schimmel M, Ono T, Lam OLT, Müller F. Oro-facial impairment in stroke patients. J Oral Rehabil. 2017;44(4):313-326. doi:10.1111/JOOR.12486 9. Johal A, Dunne B, Bolooki H, Sandler C. Oral Health-Related Quality of Life (OHRQoL), Pain and Side Effects in Adults Undergoing Different Orthodontic Treatment Modalities: A Systematic Review and Meta-Analysis. Healthc 2025, Vol 13,. 2025;13(24). doi:10.3390/HEALTHCARE13243317 10. Taj F, Zahid R, Syeda UER, Murtaza M, Ahmed S, Kamal AK. Risk Factors of Stroke in Pakistan: A Dedicated Stroke Clinic Experience. Can J Neurol Sci. 2010;37(2):252-257. doi:10.1017/S0317167100010015 11. Walcott BP, Miller JC, Kwon CS, et al. Outcomes in severe middle cerebral artery ischemic stroke. Neurocrit Care. 2014;21(1)

  BACKGROUND

MeSH Terms

Conditions

Stroke; Facial Paralysis; Synkinesis

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Mouth Diseases; Stomatognathic Diseases; Paralysis; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Dyskinesias

Study Officials

• Dr Muhammad Ateeb, PhD Public Health

  Research Associate, The University of Faisalabad, Faisalabad 38000, Pakistan

  STUDY CHAIR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate professor/ Head Department of Rehabilitation sciences

Model Details: This study followed a parallel-group randomized controlled design in which participants were allocated to one of two groups and remained in that group for the duration of the study. Both groups received conventional physiotherapy as standard care, while the experimental group received additional exteroceptive stimulation. Interventions were delivered concurrently over a four-week period, and outcomes were assessed at baseline and after completion of the intervention. No crossover between groups occurred.

Study Record Dates

• First Submitted: April 28, 2026
• First Posted: May 6, 2026
• Study Start: August 1, 2025
• Primary Completion: December 24, 2025
• Study Completion: December 24, 2025
• Last Updated: May 6, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)