Case Report: Facial Paralysis and Use of Deep Oscillation in Physiotherapy Treatment Protocol

Gabriela Galdámez Torres Medical specialist in rehabilitation medicine, Master in Gerontology. Private practice- Hospital La Policlinica, Honduras.


Clinical Summary

Patient is 20 years old, has completed secondary school, does not work. He lives in rural Honduras, where he occasionally supports his family with livestock and agriculture.

He has had facial paralysis on three occasions, the first time was at the age of eight in 2010, then in 2016, 2017.

Consultation on this occasion (30th August) was due to loss of strength and mobility of the facial mimicry muscles of the right side of the face; as well as drooling and a lot of epiphora (excessive eye tearing). Consultation was three days after the onset of symptoms. No dizziness or loss of balance was reported.

Tinnitus (ringing in the ear), especially five days prior to the consultation.
No recent infections, COVID-19 negative. Vaccination schedule included two doses of anti-COVID vaccine.
Neurosurgery referred him for a brain MRI scan, which was normal.

History of chronic left ear infections.
No alterations of strength in upper or lower limbs,

Physical Examination:

Vital signs stable, normal gait, monopedal balance unaltered. Normal coordination tests.
Evident facial asymmetry, with deviation of the lips to the left

Positive Bell’s sign to the right.


Muscle strength using Houseman-Brackman grading system in right hemicarean muscle:

Frontalis 5 Supraciliary (corrugator) 5 Orbicularis oris 6 Nasalis 5 Risoris 6 Zygomaticus 6 Buccinator 5 Mentalis 5


Global FM according to Daniels scale in the four extremities, of 5/5 Osteotendinous reflexes

++ in bicipital, tricipital, patellar and achilles.

Full range of motion in all segments (neck, shoulders, elbows, wrists and fingers, spine, hips, knees and ankles)

Initial diagnosis and treatment:

  1. Recurrent right peripheral paralysis (4th episode) of aetiology to be investigated
  2. Rule out autoimmune or infectious disease.

Treatment plan:

1) Medications: Pregabalin 50 mg for one month for pain and tinnitus. Referral to Rheumatology for autoimmune disease.

2) Physiotherapy PROTOCOL 10 sessions - A Hemicara affects (right)

Deep Oscillation x 10 sessions:

  • 160 Hz  - 5 mins
  • 80-120 Hz - 5 mins
  • 160 Hz - 2 mins

3) Hot compresses for 10 minutes. Electro-stimulation was used with pointer to motor points, x 10 minutes.

Unaffected side (left side), had muscle spasm and contracture, so 85 Hz was applied for 15 minutes. Cold compress to reduce tone for 5 minutes and manual decontracting massage.

After one month, a new evaluation was carried out and most of the muscles were found to have improved on the Houseman Brackman Scale of 3, except for the orbicularis oculis where there was still a severe deficit for occlusion (only 20%), muscle 5. The sessions were modified due to the fact that there was still a severe deficit in the eye, 5 sessions were administered:

Right side (affected side), only with electro-stimulation to motor point of Orbicularis oculis, and also with deep oscillation at 25-85 Hz x 15 minutes, accompanied by facial mimicry exercises.

Rheumatology performed all the immunological tests, which were normal. Inter consulted with Epidemiology who suggested that due to the history of contact with cattle, he should be tested for Erlichia.  It turned out to be positive and Lyme disease was diagnosed, starting treatment with Doxycycline 100 mg every twelve hours x 1 month.

Assessment at 2 months,

Almost total improvement of the condition, with a Houseman Brackman scale of 1 in all muscles.


Photography Diary of Results (patient photographic consent received)


DEEP OSCILLATION® is a unique, non-invasive and non-traumatic therapy method with strong pain-reducing potential.

DEEP OSCILLATION® is an internationally patented, proven technology based on the effects of creating an electrostatic field in the tissue of the patient. Easy application is from therapist to client via hygienic, vinyl gloved hands; utilizing all normal massage movements or via circular movements over the tissue with a handheld applicator. The handheld applicator also enables self-treatment.

The special structure of DEEP OSCILLATION® allows the creation of biologically effective oscillations in the treated tissue using electrostatic attraction and friction. In contrast to other therapies, these pleasant oscillations have a gentle and deep-acting effect on all tissue components to an 8 cm depth (through skin, connective tissue, subcutaneous fat, muscles, blood and lymph vessels.

Because of the non-invasive, non-traumatic, gentle nature of this therapy, very early possibilities of application are possible following injury and from Day One post operatively. Chronic conditions can also be worked upon with effective results.

The following physiological effects of DEEP OSCILLATION® are clinically proven: 

  • Highly effective in reducing pain
  • Anti-inflammatory
  • Effective in reabsorbing oedema (swelling)
  • Encouraging wounds to heal
  • Fibrosis Reduction
  • Improving trophicity
  • Rubor reduction (haematoma/bruising)
  • Detoxification
  • Improving quality of tissue

Learn more about DEEP OSCILLATION® biological and clinical effects





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