OBJECTIVE: To study the effects of the "Mirror Effect Plus Protocol" (MEPP) on global facial function in acute and severe Bell's Palsy. DESIGN: Single blind and randomized controlled trial to compare the effects of basic counseling (control group) versus MEPP (experimental group) over one year. SETTING: Outpatient clinic following referrals from Emergency or Otorhinolaryngology Departments. SUBJECTS: 40 patients (n = 20 per group) with moderately severe to total palsy who received standard medication were recruited within 14 days of onset. Baseline characteristics were comparable between the groups. INTERVENTIONS: The experimental group received the MEPP program (motor imagery plus manipulations plus facial mirror therapy) while the control group received basic counseling. Both groups met the clinician monthly until 6 months and at one-year post-onset for assessments. OUTCOME MEASURES: Facial symmetry, synkinesis, and quality of life were measured using standardized scales. Perceived speech intelligibility was rated before and after therapy by naive judges. RESULTS: Descriptive statistics demonstrated improvements in favor of the MEPP for each measured variable. Significant differences were found for one facial symmetry score (House-Brackmann 2.0 mean (SD) 7.40 (3.15) for controls versus 5.1 (1.44) for MEPP), for synkinesis measures (p = 0.008) and for quality-of-life ratings (mean (SD) score 83.17% (17.383) for controls versus 98.36% (3.608) for MEPP (p = 0.002). No group difference was found for perceived speech intelligibility. CONCLUSION: The MEPP demonstrates promising long-term results when started during the acute phase of moderately severe to total Bell's Palsy.

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