Hybrid Neuro-Proprioceptive Rehabilitation (NPR) option
This Bell’s palsy and Ramsay Hunt Syndrome recovery program combines the best benefits from online and in-clinic recovery programs. Click on each to find out more details.
Part 1: Video consultation with Bell's palsy expert - Dr. Alex Pashov
The first step involves a video consultation with our specialist, Alex Pashov, to help you understand your condition, answer your questions, and provide a realistic recovery prognosis with or without rehabilitation.
We will also review potential recovery programs and determine, based on your specific needs, which option will bring you the best results.
This 40-minute video consultation costs €95.
At the end of the video consultation, when you make the final decision to continue with the program, we will forward your details to our planning department. Within one working week, you will receive the suggested dates and times for your first six online sessions.
Part 2: First visit and the first working sessions
In Hybrid rehabilitation option, you will come to the clinic for a total of 1-2 visits.
Each visit to the clinic will take approximately 5 days including the arrival and departure days. During each visit, the patient will have 3 working sessions in the clinic, one per day.
Our standard hybrid plan includes 2 visits to the clinic (at the very beginning and at the very end of the program), with a total of 6 working sessions here. The remaining 4 working sessions take place online.
Adjustments to these proportions of in-clinic and online sessions are possible depending on personal requirements. Our experience shows that this type of layout shows the best results for a hybrid program.
For your first visit, you will need to stay in Rotterdam for at least 5 days: 3 days for daily treatments, 1 day for arrival, and 1 day for departure. We recommend avoiding travel on treatment days for the best results.
The very first session in the clinic, together with measurements, will last around 3 hours. During that session, Dr. Pashov will perform the Nerve Conduction Study (extended protocol) and Synkinetic Correlation Test. After the measurements, we will begin with the first working session.
During each working session in the clinic, you will receive a Crystal Touch Bell’s palsy treatment designed to improve facial symmetry, relax muscles, and help your brain “recall” normal symmetrical facial movements. The treatment is non-invasive, relaxing, and mostly done by hand to enhance nerve conductivity and muscle sensitivity, improving your perception of facial movements and facial condition. One working session with the Bell’s palsy treatment lasts 1.5-2 hours.
Part 3: Routine working sessions online
The following sessions will take place online, with an interval of 4 weeks between each session. You will have a total of 3-6 working sessions in the clinic, and 4-6 working sessions online.
During the online working sessions, we will practice specific techniques and exercises. You will also perform special exercises with your therapist’s guidance. You will learn new exercises for your homework.
Each working session at the clinic lasts about 2 hours and costs €375. Each working session online lasts about 1h 30 min and costs €315. The very first session during your first visit to the clinic will include an additional cost of €185 for the initial diagnostics and measurements. This additional diagnostic session lasts about 1 hour.
You will pay “as you go” for 3 sessions at a time. There is no need to pay upfront for the whole program. Travel and accommodation costs are not included in this price.
The total rehabilitation time required will depend on how often you will travel to the clinic, and how many sessions will take place online. In general, you can expect Hybrid recovery program to require between 7-12 months.
The total number of sessions needed will depend on your condition at the start of the rehabilitation program, your progress with the work at home and your body’s recovery potential. Which is why daily work at home is critical for the fastest results.
Part 4: Individual work at home in-between visits
In each online session, you will learn new rehabilitation techniques, review your homework, ask questions, and discuss any challenges with your therapist.
After each session, we will email your homework with detailed instructions on the techniques, repetitions, and frequency, as well as illustrations of the newly learned methods. You will keep these materials and your assignments in your Crystal Touch Passport for easy access.
You will be expected to do homework twice daily, dedicating 15-20 minutes each time. Every 2-3 weeks, you will also send us a “face observation diary” to share your progress, observations, and challenges, helping us track your development between sessions and keeping you motivated.
Some individual variations on the Online Plus program are also possible in consultation with your therapist.
Part 5: Work at home after completion of the full program
When you decide that you are satisfied with the achieved results, we will stop the rehabilitation.
After this point, you will work on your own for any further improvements and maintenance. Throughout the whole program, you will learn sufficient tools and techniques to maintain your recovery and to improve it further on your own.
We will always remain available for you to answer any questions, provide assistance, or to schedule additional online Supporting sessions if you will require them.
Important: We can only start the full rehabilitation program if at least 8 months or more have passed since the onset of your facial palsy. This is because your condition will naturally improve during active recovery in the first 8 months. We step in afterward, once recovery has plateaued and further assistance is needed.
Issues we address during the recovery program
Synkinesis
Asymmetric smile
Pains & tensions
Incomplete recovery
Excessive tears
Other issues
We actively work together to reduce manifestation of your synkinesis and make your facial expressions more balanced and symmetrical.
During your first visit to the clinic, we will instrumentally measure the level of your Synkinetic Correlation on your healthy and affected sides.
To get rid of synkinesis completely, although in theory possible, in practice will take disproportional amount of time and efforts. However, with systemic and consistent application of our method, you can achieve improvements in your facial expressions and reduction of synkinesis
In the course of your rehabilitation program, you will learn techniques that you will be able to use on your own to manage your synkinesis and continue on reducing its manifestation.
An asymmetric smile in Bell’s palsy patients occurs due to involuntary activation of the muscle that pulls down the mouth corner each time your brain sends a “Smile!” command to your face. That muscle is called Depressor Anguli Oris, and it is the antagonist of the Zygomatic Major muscle, which is responsible for normal “smile production”.
You will learn to improve the background relaxation of your facial muscles by reducing unnecessary brain activity in that direction. You will also learn certain manual techniques to maintain the depressor anguli oris muscle better relaxed at all times, reducing its opposing efforts that lead to the asymmetry of your smile.
The scale of improvements in the symmetry of your smile will greatly depend on your patience, persistence, and regularity of efforts.
Facial pains – spontaneous or in response to touch, occur due to excessive tension and even micro-cramps in facial muscles or their separate fibres.
In the course of rehabilitation programs, our patients achieve substantial reduction or even complete disappearance of facial pain.
Similarly to pains, the stiffness and tightness of facial muscles have the same origin: the presence of constant background contraction signals that the brain sends to the facial muscles. This wrong “habit” develops during the process of long recovery.
As you progress with your rehabilitation program, the tension and tightness in your facial muscles are likely to substantially reduce. In some cases, they may even completely disappear.
Please bear in mind that achieving improvements is a process that requires time, persistence and regularity of effort.
The regeneration of the facial nerve after the acute phase of Bell’s palsy is a time-consuming process. Usually, by 8-12 months, the recovery of the nerve fibres reaches a plateau and slows down substantially.
During the rehabilitation program, together, we can stimulate your facial nerve nucleus and promote a more active regeneration of nerve fibers even many years past the onset of facial palsy.
Keep in mind that in the majority of cases, it is not the regeneration level of the facial nerve that leads to visual facial asymmetry. Instead, it is a wrongly formed new mimetic habits. We will be addressing that issue as well.
Excessive lacrimation or “crocodile tears” is a phenomenon that, from our point of view, results from a disrupted function of a tiny muscle that opens and closes a tear-sack in the inner corner of the eye.
A synkinetic correlation is formed between that muscle, the muscles of the mouth, the muscle that opens the lower jaw and perhaps also the gustatory sensors of the tongue. As a result, when you eat, your tear-sack sporadically opens, releasing the tears.
In the course of a rehabilitation program, this phenomenon reduces its manifestation substantially or even disappears altogether.
Among other issues, we can name headaches, tension and pain in the neck and shoulder on the affected side, tinnitus (perceived constant buzzing in the affected ear), deeper nasolabial fold and dimples in the chin on the affected side.
All these symptoms are quite typical for patients after a long recovery from Bell’s palsy, Ramsay Hunt Syndrome and other types of peripheral facial paralysis.
All these issues substantially reduce or may even disappear altogether during rehabilitation programs, as your brain “learns” not to overdo the contraction signals and to remain “silent” unless you need to change the facial expression, eat or speak.
Tinnitus, in particular, happens due to excessive tension of the smallest muscle in our body – the stapedius muscle. This muscle can tense up involuntarily, deform your eardrum, and you perceive a sound, even though it is not there.
This symptom usually decreases noticeably or even disappears altogether in the course of a full rehabilitation program.
Advantages of completing the Hybrid NPR program
The Hybrid Bell’s palsy and Ramsay Hunt Syndrome recovery program takes advantage of the in-clinic measurement tools that significantly aid in the rehabilitation process, while staying more budget-friendly and ensuring good results.
Instrumental measurements
Special procedures
Results
During your first visit to the clinic, we will perform two instrumental measurements.
These two tests will help us to assess the level of your facial nerve recovery on the affected side compared to the healthy side, and to measure the differences in mimetic patterns that your brain sends to the affected side compared to the healthy side.
The analysis of those differences will help you to better understand why you are having facial asymmetry at this stage of recovery, and also to better understand the principles that we use in composing your individually tailored rehabilitation program.
Such measurements we only make during your first visit and at the end of the rehabilitation program when you come back to the clinic again. In this way we can objectively measure the achieved progress in the quality of the facial nerve and the achieved improvements in mimetic patterns.
When you visit the clinic for each working session, there will be 2 parts to each session. One part consists of learning special technique, and the other part involves special procedures and treatments performed by your Crystal Touch therapist.
Naturally, the these special treatments and procedures can only be performed in the clinic.
Our experience shows that patients that come to the clinic can achieve either better results or see improvements sooner than those in online-only treatments.
Visiting the clinic at least once will give you an advantage of the benefits that the clinic can provide.
One of the biggest costs of the in-clinic rehabilitation is the expense for travelling and accommodation. To keep your rehabilitation more budget-friendly and to improve your recovery potential, we recommend the Hybrid rehabilitation plan.
The instrumental measurements that we will perform in the clinic will help us see in more detail your current condition and analyze your facial nerve more in-depth. This will help us prepare a better-tailored rehabilitation plan.
The application of special procedures and treatments for a few sessions will help you to understand better the level of facial perception needed for your recovery. It also helps to reach the right levels of relaxation and focus on specific points better.
Visiting the clinic will help you psychologically to stay focused on achieving results.
Who is the Hybrid program for?
The Hybrid program is the best for long-term Bell’s palsy, Ramsay Hunt Syndrome and other facial palsy sufferers who want to achieve a high level of recovery for their case and who have a limited capacity to travel to the clinic.
The NPR program uses the Neuro-Proprioceptive Rehabilitation (NPR) method developed by our specialists to work with cases of peripheral facial palsy after 8 months or more since the onset.
This means that the method is suitable for those whose Bell’s palsy, Ramsay Hunt Syndrome and other peripheral facial palsies that happened 1 year, 5 years, and even 30 or more years ago.
You need to be motivated and ready to work every day on your recovery in order to achieve positive results.
The program requires active involvement and will not bring results if you only rely on working sessions in the clinic or online and do not follow your work to be done at home in between visits to the clinic.
Time since the onset:
8 months to 50 and more years
Self-motivation required:
Medium to high requirement, as you need to motivate yourself after the 1st visit
Expected level of results*:
High level of results that is possible in your case
Financial investment:
Medium due to fewer visits
*The expected level of results depends on your particular case. This is a general indication of the average level of results.
Example timeline of the Hybrid recovery program:
This is the general timeline of how your program can look like with 1 visit to the clinic and remaining sessions done online. Your actual program may differ slightly based on individual needs. All preferences and conditions are discussed during the initial video consultation.
Day 1: arrival day (no session)
Day 2: 1st working session and measurements (3h)
Day 3: 2nd working session (1.5h)
Day 4: 3rd working session (1.5h)
Day 5: departure (no session)
Day 1: arrival day (no session)
Day 2: 1st working session and measurements (3h)
Day 3: 2nd working session (1.5h)
Day 4: 3rd working session (1.5h)
Day 5: departure (no session)
In case if more work is needed, you will continue with online sessions, or you can choose to visit the clinic again to improve your progress further.
What to expect after the completion of the program?
Each case of facial palsy, whether Bell’s palsy or Ramsay Hunt Syndrome, is unique and requires an individualized approach. As a result, the outcomes of the program will vary from person to person.
During the initial analysis and video consultation, we will explain what results you can expect from the full program based on your specific condition.
Our goal is to achieve a recovery that you are satisfied with. While 100% recovery is possible with the NPR method, reaching the last 15-20% of improvement can require a disproportionately large amount of time, effort, and resources.
After completing your NPR program you will have a set of tools and techniques that you will use to improve your recovery even after you complete the program.
During the working sessions, we teach you techniques that become your personal recovery toolkit. You will have everything you need to continue making progress and improve your recovery independently.
Even after completing the NPR program, we are always available to answer questions, offer support, and provide further guidance whenever needed.
From our patients
Here is what our patients who completed the Hybrid program share:
From my initial virtual consultation with Alex, he was able to explain the reasons for my experience of facial soreness, muscle tension, and lack of face movement (e.g. asymmetrical smile) even after “recovery” from Bell’s Palsy. No one else had been able to do this, including my doctor. From our initial conversation I understood what I could do to help alleviate my symptoms.
I travelled to Rotterdam for an initial assessment where I met Alex , Elena, and Jana in person. Everyone was very warm and welcoming. The clinic is modern, clean, and neat. I had initial diagnostics completed. Then, Jana started teaching me exercises to do at home myself.
I completed the rest of the program virtually. Since doing the program I have noticed that my facial muscles are not as tense as before I started daily exercises. I now have no more pain. When I smile, my one eye does not close, which was one of the most concerning symptoms. I recently returned to the Rotterdam clinic for a second time, and it was amazing to see the improvements in my facial symmetry.
Thank you Jana, Alex, and Elena for giving me guidance and hope!
We respect the privacy of our patients and upon their wish we do not share full name and photos.
I have found Crystal Touch Clinic on you tube while searching for some improvements for my synkinesis which appeared during my recovery from Bell’s palsy in 2022. What made me an impression is that the explanations given by the specialists from Crystal Touch clinic are indicating very well my condition and are giving some meaningful clue how I can improve it.
I have had very positive experience with all specialists from the clinic – they are very polite, very kind and open minded. Elena is a wonderful person who understands deeply the psychological impact of Bells Palsy and its complications, she welcomes and teaches her patients very warmly and gentle, gives very good tips and practical advises for the rehabilitation program daily routine, highlights the self-respect and nourishes the self-esteem of her patients.
I am very glad with the rehabilitation program which I followed in Crystal Touch Clinic and I would encourage all people with complications like synkinesis or chronic pains or any kind of complications after Bells palsy or Ramsey Hunt syndrome to visit the clinic. The results of improvement do not happen over a week – much more time, patience, discipline and goodwill are needed.
We respect the privacy of our patients and upon their wish we do not share full name and photos.
Register for Hybrid NPR program
Step 1: Complete registration form
To register for the Hybrid NPR Bell’s palsy rehabilitation program, you need to fill in the registration form. No payment is required at this stage.
Step 2: Schedule a video consultation
After your registration, we will schedule a video consultation. The consultation lasts about 40 min and costs €95.
Step 3: Schedule your first visit
During the first video consultation, we will discuss your first visit to the clinic and your program will begin.