case presentation- bell's palsy.pptx

Physiotherapy plays a vital role in managing Bell's palsy, a condition marked by temporary facial paralysis often stemming from facial nerve inflammation or compression. Through tailored exercises, like facial muscle strengthening and mimicry routines, physiotherapists help restore muscle tone and control. Techniques such as electrical stimulation and massage therapy aid in improving circulation, reducing stiffness, and alleviating pain. Heat and cold therapy further promote healing by reducing inflammation. Biofeedback assists patients in gaining muscle awareness and control, while joint mobilization addresses potential stiffness in facial joints. Physiotherapists also offer education, support, and personalized self-care strategies to optimize recovery, emphasizing the importance of tailored treatment plans and interdisciplinary collaboration for the best outcomes.

1. Clinical Case Bell’s palsy By Dr. Avani Akbari (PT)

2. Name: Aslambhai Age: 51 year Sex: male Mobile number: Occupation: hand craft worker Reference doctor: Address: Surat Demographic details:

3. Chief complaints Patient is having difficulty In speaking fluid and food leak from the angle of the mouth (right side) difficulty In rinsing mouth after brushing since 10 days.

4. History On 15 th at 9:00 PM, patient told his wife that he feels dry mouth and heavy head. He immediately consulted doctor for this and doctor consulted to get admitted and suggested MRI report. He was admitted in ICU and then after one day he was shifted to ward, next day he got discharged and he was suggested physiotherapy treatment.

5. Past history : patient had an history of stroke on right side before 4 years ago. Medical history : patient is having blood pressure since 2020 and he was not taking blood pressure medication regularly. Surgical history : not present Socio-economic history : patient is belongs to upper middle class (according to kuppu swami scale)

6. Personal history : he is having habit of tobacco chewing since 15 years. Sleep : normal Appetite: normal Bowel and bladder: normal Family history: patient’s mother and brother both are having history of stroke Drug history: patient is taking anti hypertensive drugs Differential diagnosis: LMN facial palsy UMN facial palsy

7. Facial asymmetry present, drooping of right side corner of mouth and eyes are wide open compared to left side Slight swelling is present at right side below the ear and over the cheek Objective assessment On Observation Bell’s phenomenon is present right side Synkinesis is present right side

8. On Palpation Warmth: right side is warmer than opposite side (below ear and cheek) Spasm: present over right side cheek and jaw region.

9. On Examination 01 05 04 03 Corneal reflex : normal blinking response is not present Sensory examination: normal bilaterally Cranial nerve examination: 7 th cranial nerve is affected Hyperacusis: not present Headache: not present Increased lacrimation/ dry eyes : present

10. On Examination 01 05 04 03 Dry mouth : not present Loss taste: not present Food stuck between cheek and teeth: present Heaviness/ numbness over face: not present Tongue deviation: not present

11. Facial muscle grading Functional Complete movement/ slight impairment Weak functional Moderate impairment - perform test with difficulty Non functional Minimal muscle contraction – severe impairment

12. Facial muscle grading Smile – non functional Lip pucker – Weak functional Lowering of lower lip – Weak functional Blow cheek - Weak functional Frowning – non functional Raising eyebrow – non functional Gentle eye closing – Weak functional Snarl – non functional Flaring of nose – non functional

13. Sunnybrook facial grading system:

14. House brackmann facial nerve grading system: Grade 5 : severe dysfunction

15. SD Curve nasalis frontalis

16. Investigation MRI shows gliosis involving left lentiform nucleus, age related neuroparenchymal atrophy

17. Diagnosis Right side bell’s palsy

18. Problem list Swelling present Spasm present Muscle tone is decreased Facial muscle strength is reduced

19. Physiotherapy management Short term goals: Patient education Reduce swelling Muscle activation Long term goals Improve muscle strength

20. Physiotherapy management Patient education: Ask patient to take rest for 2 weeks before physiotherapy treatment wear glasses to prevent eye infection Cover ear against cold wind Galvanic muscle stimulation: For muscle activation in staring phase of treatment, it will also maintain muscle properties

21. Physiotherapy management Massage: It can be done for 10 min Effleurage, kneading, stroking or vibration type of massage can be done Visual feedback: Exercise in front of mirror can be done using PNF technique Can be treated using irradiation concept Can be done by patient also at home

22. Physiotherapy management Taping: To decrease facial muscle asymmetry To increase muscle facilitation To increase proprioception To decrease swelling Faradic current: It can be given to stimulate trunk Lymphatic drainage technique: Neuromuscular re-training: EMG bio-feedback: Kabat technique: Mime therapy:

23. Thanks