Belle's Palsy

8/8/2019 Belle's Palsy

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KHUSHBOO WALIA

BPT IV YR


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SUBJECTIVE ASSESSMENT


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DEMOGRAPHIC DATAy Name Rahul sachdeva

yAge 26 yrs

y Sex Maley Occupation student

y Handedness RT

y Roomno - 144 bedno-2

yAddress - phagwara

y D.O.Ad 10-11-2010

y D.O.As 12-11-2010


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chiefcomplaints:

Difficultyin speech

Difficultyinholding thefoodinmouth

Difficultyinclosing the righteye


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HISTORY

y Present med history:

Patient was apparently well before 9thNov,2010.On 9thNov,2010 around 9p.m.intheevening,patientfelt

difficultyin speechand suddenlyfeltdifficultyineatingfood whilehaving dinner. On 10th Nov,inthemorningpatientfeltdrooping ofrighteyeand right sidecorner ofthemouth, So was immediatelytakentoDoabahospital

andnow is under themedicalandphysiotherapymanagement both.

y Past med history :

Positivehistoryofear infection 4-5 weeks before.


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yPersonal history :

Noh/o Smoking & Alcohol

y Socio-economic history :

Middle class


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Vitals T0 98.4o F

BP 130/80mmHg

HR 74

RR 18


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OBJECTIVE EXAMINATION


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ON OBSERVATION

y Built Mesomorphic

y Posture Halflying

y Attitude of face

y Drooping ofcorner ofRT eye

y Drooping ofRT sidecorner ofthemouth.

y Drooling ofsalivafromthe RT sideofthemouth


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Attitude of limb

RTUPPERLIMB RTLOWERLIMB

y Shoulder Add & flexed

y Elbo w Flexed

y Forearm Pronated

y Wrist Slight extended

y Fingers - Semiflxd

y Hip ER & Flexed

y Knee Extended

y Ankle Mild PF

y Toes PF


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Attitude of lt ul & lly Shoulder Add & flexed

y Elbo w Slightlyflexed

y Forearm Midprone

yWrist Slight extended

y Fingers - Semiflexed

Hip ER & Flexed

Knee Extended

Ankle Mild PF

Toes PF


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y

Typeofrespiration Abdomino-thoracic

y Patternofrespiration -Normal(Eupnoea)

y Modeofventilation Spontaneous


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ON PALPATION


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Muscle tone

y Softandflabbytoneon right sideoftheface.

y Firmtoneontheleft sideoftheface.


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ON EXAMINATION


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Higher cortical function

y Cognition-normal

y Perception-normal


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Cranial nerve assessmentFACIAL NERVE-

Motor function (rt side of face)

yWrinkling-difficultyy Raising theeyebrows - difficulty

y Show theteeth- difficulty

yWhistling- difficulty

y Compressionofcheeks-difficulty

y Closing eyes tightly- difficulty

Sensory function

Taste sensationis absentonanterior 2/3rdofthetongue


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TRIGIMINAL NERVE

Superficial sensations intacton both sideoftheface.

VESTIBULARNERVE

yWebers test

Normal-no sound/sounds in bothears.


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Sensory System


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Sensations:

SuperficialRTSIDE OFFACE

LTSIDE OFFACE

Pain Normal Normal

Touch Normal Normal

Pressure Normal Normal


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y SUPERFICIALAND DEEP SENSATIONSofboth rtandltupper andlower limb is normal


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Motor system


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RANGE OF MOTION

Upper limbJoints Moveme

ntsRT- LTACTIVE

SHOULDER Flex 0-165

Abd 0-170

ELBOW Flx 0-140

FOREARM Pron 0-80

Supin 0-80


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lower limbjoints movement Rt-lt

active

hip flexion 0-110

abd 0-40

knee flexion 0-130

ankle plantarflexion 0-50

dorsiflexion 0-15


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MUSCLE POWER

MMT OF FACIAL MUSCLESMuscles Grade(RIGHT)

Frontalis NF(ONLY SLIGHT MOTION

DETECTED)Orbiculrais oris NF(HAS SOME LIP MOVEMENT BUT

UNABLE TO BRING LIP TOGETHER)

Buccinator NF(MOVEMENT IS DETECTABLE BUTNOT COMPLETE)

Orbicularis oculi NF(UNABLE TO CLOSE THEEYES)Corriugator supercili NF(SLIGHT MOTIONDETECTED)


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y MMT ofLT sideoffaceis having grade-F iefunctional


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Differential diagnosisy Facial nerve palsy

Upper partoffaceis preserved.

Trigeminal neuralgiaSevere stabbing painover theface

Superficial sensations ofaffected sideoffaceis lost


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Diagnosis

y Etiologicaldiagnosis infectionoftheinternalear( rt)

yAnatomicaldiagnosis lower fibres ofthefacialnerve

y Pathologicaldiagnosis inflammationofthefacialnerve

y Provisionaldiagnosis- right side BELLS PALSY


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Management

Goals:

y Tofacilitate/improvemusclecontraction.

y Tofacilitate/improvefacial symmetry.


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To facilitate the muscle contraction

Electrical stimulationoftheaffectedfacialmuscles Biofeedback


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To improve the facial symmetry

y MANUAL MASSAGE Massagemanipulations onthe

faceinclude:1.Effleurage

2. Finger or thumb kneading

3. Stroking

4. Hacking

5. Tapping


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Neuromuscular retraining:

y Neuromuscular retraining is appliedusing selectivemotor training tofacilitate symmetricalmovementofface.

y EMG feedbackand/or specificmirror exercises aregiventhat willprovidea sensoryfeedbacktopromotelearning.

y Repetitions & frequencyofexercises can bemodifiedaccording toimprovement status.

y

Themovements should beinitiated slowlyandgraduallytoavoidabnormalmovement.

y Thepatientcanapplyamanual resistanceas isolatedfacialmovementimprovedinaffected sideto beobvious withoutanyabnormalmovement.


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PRECAUTIONS

y a) Useofeyedrops regularly.

y b)Exposuretodirect sunlight should beavoided.

y c) Sun glasses should be wear toprotecteyes.


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THANX..

Belle's Palsy

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