- 1.BELLS PALSY BELL'S PALSY IS A FORM OF FACIAL PARALYSIS
RESULTING FROM A DYSFUNCTION OF THE CRANIAL NERVE VII (THE FACIAL
NERVE) CAUSING AN INABILITY TO CONTROL FACIAL MUSCLES ON THE
AFFECTED SIDE 7/19/2014Jacqui van Wyk Therapeutic Health Options
1
2. SIR CHARLES BELL (12 NOVEMBER 1774 28 APRIL 1842) A SCOTT
NOTED FOR DISCOVERING THE DIFFERENCE BETWEEN SENSORY NERVES AND
MOTOR NERVES IN THE SPINAL CORD AND FOR DESCRIBING BELL'S PALSY.
7/19/2014Jacqui van Wyk Therapeutic Health Options 2 3. 12 CRANIAL
NERVES 7/19/2014Jacqui van Wyk Therapeutic Health Options 3 4.
Bell's palsy is the most common cause of acute facial nerve
paralysis. There is no known cause of Bell's palsy, although it has
been associated with herpes simplex infection. Bell's Palsy may
develop over several days, and may last several months, in the
majority of cases recovering spontaneously. It is typically
diagnosed clinically, in patients with no risk factors for other
causes, without vesicles in the ear, and with no other neurological
signs. Recovery may be delayed in the elderly, or those with a
complete paralysis. Bell's palsy is often treated with
corticosteroids. BELLS PALSY 7/19/2014Jacqui van Wyk Therapeutic
Health Options 4 5. BELLS PALSY AFFECTS THE FACIAL NERVES CONTROL A
NUMBER OF FUNCTIONS, SUCH AS BLINKING AND CLOSING THE EYES,
SMILING, FROWNING, LACRIMATION, SALIVATION, FLARING NOSTRILS AND
RAISING EYEBROWS. THEY ALSO INNERVATE THE STAPEDIAL (STAPES)
MUSCLES OF THE MIDDLE EAR AND CARRY TASTE SENSATIONS FROM THE
ANTERIOR TWO-THIRDS OF THE TONGUE. BECAUSE BOTH THE NERVE TO THE
STAPEDIUS AND THE CHORDA TYMPANI NERVE (TASTE) ARE BRANCHES OF THE
FACIAL NERVE, PATIENTS WITH BELL'S PALSY MAY PRESENT WITH
HYPERACUSIS OR LOSS OF TASTE SENSATION IN THE ANTERIOR 2/3 OF THE
TONGUE. THE FOREHEAD MUSCLES ARE USUALLY AFFECTED. ALTHOUGH DEFINED
AS A MONONEURITIS (INVOLVING ONLY ONE NERVE), PATIENTS DIAGNOSED
WITH BELLS PALSY MAY HAVE "MYRIAD NEUROLOGICAL SYMPTOMS" INCLUDING
"FACIAL TINGLING, MODERATE OR SEVERE HEADACHE/NECK PAIN, MEMORY
PROBLEMS, BALANCE PROBLEMS, IPSILATERAL LIMB PARESTHESIAS,
IPSILATERAL LIMB WEAKNESS, AND A SENSE OF CLUMSINESS" THAT ARE
"UNEXPLAINED BY FACIAL NERVE DYSFUNCTION". BELL'S PALSY IS A
DIAGNOSIS OF EXCLUSION, MEANING IT IS DIAGNOSED BY ELIMINATION OF
OTHER REASONABLE POSSIBILITIES. BY DEFINITION, NO SPECIFIC CAUSE
CAN BE DETERMINED. THERE ARE NO ROUTINE LAB OR IMAGING TESTS
REQUIRED TO MAKE THE DIAGNOSIS THE DEGREE OF NERVE DAMAGE CAN BE
ASSESSED USING THE HOUSE-BRACKMANN SCORE. 7/19/2014Jacqui van Wyk
Therapeutic Health Options 5 6. TEST THEY USE TO DETERMINE THE
GRADE OF BELLS PALSY HOUSE-BRACKMANN SCORE 7/19/2014Jacqui van Wyk
Therapeutic Health Options 6 7. AN INFLAMMATORY CONDITION LEADS TO
SWELLING OF THE FACIAL NERVE. THE NERVE TRAVELS THROUGH THE SKULL
IN A NARROW BONE CANAL BENEATH THE EAR. NERVE SWELLING AND
COMPRESSION IN THE NARROW BONE CANAL ARE THOUGHT TO LEAD TO NERVE
INHIBITION, DAMAGE OR DEATH. NERVE AFFECTED BY BELLS PALSY FACIAL
NERVE CNVII 7/19/2014Jacqui van Wyk Therapeutic Health Options 7 8.
WHEN THE FACIAL NERVE IS WORKING PROPERLY, IT CARRIES A HOST OF
MESSAGES FROM THE BRAIN TO THE FACE. THESE MESSAGES MAY TELL AN
EYELID TO CLOSE, ONE SIDE OF THE MOUTH TO SMILE OR FROWN, SALIVARY
GLANDS TO MAKE SPIT. FACIAL NERVES ALSO HELP OUR BODIES MAKE TEARS
AND TASTE FAVOURITE FOODS. BUT IF THE NERVE SWELLS AND IS
COMPRESSED, AS HAPPENS WITH BELL'S PALSY, THESE MESSAGES DON'T GET
SENT CORRECTLY. THE RESULT IS WEAKNESS OR TEMPORARY PARALYSIS OF
THE MUSCLES ON ONE SIDE OF THE FACE. EXPLAINING THE BRAIN AND
FACIAL NERVE IMPLICATION 7/19/2014Jacqui van Wyk Therapeutic Health
Options 8 9. The facial nerve carries axons of type GSA, general
somatic afferent, to skin of the posterior ear. The facial nerve
also carries axons of type GVE, general visceral efferent, which
innervate the sublingual, submandibular, and lacrimal glands, also
mucosa of nasal cavity. The facial nerve also carries axons of type
SVE, special branchial-motor efferent, which innervate muscles of
facial expression, stapedius, the posterior belly of digastric, and
the stylohyoid. The facial nerve also carries axons of type SVA,
special visceral afferent, which provide taste to anterior
two-thirds of tongue via chorda tympani The facial nerve also
carries axons of type GVA, general visceral afferent, which provide
sensation to the soft palate and parts of the nasal cavity. THE
MEDICAL TERMS 7/19/2014Jacqui van Wyk Therapeutic Health Options 9
10. CORTICOSTEROIDS HAVE BEEN FOUND TO IMPROVE BELLS PALSY, WHEN
USED EARLY, WHILE ANTI-VIRAL DRUGS HAVE NOT. OFTEN THE EYE ON THE
AFFECTED SIDE CANNOT BE CLOSED. THE EYE MUST BE PROTECTED FROM
DRYING OUT, OR THE CORNEA MAY BE PERMANENTLY DAMAGED RESULTING IN
IMPAIRED VISION. IN SOME CASES DENTURE WEARERS EXPERIENCE SOME
DISCOMFORT Facial nerve: the facial nerve's nuclei are in the
brainstem (they are represented in the diagram. Orange: nerves
coming from the left hemisphere of the brain. Yellow: nerves coming
from the right hemisphere of the brain. Note: the forehead muscles
receive innervation from both hemispheres of the brain (represented
in yellow and orange). TREATMENT FOR BELLS PALSY 7/19/2014Jacqui
van Wyk Therapeutic Health Options 10 11. HOW DOES THE FACIAL NERVE
INNERVATE THE FACE Cortical innervation is bilateral to portions of
the forehead. Cortical innervation to the lower facial muscles is
unilateral and contralateral. After a Cortical or corticonuclear
lesion, forehead function may remain but lower facial muscles on
CONTRALATERAL SIDE do not remain Facial nerve lesioned as in bells
palsy all facial movement on affected side is lost 7/19/2014Jacqui
van Wyk Therapeutic Health Options 11 12. FACIAL NERVE
7/19/2014Jacqui van Wyk Therapeutic Health Options 12 13. I WOULD
LIKE TO EXPLAIN OUR PERSONAL EXPERIENCE WITH BELLS PALSY DIAGNOSED
ON 10 FEBRUARY 2014 MEDICATION FROM THE DOCTOR, PHYSIOTHERAPY WITH
ELECTRONIC EQUIPMENT, THERAPEUTIC REFLEXOLOGY AND SHIATSU THERAPY
THIS IS A COMPLETELY DIFFERENT WAY TO HOW SCIENTIST THINK
THERAPEUTIC REFLEXOLOGY WAS STARTED 4TH MARCH 2014 THERAPEUTIC
REFLEXOLOGY WAS DONE ON THE PATIENT WITH BELLS PALSY TWICE A WEEK
7/19/2014Jacqui van Wyk Therapeutic Health Options 13 14. RIANA
THEDVALL Name: Riana Thedvall Age: 39 years Occupation: Project
Manager Diagnosed with Bells Palsy: 10 February 2014 Severity:
Grade VI 7/19/2014Jacqui van Wyk Therapeutic Health Options 14 15.
I WOULD LIKE TO INTRODUCE YOU TO RIANA A PATIENT AND FRIEND AS YOU
ALL PROBABLY KNOW BY NOW, I DECIDED TO DO MY PROJECT ON BELLS
PALSY. SATURDAY EVENING 08 FEBRUARY 2014 RIANA STARTED WITH
TERRIBLE NECK PAIN (TRAPEZIUS MUSCLE) SUNDAY 09 FEBRUARY 2014 SHE
WENT AND LAY DOWN FOR A FEW HOURS DUE TO THE NECK PAIN, ON WAKING
UP AROUND 6PM HER LEFT EYE BEGAN TO TEAR A LOT AROUND 10PM SHE FELT
HER MOUTH PULL TO ONE SIDE THE NEXT MORNING (PICTURE TELLS THE
STORY) This photograph was taken 3 days later in hospital on13
February 2014 7/19/2014Jacqui van Wyk Therapeutic Health Options 15
16. SAW THE DOCTOR MONDAY 10 FEBRUARY2014 DOCTOR REFERRED HER TO A
NEUROLOGIST, NEUROLOGIST ADMITTED HER TO HOSPITAL MEDICATION GIVEN
INTRAVENOUSLY: STEROIDS AND CORTIZONE PRESCRIPTION TO TAKE HOME:
DORMONOCT 2MG (SHORT-TERM TREATMENT OF INSOMNIA) SLEEP DISTURBANCES
IN THE GERIATRIC PATIENT. PRE-OPERATIVE SLEEP DISTURBANCES.
DORMONOCT IS ONLY INDICATED WHEN THE DISORDER IS SEVERE, DISABLING
OR SUBJECTING THE INDIVIDUAL TO EXTREME STRESS. ADCO-ALZAN 0.25MG
ALZAM (ALPRAZOLAM) IS INDICATED FOR THE TREATMENT OF ANXIETY
DISORDERS, OR THE SHORT-TERM RELIEF OF SYMPTOMS OF ANXIETY. ANXIETY
ASSOCIATED WITH DEPRESSION IS RESPONSIVE TO ALZAM. ALZAM IS ALSO
INDICATED FOR THE TREATMENT OF PANIC DISORDERS FOR UP TO EIGHT
MONTHS. THE DOCTOR SHOULD PERIODICALLY RE-ASSESS THE USEFULNESS OF
ALZAM (ALPRAZOLAM) IN THE TREATMENT OF ANXIETY DISORDERS; ANXIETY
ASSOCIATED WITH DEPRESSION, FOR LONG TERM USE EXCEEDING SIX MONTHS
HAS NOT BEEN ESTABLISHED. ALZAM IS ONLY INDICATED WHEN THE DISORDER
IS SEVERE, DISABLING OR SUBJECTING THE INDIVIDUALS TO EXTREME
STRESS.) TRIPLINE 25MG (STILL ON THE CHILL MEDS) AMITRIPTYLINE IS
AN TRICYCLIC ANTIDEPRESSANT USED IN THE TREATMENT OF PATIENTS WITH
ENDOGENOUS DEPRESSION. IT ALSO POSSESSES MILD TRANQUILLISING AND
SEDATIVE PROPERTIES WHICH IS HELPFUL IN ALLEVIATING ANXIETY OR
AGITATION THAT OFTEN ACCOMPANIES DEPRESSION. IT HAS BEEN USED WITH
BENEFIT IN DEPRESSION OF LONG OR SHORT DURATION. ALL PATIENTS DO
NOT RESPOND TO THE SAME DEGREE. SOME MAY RESPOND IN 4 TO 10 DAYS
WHILE OTHERS MAY REQUIRE UP TO 30 DAYS TO OBTAIN BENEFIT. LACK OF
RESPONSE MAY OCCUR OCCASIONALLY. Photograph taken on 17 February
2014 7/19/2014Jacqui van Wyk Therapeutic Health Options 16 17.
MEDICATION WAS GIVEN FOR 10 MORE DAYS CORTISONE AND STEROIDS
(TABLETS) Photograph was taken 18 February 2014 7/19/2014Jacqui van
Wyk Therapeutic Health Options 17 18. DOCTOR WAS NOT HAPPY WITH THE
PROGRESS AND SEND PATIENT TO EAR NOSE AND THROAT SPECIALIST (ENT)
ON FRIDAY 21 FEBRUARY 2014 CONFIRMED THAT ITS MORE THAN JUST
CRANIAL NERVE 7 OTHER NERVES AFFECTED CRANIAL 5 AND 8 ENT DOCTOR
PRESCRIBED EYE CREAM (DURATEARS+) AND TO CLOSE THE LEFT EYE AT
NIGHT USING AN EYE PATCH +(DURATEARS: LUBRICATING EYE OINTMENT IS A
MULTI-USE PRESERVATIVE FREE OINTMENT THAT HAS BEEN SPECIALLY
FORMULATED FOR THE SYMPTOMATIC TREATMENT OF DRY EYE CONDITIONS. THE
OINTMENT FORMS A SMOOTH, COMFORTABLE PROTECTIVE FILM WHEN APPLIED
TO THE EYES. IT IS PARTICULARLY EFFECTIVE FOR USE WHILE SLEEPING
AND IN PATIENTS WHO ARE SENSITIVE TO PRESERVATIVES OR WHERE THE USE
OF PRESERVATIVES IS CONSIDERED INAPPROPRIATE. EAR NOSE AND TROAT
SPECIALIST DIAGNOSIS 7/19/2014Jacqui van Wyk Therapeutic Health
Options 18 19. CRANIAL NERVE 5 TRIGEMINAL NERVE The trigeminal
nerve is a nerve responsible for sensation in the face and certain
motor functions such as biting and chewing. It is the largest of
the cranial nerves. Its name derives from the fact that each
trigeminal nerve, one on each side of the pons, has three major
branches: ophthalmic nerve (V1) maxillary nerve (V2) mandibular
nerve (V3) The ophthalmic and maxillary nerves are purely sensory.
The mandibular nerve has both cutaneous and motor functions.
Sensory information from the face and body is processed by parallel
pathways in the central nervous system. The motor division of the
trigeminal nerve is derived from the basal plate of the embryonic
pons The sensory division originates from the cranial neural crest.
7/19/2014Jacqui van Wyk Therapeutic Health Options 19 20. 3
BRANCHES OF TRIGEMINAL NERVE The ophthalmic, maxillary and
mandibular branches leave the skull through three separate
foramina: superior orbital fissure foramen rotundum foramen ovale
The ophthalmic nerve (V1) carries sensory information from the
scalp and forehead, the upper eyelid, the conjunctiva and cornea of
the eye, the nose (including the tip of the nose, except alae
nasi), the nasal mucosa, the frontal sinuses, and parts of the
meninges (the Dura and blood vessels). The maxillary nerve (V2)
carries sensory information from the lower eyelid and cheek, the
nares and upper lip, the upper teeth and gums, the nasal mucosa,
the palate and roof of the pharynx, the maxillary, ethmoid and
sphenoid sinuses, and parts of the meninges. The mandibular nerve
(V3) carries sensory information from the lower lip, the lower
teeth and gums, the chin and jaw (except the angle of the jaw,
which is supplied by C2- C3), parts of the external ear, and parts
of the meninges. The mandibular nerve carries touch/position and
pain/temperature sensation from the mouth. It does not carry taste
sensation (chorda tympani is responsible for taste), but one of its
branches, the lingual nerve, carries somatic sensation from the
tongue. 7/19/2014Jacqui van Wyk Therapeutic Health Options 20 21.
CRANIAL NERVE 8 VESTIBULOCOCHLEAR The vestibulocochlear nerve
consists mostly of bipolar neurons and splits into two large
divisions: cochlear nerve vestibular nerve The cochlear nerve
travels away from the cochlea of the inner ear where it starts as
the spiral ganglia. Processes from the organ of Corti conduct
afferent transmission to the spiral ganglia. It is the inner hair
cells of the organ of Corti that are responsible for activation of
afferent receptors in response to pressure waves reaching the
basilar membrane through the transduction of sound. The exact
mechanism by which sound is transmitted by the neurons of the
cochlear nerve is uncertain; the two competing theories are place
theory and temporal theory . The vestibular nerve travels from the
vestibular system of the inner ear. The vestibular ganglion houses
the cell bodies of the bipolar neurons and extends processes to
five sensory organs. Three of these are the cristae located in the
ampullae of the semicircular canals. Hair cells of the cristae
activate afferent receptors in response to rotational acceleration.
The other two sensory organs supplied by the vestibular neurons are
the maculae of the saccule and utricle. Hair cells of the maculae
activate afferent receptors in response to linear acceleration.
7/19/2014Jacqui van Wyk Therapeutic Health Options 21 22. RELEASE
SOME ENDORPHINS AND SEROTONIN 7/19/2014Jacqui van Wyk Therapeutic
Health Options 22 23. MONDAY 24 FEBRUARY 2014 STARTED WORKING
AGAIN. WAS SUPPOSE TO ONLY WORK HALF DAY BUT YOU KNOW HOW IT IS WE
NEVER DO Photograph taken 27 February 2014 7/19/2014Jacqui van Wyk
Therapeutic Health Options 23 24. THERAPEUTIC REFLEXOLOGY TREATMENT
STARTED TWICE A WEEK ON 4TH MARCH 2014 Photograph was taken 6 March
2014 Reflexology is the science of using the principals that the
feet hands and ears are the mirror image of what is happening in
the body Treatment was working on the cranial nerves especially
Cranial Nerve 5, 7,8 7/19/2014Jacqui van Wyk Therapeutic Health
Options 24 25. CONTINUES TREATMENT OF THE MEDICATION AND
THERAPEUTIC REFLEXOLOGY Photograph was taken 9 March 2014 JUST A
LITTLE ON WHAT WAS WORK ON THE PATIENT FROM A THERAPEUTIC
REFLEXOLOGY POINT OF VIEW WORKING THE LARGE TOES REFERS TO WORKING
THE BRAIN THE DORSUM OF THE FOOT WAS WORKED TO ASSIST IN HELPING
THE FACIAL NERVES TO RECOVER ADRENAL REFLEXES TO ENCOURAGE NATURAL
CORTISONE RELEASE NECK MUSCLES TO RELEASE THEM AND THE FACIAL
MUSCLES NECK VERTEBRAE REFLEXES TO RELEASE THEM 7/19/2014Jacqui van
Wyk Therapeutic Health Options 25 26. SEE THE DIFFERENCE ON THE
FACIAL NERVE Photograph taken 13 March 2014 Photograph taken 13
February 2014 7/19/2014Jacqui van Wyk Therapeutic Health Options 26
27. PICTURES TELL A THOUSAND WORDS Photograph take 20 March 2014
Photograph taken 27 March 2014 7/19/2014Jacqui van Wyk Therapeutic
Health Options 27 28. NEW THERAPIST TOOK OVER DUE TO ILLNESS OF
FIRST THERAPIST (28 MARCH 2014) Photograph taken 12 April 2014
7/19/2014Jacqui van Wyk Therapeutic Health Options 28 29. STILL ON
THE SAME MEDICATION AND CONTINUE TREATMENT OF THERAPEUTIC
REFLEXOLOGY(TWICE A WEEK) Photograph taken 10 May 2014 Photograph
taken 24 May 2014 7/19/2014Jacqui van Wyk Therapeutic Health
Options 29 30. SHIATSU THERAPY WAS STARTED ON 4TH APRIL 2014 TO
HELP RELAX THE NECK MUSCLES Shiatsu Therapy: Scientific explanation
is that shiatsu calms an overactive sympathetic nervous system,
which improves circulation, relieves stiff muscles, and alleviates
stress. Lots of work was done on the muscles of the neck
(Sternocleidomastoideus, Levator Scapulae, Trapezius) and on the
face (Masseter, Temporalis) Treatment was done twice a week
7/19/2014Jacqui van Wyk Therapeutic Health Options 30 31. WHAT A
DIFFERENCE Photograph taken 12 July 2014 Riana continues with her
treatment of Therapeutic Reflexology once a week now and the
Shiatsu Therapy twice a week. She is still on the chill meds. Full
recovery grading I Photograph taken 13 February 2014
7/19/2014Jacqui van Wyk Therapeutic Health Options 31 32.
BIBLIOGRAPHY GOOGLE INTERNET IMAGES PROF P MASON (COURSE
NEUROBIOLOGY) GOOGLE WIKIPEDIA ANATOMY TEXT BOOK FOURTH EDITION
HUMAN ANATOMY AND PHYSIOLOGY CLINICAL ANATOMY SEVENTH EDITION MIMS
RIANA THEDVALL SHARON DU RAAN 7/19/2014Jacqui van Wyk Therapeutic
Health Options 32 33. THANK YOU THANK YOU TO PROF MASON THANK YOU
TO PROF MASON AND HER TEAM SPECIAL THANK YOU TO MY PEERS FOR TAKING
THE TIME TO READ MY MATERIAL THANK YOU TO MY COLLEAGUE AND FRIEND
LAUREN RICHER THANK YOU TO MY PATIENT AND FRIEND RIANA THEDVALL
THANK YOU TO MY MENTOR, COLLEAGUE AND FRIEND SHARON DU RAAN PROF
MASON WITH ALL THE KNOWLEDGE YOU GAVE US ON THIS COURSE WE CAN ONLY
SAY A HUGE THANK YOU 7/19/2014Jacqui van Wyk Therapeutic Health
Options 33