bells palsy

1. CASE PRESENTATION
pty 322
ca 2

2. CASE
SUBJECTIVE EXAMINATION
DEMOGRAPHIC DATA:
• Name of the patient: Ranjit Singh
• Age/sex : 51/MALE
• Address: Phagwara
• Occupation: Businessman
CHIEF COMPLAINTS:
• Weakness on the RIGHT SIDE of the face since a week.
• Problem in speaking, chewing, drinking and eye closing.
• drooling from right side of mouth.
HISTORY OF PRESENT ILLNESS:
• Patient 51-years old male, with a personal history of hypertension suffered from a sudden
paralytic attack of the face 3 years ago, he visited the doctor and was diagnosed as bell’s
palsy. He recovered after the given treatment.
• Presently few days back he got the attack again and came for treatment of the same.
ONSET : Rapid (over 48 hours)

3.  PAST MEDICAL HISTORY - No diabetes, Hypertension, no bronchial asthma, no CAD
 PRESENT MEDICAL HISTORY - Allergies- none, Surgeries- none, Current Medications-
Ramepril/ Amlodipine (for HTN)
 PERSONAL HISTORY- No smoking, no alcohol, denies use of illegal drugs
 OCCUPATIONAL HISTORY- Businessman
 FAMILY HISTORY- N/A
 SOCIO-ECONOMIC HISTORY- Middle class
OBJECTIVE EXAMINATION
ON OBSERVATION:
• Asymmetry on right side of the face.
• Partial Eye closing
• Partial Frowning
• Cannot raise eyebrows.
• Deviation of face on opposite side (left side)
• Absent nasolabial fold
• He was not able to smile on the affected side.
• Not able to speak clearly.

4. ON PALPATION:
• Decreased muscle tone on the right side of the face as compared to
the left side.
ON EXAMINATION:
• HIGHER MENTAL FUNCTIONS: No Abnormality seen.
• Sensory examination ( the anterior 2/3rd of the tongue) - Normal.
• Motor examination: Patient was not able to puff cheeks, completely
close his eyes, flare his nose, and was not able to show his teeth on
the affected side or smile.
• VITAL SIGNS: Blood Pressure: 160/90 mm hg, respiratory rate-
18bpm, pulse-80bpm, Temperature: afebrile, spo2- 96%.

5. ASSESSMENT
• SCALE FOR BELL’S PALSY:
HOUSE BRACKMANN SCALE -
total 6 grades
• Grade 4 ( Moderately severe
dysfunction, incomplete eye
closure, disfiguring asymmetry)
• PROVISIONAL DIAGNOSIS :
BELL’S PALSY

6. GOALS OF PHYSIOTHERAPIST
SHORT TERM GOALS:
• Treat Asymmetry.
• Prevent infection in the affected side eyeball.
• To help patient closing his right side eye.
LONG TERM GOAL:
• To imbibe confidence within the patient for social participation.
• To increase the muscle power of facial muscles of affected side.
• To help the patient to achieve normal facial expressions.
• To help patient in leading daily life normaly (speaking, eating,
smiling)

7. CLINICAL PRESENTATION OF THE PATIENT
{Patient and therapist consent received}

8. TREATMENT
• Electrical stimulation on
the motor points of the
face including:
Frontalis, Corrugator Supercilli,
Orbicularis occuli,Facial nerve
trunk, Orbicularis oris, Risorious,
Nasalis, Mentalis, Levator labii
superioris, Levator labii
inferioris, Zygometicus.

9. Applying electrical stimulation over facial muscles motor points using pen electrode.

10. • Exercises:
Blowing,Frowning, Eye closing, Chewing, Drinking water using straw, Smiling
(20reps X 3 sets)
• Facial Massage: Helps in strength of the muscle.
• upper massage for FOREHEAD
• middle for CHEEKS
• lower massage for LOWER FACIAL MUSCLES

11. HOME EXERCISES
• The patient is adviced to sit in front of mirror and give a self facial
massage in a circular way (both clockwise and anti-clockwise)
throughout all the motorpoints berally and simultaniously.
• Candle blowing: The patient is adviced to light a candle and try to
put it out by blowing.
• Blowing of baloon.
• Chewing a chewing gum (for non-diabetic only)
• Use doctor suggested eyedrops to prevent dryness of eyes and
tape while sleeping.