Bell's palsy description along with it's physiotherapy management

1. BELL’S PALSY
By- Dr Shiksha Verma (PT)
Assistant Professor
SRMS institute of Paramedical Sciences Bareilly

2. INTRODUCTION
 It is an idiopathic infranuclear facial nerve palsy.
 Bell’s palsy is the paralysis or severe weakness of
the nerve that controls the facial muscles on the
same side of the face - the facial nerve (7th cranial
nerve).
 Charles Bell known for his studies on the nervous
system and the brain. In the 19th century discovered
that lesions of the 7th cranial nerve causes facial
paralysis

6. INCIDENCE
 It more commonly affects people over 15 and under
60 years of age.
 Affects men and women equally.
 Many patients recover without Intervention;
however, up to 30% have poor recovery of facial
muscle control.

7. CAUSES
 Although the cause is unknown (idiopathic)
 Theories about causes include-
 Vascular ischemia
 Viral disease ( herpes simplex, herpes zoster)
 Autoimmune disease
 Nerve trauma

8. RISK FACTORS
 The third trimester of pregnancy
 In individuals with immune disorders such as HIV
infection
 Individuals withy diabetes
 Viral upper respiratory infection

9. PATHOPHYSIOLOGY
Etiology
Inflammation of facial nerve
The inflamed, oedematous nerve becomes compresses to
the point of damage, or its blood supply is occluded
Producing ischemia
Necrosis of facial nerve
Paralysis of facial muscles

10. SYMPTOMS
 Varies from person to person
 Comes on suddenly
 Mild to total paralysis
 Facial; and eyelid droop
 Drooling
 Dryness of eye or mouth
 Impairment of taste
 Excessive tearing of eyes
 Pain or discomfort in jaw and behind the ear
 Difficulty in eating and drinking

12. DIAGNOSTIC EVALUATION
 History of onset of symptoms is used to diagnosis
Bell’s palsy.
 Observation of the patient confirm the
diagnosis.(examine the upper and lower facial
weakness)
 An EMG may be done. This test can confirm the
presence of nerve damage and determine its
severity and the possibility of a stroke must be rule
out.
 MRI or CT : to rule out the causes of pressure on
nerve.

13. MEDICAL TREATMENT
 No real treatment- symptoms usually subsides.
 Corticosteroids- drug of choice
 Anti-inflammatory and antiviral
 Prednisone may start immediately. Best if initiated
before paralysis is complete. Taper off over 2weeks.
Decrease edema and pain.
 Analgesics may be needed for pain
 Antiviral-acyclovir (HSV is implicated in 70% of cases.
 Acupuncture and surgery – for long term paralysis

14. ASSESSMENT
 Subjective
 Patient profile
 Chief complaints
 Present illness
 Past medical h/o
 social h/o
 Objective
 Observation: (eg.- facial drooping, drooping at corner of eyes
and mouth)unilateral.
 CN VII testing : facial expression (lift corner of mouth, raise
mouth, pucker lips)
 Sensation testing: taste to anterior 2/3rd of tongue intact (test-
cotton swab dipped in salt vs sugar)
 Outcome measure:
1. Visual analog scale( VAS): (at rest and after eating or
speaking)

15. 2. house-Brackmann facial nerve scale :

16.  Functional status: (speech slightly slurred,
noticeable effort when talking)

17. PROBLEM LIST (FOR EXAMPLE)

18. PHYSIOTHERAPY MANAGEMENT
 Resolving the inflammation: if the patient comes
immediately following the onset of paralysis, then
he may be treated with the modalities to increase
the circulation in the stylomastoid foramen so that
the inflammation can be resolved.
 Modalities like: SWD, IRR, US, LASER.

20.  Maintain the muscle properties: this can be
achieved with interrupted galvanic stimulation to the
paralyzed muscle.

21.  Facial massage: is essential to maintain the circulation to the
face as well as to keep the face supple. The direction of the
manipulation used should be in upward direction not in
downward direction as downward movements tend to stretch the
paralyzed muscles more and can have deleterious effect.
 Taping/ splinting: these methods are used to decrease the facial
asymmetry noticed in bells palsy.
 Eye care: the patient may be instructed to wash their eyes at
regular interval and to wear protective goggles to prevent entry of
foreign particles into the eyes.
 Faradic re-education: only if patient can tolerate sensory
stimulation. Other means of re-educating muscle is through pnf
technique.
 Visual feedback exercises: the patient may asked to do facial
exercises in front of the mirror, so that he gets a visual feedback
and can perform the exercise more efficiently.
 Strengthening exercise : by using resistance.

22.  Exercises includes :

23. FACIAL EXPRESSIONS

24. ALTERNATIVE MEDICINE