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 15th 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: 7th 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. ICF
(Healthcondition-bell’spalsy)
Body structureandfunction
•Flaccidtone
•Decreasedmuscle strength
•Problemin facialexpression
•Cranialnerveno.7-affected
Personalfactor
facilitator
Aware abouthis condition andworking
for it
Activitylimitation
Sleepingdifficulty
Difficultyin drinkingandchewingfood
Difficultyin expressionwhiletalking
Participation restriction
Avoidssocialgathering

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

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

21. 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

22. 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

23. 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:

24. CREDITS: This presentation template was created by
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Thanks