This document provides an overview of facial palsy and updates on treatment options. It discusses the functions of the face, including facial expression, communication, attractiveness and sensory functions. Causes of facial palsy include Bell's palsy and lesions of the facial nerve. Treatment options discussed include steroids, antivirals for acute Bell's palsy, physical therapy techniques like exercises, mirror therapy and electrical stimulation, as well as coping strategies. Outcome measures for facial palsy are also reviewed. While many treatments are discussed, the evidence for most is limited and more research on interventions is still needed.
Bell’s palsy
Trigeminal Neuralgia ( Tic Douloreux)
Cranial & spinal neuropathies
Bell’s palsy (facial paralysis) is due to unilateral inflammation of the ( CN VII Facial nerve) seventh cranial nerve, which results in weakness or paralysis of the facial muscles on the affected side.
Acute Transverse Myelitis
Blockage of the Spinal Cord’s Blood Supply
Cervical Spondylosis
Compression of the Spinal Cord
Hereditary Spastic Paraparesis
Subacute Combined Degeneration
Syrinx of the Spinal Cord and Brain Stem
Bell’s palsy
Trigeminal Neuralgia ( Tic Douloreux)
Cranial & spinal neuropathies
Bell’s palsy (facial paralysis) is due to unilateral inflammation of the ( CN VII Facial nerve) seventh cranial nerve, which results in weakness or paralysis of the facial muscles on the affected side.
Acute Transverse Myelitis
Blockage of the Spinal Cord’s Blood Supply
Cervical Spondylosis
Compression of the Spinal Cord
Hereditary Spastic Paraparesis
Subacute Combined Degeneration
Syrinx of the Spinal Cord and Brain Stem
BELL'S PALSY IS AN IDIOPATHIC LMN TYPE FACIAL PALSY..THE SEMINAR TELLS YOU OF COURSE OF NERVE..FACIAL MUSCLES THEIR ACTION..HOW TO EXAMINE..THE SEQUELAE OF FACIAL PALSY...LOOK AT IT..
Crocodile Tears Syndrome (Bogorad's Syndrome) is a condition that usually occurs during recovery of Bell's palsy. Synkinesis of the facial nerve is responsible for the symptoms (crying instead of salivating, salivating while crying, etc.).
Intelligence Led Policing for Police Decision MakersDeborah Osborne
Intelligence-Led Policing for Decision-Makers Webinar
Audio is at http://www.blogtalkradio.com/Deborah-Osborne/2009/09/23/Intelligence-Led-Policing-for-Decision-Makers-Webinar
This webinar, designed for law enforcement managers, covers the following topics:
* Intelligence: what it is, what it is not, and what it can be
* The role of the decision-maker in the intelligence cycle
* Defining Intelligence-Led Policing and the 3 i's cycle
* The 7 stages of Intelligence-Led Policing
* Resources for learning more about Intelligence-Led Policing
Models of disability, models of learning, accessibility (calrg2014)Martyn Cooper
Presentation for the CALRG Conference 2014 at the Open University in the UK. It considers how our models of disability impact attitudes and solutions to accessibility. It argues that although limited theories of learning help in the design of learning activities. Integrating the two promotes accessibility in e-learning. This approach is exemplified by considering remote labs and learning analytics.
The term facial palsy generally refers to weakness of the facial muscles, mainly resulting from temporary or permanent damage to the facial nerve
Facial palsy not only cause a paresis of the target muscles, but as the nerve is responsible for a range of facial expressions, it causes serious disturbances in social life, facial expression being so important in transferring emotion.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
4. Facial functions
• Facial functions are multidimensional,
serving emotional, social and physical
aspects of an individual’s health.
• The primary functions of the face include
displaying affective emotions, identifying
and communicating with other human
beings.
• Sensory- motor function
5. Sensory motor functions of face
1.
2.
3.
4.
5.
6.
Controls muscles of facial expression.
Taste perception from the anterior two-thirds of the tongue;
Perception of cutaneous stimuli in the external auditory canal and over part
of the pinna and mastoid region;
Innervation of the stapedius muscle in the middle ear;
Innervation of the lacrimal gland
Two of the salivary glands (the submaxillary and submandibular
6. Sensory motor function
• Face also play a major role in
– eye protection,
– eating,
– drinking
– speech.
7. Communication function
• We communicate and with
facial expression
• Display affective emotion
• Emotions are contextual in
turn facial expression are
also
• Emotion determine – facial
muscle activity
• Facial muscle activityemotion
10. Example Smile
• Fake smiles can be
performed at will, because
the brain signals that create
them come from the
conscious part of the brain
and prompt the
zygomaticus major muscles
in the cheeks to contract.
• Muscles pull the corners of
the mouth outwards.
• Genuine smiles, on the
other hand, are generated
by the unconscious brain, so
are automatic.
• As well as making the
mouth muscles move, the
muscles that raise the
cheeks – the orbicularis
oculi and the pars orbitalis –
also contract, making the
eyes crease up, and the
eyebrows dip slightly.
17. Bells palsy
When the cause of the peripheral facial weakness
cannot be determined, a diagnosis of Bell’s palsy is
made.
18. Bells palsy
• The incidence of Bell’s palsy is 20 to 30 cases
per 100,000 people per year
• 60 to 75 percent of all cases of unilateral facial
paralysis.
• Most recover fully- 70- 80%
Peitersen E. Bell’s palsy: the spontaneous course
of 2,500 peripheral facial nerve palsies of diff erent etiologies. Acta Otolaryngol 2002; 549 (suppl): 4–30.
• Residual facial paralysis
20. Who might not recover fully
• Poor prognostic factors:
– older age,Hauser WA, Karnes WE, Annis J, Kurland LT. Incidence and prognosis of Bell’s palsy in
the population of Rochester, Minnesota. Mayo Clin Proc 1971;46:258-64.
– Hypertension Adour KK, Wingerd J. Idiopathic facial paralysis (Bell’s palsy): factors affecting
severity and outcome in 446 patients. Neurology 1974;24:1112-6.
– impairment of taste, Diamant H, Ekstrand T, Wiberg A. Prognosis of idiopathic Bell’s
palsy. Arch Otolaryngol 1972;95:431-3.
– pain other than in the ear, and complete facial
weakness. Cawthorne T, Wilson T. Indications for intratemporal facial nerve surgery. Arch
Otolaryngol 1963;78:429-34.
21. Pathology of bells palsy
• The facial nerve to swelling
• Inflamed in reaction to the
infection?
• Swelling can cause the nerve
to become pinched in the
bony canal
• Death of nerve cells due to
insufficient blood or oxygen
supply
22. Symptoms
• Classic presentation of Bell's palsy is weakness on
one side of the face.
• Drooling after brushing the teeth or when
drinking,
• An asymmetrical appearance of the mouth noticed
in the mirror
• Drooping of the face, such as the eyelid or corner
of the mouth
• Hard to close one eye
• Problems smiling, grimacing, or making facial
expressions
23. Symptoms
• Twitching or weakness of the muscles in the
face
• An inability to whistle, or excessive tearing in
one eye.
• Unable to blow out his cheeks when shaving
• Synkinesis
24. Symptoms
• Pain in or behind the ear,
• Numbness or tingling in
the affected side of the
face usually without any
objective deficit on
neurological examination,
• Hyperacusis
• Disturbed taste on the
ipsilateral anterior part of
the tongue
26. Synkinesis
• Most distressing consequences of facial
paralysis.
• Synkinesis refers to the abnormal involuntary
facial movement that occurs with voluntary
movement of a different facial muscle group.
• Abnormal regeneration of facial nerve fibers
to the facial muscle groups
28. Crocodile tears
• After acute facial paralysis,
preganglionic
parasympathetic fibers
that previously projected
to the submandibular
ganglion may regrow and
enter the major superficial
petrosal nerve.
• Such aberrant
regeneration may lead to
lacrimation after a salivary
stimulus (the syndrome of
crocodile tears).
31. • unanticipated pronunciation errors while
speaking, leaking of fluid or food while
drinking and eating especially in a social
context
• Asymmetry
32. Psychological and social impact
People being subjected to
unwanted intrusions such
as staring or comments
The Negative feedback loop.
PARTRIDGE, J. (1998). Changing Faces: taking up Macgregor’ s challenge. Journal of
Burn Care and Rehabilitation, 19, 174- 180.
33. Interaction of Factors that Contribute to Disability in
Persons with Chronic Facial Paralysis
Impaired ability
to express
context specific
emotions
Facial
Paralysis
Depression,
maladaptive coping
strategies,
social isolation
Inability to close the
eyes, Slurring of
speech, leaking of
fluid during drinking
and eating etc.,
34. Treatment for bells palsy
A critical evaluation of the current treatment
option
35. Acute Bells palsy
• 20 to 30 percent who do not recover fully
remain the focus of treatment.
• Facial-nerve swelling, MRI changes consistent
with inflammation
– Steroids- Prednisone
– Antiviral drugs ?!
36. Types of physical therapy interventions for facial
palsy
• Facial exercises, such as
– Strengthening and Stretching,
– Endurance,
– Therapeutic and facial mimic exercises ("mime
therapy")
•
•
•
•
Electrotherapy,
Biofeedback,
Transcutaneous electrical nerve stimulation (TENS)
Thermal methods or massage, alone or in
combination with any other therapy.
38. Simple traditional exercise
• To improve the activation level of various
group of facial muscles
– Suck the cheeks between the teeth
– Wrap the lips over the teeth
– Puckering of the lips
– Speech sounding “sh”, “P”, “B”, “F” with teeth held
together or fixed
– Eye closing exercise; “look down, close the eyes,
once closed continue to look down” .
39. MIME
Title
Method
sample
Outcome
Result/
conclusion
Otol Neurotol. 2003 Jul;24(4):67781. Positive effects of mime
RCT
50 patients
HouseBrackmann
score of Grade
IV.
Facial
Disability
Index
Facial Disability
Index improved
substantially
Follow up
of the
above
RCT
48
9 months
majority
absence of
deterioration
50
Sunnybrook
Improvement in
Facial Grading symmetry
System
House facial
grading
therapy on sequelae of facial
paralysis: stiffness, lip
mobility, and social and
physical aspects of facial
disability.
Otol Neurotol. 2006
Oct;27(7):1037-42.
Stability of benefits of mime
therapy in sequelae of facial
nerve paresis during a 1-year
period.
Aust J Physiother. 2006;52(3):177RCT
83. Mime therapy improves
facial symmetry in people with
long-term facial nerve paresis:
a randomised controlled trial
40. • Mime – combination of mime and
physiotherapy
• Performing expression
• Can also be helpful in chronic facial paralysis
41. Functional exercise
• Developed as a multi dimensional and patientcentered approach to rehabilitation of
individuals with facial paralysis Prakash V, Hariohm K, Vijayakumar
P, Thangjam Bindiya D. Functional training in the management of chronic facial paralysis. Phys Ther.
2012;92:605–613.
• Encompasses major facial functions
• The functional training program consists of
patient education, functional training and
complementary exercises
42. Functional training
Improved ability to express
context specific emotions
and other physical functions
of face
Patient education
Positive coping
strategies and Improved
social interaction skills
Functional
Training
Program
Functional
training
Complimentary
exercise
Improved ability to
activate various facial
muscles
43. Functional training
• To facilitate context specific spontaneous and
voluntary emotions
1. Watch movies, television programs and funny
videos.
2. Narrate them during the treatment session in
the clinic.
3. Think about the funny incidents that had
happened in your life or the jokes you heard or
read recently and share it with friends or family
members.
44. Functional training
• To facilitate motor functions of facial muscles around
the eyes, lips and mouth.
1. Hum or sing songs that you like as frequently as
possible
2. Play games like peek -a- boo, blowing bubbles with
your kids.
3. Rinse the mouth and spit the water down slowly.
4. Blow a pipe while imagining that you are cooking in
the kitchen and suddenly the fire puts off in the wood
stove; you have to blow the pipe to make the fire
again.
46. Tile and author
Electrical stimulation
Design
Sample size Outcome
Effect / result
Physiotherapy for Bell's
palsy. British Medical
Journal 1958;2(5097):675-7
RCT
83
Exp- ES
N= 43 (exp)
Con- massage N=40 (con)
1 year
follow up
No significant
advantage
Tratamiento de la parálisis
facial periférica idiopática:
terapia física versus
prednisona Revista médica del
Instituto Mexicano del Seguro
Social1998;36(3):217-21.
RCT
Group1- ES
Group2prednisone
149
n-=76
May scale
No difference
at 3 months
Physical therapy for Bell´ s
palsy (idiopathic facial
paralysis)
(Review) . Cochrane
Database of Systematic
Reviews 2008, Issue 3. Art.
No.: CD006283.
review
294
participants
47. Title and author
Electrical stimulation
Design
Sample
Outcome
Effect / result
size
measure
Effects of electrical stimulation A pretest posttest
on House-Brackmann scores in control vs.
early Bell's palsy. Rev Med Inst experimental
Mex Seguro Soc. 2009 Julgroups design
Aug;47(4):413-20
N=8 in
each
group
HouseBrackmann
scores
No significant
difference
[Observation on non-invasive
electrode pulse electric
stimulation for treatment of
Bell's palsy]. Zhongguo Zhen
Jiu. 2006 Dec;26(12):857-8.
RCT
N=138
?
EC No
Therapeutic
effect on Bell
palsy.
Effect of facial neuromuscular
re-education on facial
symmetry in patients with
Bell's palsy: a randomized
controlled trial. Clin
Rehab 2007;21(4):338-43
RCT
Group1-exercise &
ES
Group2- ES
59
n-=30
N=29
Facial
Grading
Scale
No difference
at 3 months
Compared with
prednisone etc
48. Electrotherapy ES
• May have an adverse effect on recovery
• Avoid in acute stage
• Poor evidence to show it may be helpful in
chronic facial paralysis.
53. Education- assumptions and content
• Behaviour of the individual rather than
physical appearance can be instrumental in
influencing the response from other people
• Coping strategies
54. Coping strategies
• To change the way one think to feel / act
better even if the situation does not change.
• To reconstruct one’s thoughts and perception
of the problem like negative self-perception of
facial attractiveness (body image),
interpretation of others/society’s views
towards one’s disability etc...
55. Synkinesis
• Most common areas of
injection are eye
muscles (orbicularis),
neck bands (platysma),
and chin dimpling
(mentalis).
60. Synkinesis Assessment Questionnaire
Validation of the Synkinesis Assessment Questionnaire Ritvik P. Mehta, MD; Mara
WernickRobinson, PT, MS, NCS; Tessa A. Hadlock, MD Laryngoscope, 117:923–926, 2007
61.
62.
63.
64. Conclusion
• About 20- 23% of people with Bell's palsy are
left with either moderate to severe symptoms
• Don’t just think of it as a motor problem
• Intervention needed to concentrate on all
aspects of the disability
• Update the interventional strategies