This document provides an overview and update on facial palsy. It discusses the functions of the face, including displaying emotions, communication, sensory functions, and physical roles. Facial nerve lesions can be central or peripheral. Bell's palsy is described as an idiopathic peripheral facial paralysis. Treatment options discussed include steroids, antivirals, physical therapy techniques like exercises and mime therapy, and a functional training program. Chronic facial palsy can cause issues like synkinesis, asymmetry, and psychological impacts that rehabilitation aims to address.
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.
This document discusses several primitive and tonic reflexes seen in infants, including their typical onset, integration period, grading scales, and clinical descriptions. The reflexes discussed include the asymmetric and symmetric tonic neck reflexes, positive support reflex, tonic labyrinthine reflex, and others. The document provides details on techniques for eliciting each reflex and what physical findings correspond to different grades of response.
A 57-year-old diabetic man presented with double vision for 6 days and difficulty walking for 4 days. On examination, he had bilateral eye muscle paralysis, weakness of the limbs, reduced reflexes, and an unsteady gait. Tests showed a motor nerve disorder and diabetes complications. He was diagnosed with Guillain-Barré syndrome (Miller Fisher variant), diabetes mellitus type 2, and white matter brain changes. He received treatment and showed improvement in the hospital.
This document discusses primitive reflexes, which are innate reflexes present at birth that typically disappear during normal development as higher brain centers take control. It describes several primitive reflexes organized by the level of the central nervous system that controls them, including spinal, brainstem, midbrain, and cortical reflexes. For each reflex, it provides the positioning, stimulus, expected response, typical age of presence, and sometimes a video demonstration. Retained primitive reflexes can indicate neurological abnormalities.
This document discusses several functional assessment scales used to evaluate patients. The Berg Balance Scale assesses static and dynamic balance abilities through 14 tasks. The Barthel Index measures dependence in activities of daily living like feeding, bathing, and mobility. The Functional Independence Measure assesses disability levels and needed assistance for 18 activities. The Action Research Arm Test evaluates upper extremity function through 19 hand and arm tasks. The Functional Reach Test measures forward balance ability, while the Multi-directional Reach Test assesses limits of stability in four directions. All scales are reliable and valid for assessing functional abilities.
This document discusses neurological principles including brain localization and lateralization of functions. It describes how lesions in different areas of the cortex can cause various neurological deficits. It also covers neurological examination techniques like assessing level of consciousness, cognitive function, cranial nerves, motor function, sensation, and gait. Localization of lesions is important for neurological diagnosis and determining the pathological cause. A thorough history and neurological examination are crucial for evaluation.
The document discusses the Berg Balance Scale (BBS), which is a 14-item clinical test used to assess static and dynamic balance abilities. It involves tasks of increasing difficulty ranging from sitting to standing to walking. Scores are interpreted on a scale of 0 to 4 for each item, with a maximum total of 56 indicating low fall risk. The BBS has been validated as a reliable tool for measuring balance impairment, especially in elderly patients and those with conditions like stroke. However, it may lack sensitivity for early-stage stroke patients and not adequately challenge very high-functioning individuals.
This presentation discusses Bell's palsy, a condition causing paralysis of the facial nerve. It defines Bell's palsy, describes the facial muscles affected and symptoms experienced. Treatment may include oral steroids, surgery, and physiotherapy techniques like massage, exercises and electrical stimulation to aid recovery which typically occurs within 3 months for 50% of patients. The cause of Bell's palsy is unknown but it can develop suddenly and affect people of any age or gender.
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.
This document discusses several primitive and tonic reflexes seen in infants, including their typical onset, integration period, grading scales, and clinical descriptions. The reflexes discussed include the asymmetric and symmetric tonic neck reflexes, positive support reflex, tonic labyrinthine reflex, and others. The document provides details on techniques for eliciting each reflex and what physical findings correspond to different grades of response.
A 57-year-old diabetic man presented with double vision for 6 days and difficulty walking for 4 days. On examination, he had bilateral eye muscle paralysis, weakness of the limbs, reduced reflexes, and an unsteady gait. Tests showed a motor nerve disorder and diabetes complications. He was diagnosed with Guillain-Barré syndrome (Miller Fisher variant), diabetes mellitus type 2, and white matter brain changes. He received treatment and showed improvement in the hospital.
This document discusses primitive reflexes, which are innate reflexes present at birth that typically disappear during normal development as higher brain centers take control. It describes several primitive reflexes organized by the level of the central nervous system that controls them, including spinal, brainstem, midbrain, and cortical reflexes. For each reflex, it provides the positioning, stimulus, expected response, typical age of presence, and sometimes a video demonstration. Retained primitive reflexes can indicate neurological abnormalities.
This document discusses several functional assessment scales used to evaluate patients. The Berg Balance Scale assesses static and dynamic balance abilities through 14 tasks. The Barthel Index measures dependence in activities of daily living like feeding, bathing, and mobility. The Functional Independence Measure assesses disability levels and needed assistance for 18 activities. The Action Research Arm Test evaluates upper extremity function through 19 hand and arm tasks. The Functional Reach Test measures forward balance ability, while the Multi-directional Reach Test assesses limits of stability in four directions. All scales are reliable and valid for assessing functional abilities.
This document discusses neurological principles including brain localization and lateralization of functions. It describes how lesions in different areas of the cortex can cause various neurological deficits. It also covers neurological examination techniques like assessing level of consciousness, cognitive function, cranial nerves, motor function, sensation, and gait. Localization of lesions is important for neurological diagnosis and determining the pathological cause. A thorough history and neurological examination are crucial for evaluation.
The document discusses the Berg Balance Scale (BBS), which is a 14-item clinical test used to assess static and dynamic balance abilities. It involves tasks of increasing difficulty ranging from sitting to standing to walking. Scores are interpreted on a scale of 0 to 4 for each item, with a maximum total of 56 indicating low fall risk. The BBS has been validated as a reliable tool for measuring balance impairment, especially in elderly patients and those with conditions like stroke. However, it may lack sensitivity for early-stage stroke patients and not adequately challenge very high-functioning individuals.
This presentation discusses Bell's palsy, a condition causing paralysis of the facial nerve. It defines Bell's palsy, describes the facial muscles affected and symptoms experienced. Treatment may include oral steroids, surgery, and physiotherapy techniques like massage, exercises and electrical stimulation to aid recovery which typically occurs within 3 months for 50% of patients. The cause of Bell's palsy is unknown but it can develop suddenly and affect people of any age or gender.
An incomplete spinal cord injury results in partial damage to the spinal cord, leaving some motor and sensory function remaining below the level of injury. The effects depend on the area of the cord damaged, such as the anterior, central, or posterior regions. Common types of incomplete injury include anterior cord syndrome, central cord syndrome, and Brown-Séquard syndrome. Recovery from incomplete injuries can vary greatly between individuals based on the specific nerves impacted.
Orthopedic Surgeries and Physiotherapy in Cerebral PalsySreeraj S R
This document discusses orthopaedic surgeries and physiotherapy for cerebral palsy, focusing on spine/scoliosis, hips, knees, and lower legs. For scoliosis, conservative treatments include bracing and physical therapy while surgical treatment is posterior spinal fusion. For hips, soft tissue releases and osteotomies are used to treat subluxation/dislocation, while contractures may be treated with botulinum toxin or soft tissue lengthening. Knee flexion contractures are treated first with stretching and bracing but may require hamstring lengthening, capsulotomy, or femoral osteotomy. Post-operative rehabilitation focuses on range of motion, stretching, strengthening, and functional training.
constraint induced movement therapy.pptxibtesaam huma
Constraint induced movement therapy
Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Content
Introduction
History of CIMT
Components of CIMT
Population for CIMT
Advantages of CIMT
Recent advances
Introduction
History of CIMT
CIMT is based on research by Edward Taub ,his hypothesize that the non use was a learning mechanism and calls this behavior “Learned non-use”.
It was observed that patients with hemiparesis did not use their affected extremity .
Overcoming learned non use
Mechanisms of CIMT
Population for CIMT
Stroke
Traumatic Brain Injury
Spinal Cord Injury
Multiple Sclerosis
Cerebral Palsy
Brachial Plexus Injury
Advantages of CIMT
Overall greater improvement in function than traditional treatment.
Highly researched and credible treatment approach.
There are brain activity and observed gray matter reorganization in primary motor, cortices and hippocampus.
Increase social participation
Components Of CIMT
Types of CIMT
Restraining Tools for CIMT
Minimal Requirement of hand function for CIMT
Recent Advances
The EXCITE Trial: Retention of Improved Upper Extremity Function Among Stroke Survivors Receiving CI Movement Therapy.(2008)
The Extremity Constraint Induced Movement Therapy Evaluation (EXCITE) demonstrated that CIMT administered 3-9 months post-stroke, resulted in statistically significant and clinically relevant improvement in upper extremity function during the first year compared to those achieved by participants undergoing usual and customary care.
This study was the first randomized clinical trial to examine retention and improvements for the 24 month period following CIMT therapy in a subacute sample.
Study design - single masked cross-over design, with participants undergoing adaptive randomization to balance ,gender, prestroke dominant side, side of stroke, and level of paretic arm function across sites.
CIMT was delivered up to 6 hours per day, 5 days per week for 2 weeks.
Subsequent evaluations were made after the two week period, and at 4, 8, and 12 months.
Because the control group was crossed over to receive CIMT after one year.
Primary outcome measures – Wolf Motor Function Test
Motor Activity Log
Secondary outcome measure - Stroke Impact Scale (SIS)
were assessed at each of these time intervals, was administered only at baseline, 4, 12, 16 and 24 month evaluations.
Result :There was no observed regression from the treatment effects observed at 12 months after treatment during the next 12 months for the primary outcome measures of WMFT and MAL.
In fact, the additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT the changes were significant (P < .05) Secondary outcome variables, including the SIS, exhibited a similar pattern.
Conclusion: Mild to moderately impaired patients who are 3-9 months post-stroke demonstrate
This document discusses various types of movement disorders including tics, chorea, dystonia, ballismus, myoclonus, tremors and ataxia. It describes the characteristics, causes and treatment of each condition. Movement disorders can have different presentations but often represent an underlying neurological or medical issue. Precise definitions can be difficult, and treatment may involve addressing the root cause in addition to specific therapies for symptom management.
Functional Independence Measure (FIM)
Is an 18-item, 7-level ordinal scale
Is designed to assess areas of dysfunction in activities that commonly occur
The scale has few cognitive, behavioral, and communication-related functional items
Is not specific for spinal cord injuries but is designed to assess neurological, musculoskeletal, and other disorders.
Guillain-Barré syndrome with Physiotherapeautic managementsSAGAR KUMAR GOUDA
GBS, also known as Guillain-Barre syndrome, is an acute immune-mediated polyneuropathy that results in demyelination of peripheral nerves. It typically presents with ascending paralysis, though some patients experience descending paralysis or a Miller-Fisher variant characterized by ophthalmoplegia. Physiotherapy management aims to prevent complications through techniques like chest physiotherapy, range of motion exercises, positioning, and addressing pain and weakness. Treatment includes supportive care, plasmapheresis, IVIG, and focusing on recovery of motor and sensory function.
Occupational therapy management in traumatic brain injuryDineshKandeepan
The document discusses occupational therapy management for patients with traumatic brain injury. It describes common impairments patients may experience such as abnormal reflexes, muscle tone issues, weakness, sensory changes and more. It then outlines the evaluation tools and interventions occupational therapists use at different stages of recovery including positioning, range of motion exercises, splinting, sensory stimulation and family education. The goal is to optimize motor and cognitive functioning and help patients regain independence in daily activities.
Brachial Plexus Injury - An Introduction to the PhysiotherapistsJebarajFletcher
The document provides details about the brachial plexus, which is formed by the ventral rami of spinal nerves C5-T1. It innervates the upper limb and pectoral girdle. The brachial plexus consists of roots, trunks, divisions, cords, and branches. The trunks are the upper, middle, and lower trunks formed from C5/C6, C7, and C8/T1 respectively. The cords are the lateral, medial, and posterior cords. The major nerves include the axillary, radial, musculocutaneous, ulnar, and median nerves. Injuries to different parts of the brachial plexus can result
The document discusses Bell's palsy, which causes sudden weakness or paralysis of the muscles on one side of the face. It is caused by inflammation and swelling of the 7th cranial nerve, which controls facial muscle movement. Symptoms include an inability to smile or close one eye fully. Treatment involves corticosteroids to reduce swelling along with antiviral medications, as herpes simplex virus is a common cause. Most people fully recover facial function within a few months, though symptoms may persist in rare cases.
This document provides an overview of syringomyelia, including its pathogenesis, pathology, classification, clinical features, and natural history. Syringomyelia is a condition characterized by fluid-filled cavities within the spinal cord. It most commonly affects the cervical and thoracic regions. Clinical features include pain and sensory loss. The natural history varies, but symptoms typically progress slowly over years, with some patients experiencing stabilization or spontaneous resolution in rare cases.
This presentation briefs out the approach of dementia assessment in line with consideration of recent advances. Now the pattern of assessment has evolved towards examining each individual domain rather than lobar assessment.
How to Prevent and Treat Shoulder Subluxation After Stroke?Techcare Innovation
Yvonne Khor is a senior physiotherapist and founder of YK Natural Physio & Academy with over 8 years of experience. She provides training on how to prevent and treat shoulder subluxation, a common complication after stroke where the shoulder partially dislocates. The document discusses assessing the grade of subluxation, using positioning, slings, bracing and exercises to strengthen muscles and support the shoulder joint. Prevention techniques like proper positioning and avoiding overstretching can help reduce the risk of subluxation developing after a stroke.
This document outlines the Fugl-Meyer Assessment of motor recovery after stroke (FMA-UE), which evaluates upper extremity impairment and physical performance in several domains. It assesses: I) Reflex activity, II) Volitional movement within synergies, III) Volitional movement mixing synergies, IV) Volitional movement with little synergy, V) Normal reflexes, B) Wrist function, C) Hand function, D) Coordination/speed, and also evaluates H) Sensation, J) Passive joint motion, and J) Joint pain. Scores are provided for each domain to quantify impairment and higher scores indicate better motor recovery and function.
This document provides an overview of Complex Regional Pain Syndrome (CRPS). It defines CRPS as a multi-symptom syndrome affecting one or more extremities that is usually out of proportion to the inciting cause. CRPS involves pain, changes in skin temperature or color, swelling, or restricted joint movement. It discusses the stages of CRPS from initial pain and swelling to potential long-term tissue damage. The document also outlines medical and surgical treatment options.
The document describes the Motor Re-Learning Program (MRP), an approach to improving motor control after stroke. The MRP focuses on relearning daily activities through task-oriented practice and is based on theories of distributed motor control. The summary is:
1. The MRP involves analyzing tasks, practicing missing components, practicing whole tasks, and transferring learning to other contexts.
2. Intervention follows four steps - analyzing the task, practicing missing components, practicing the whole task, and transferring learning.
3. The program evaluates and improves functions like upper limb use, sitting, and walking through identifying normal movement and compensatory strategies.
Bell's palsy is an acute onset of non-suppurative inflammation of the facial nerve above the stylomastoid foramen, causing unilateral facial paralysis. It has an incidence of 23 per 100,000 people and affects men and women equally of all ages. Common causes include HSV type 1 and varicella zoster virus. Symptoms include drooping of the mouth corner, inability to close the eyelid on the affected side, and loss of taste sensation. Most patients recover facial function within 3 months, though 10-15% may have some permanent weakness or contractures. Treatment focuses on eye protection and facial exercises, with corticosteroids sometimes used to reduce inflammation and swelling.
The blink reflex is a disynaptic or multisynaptic reflex that involves the trigeminal and facial nerves. It has two responses - an early ipsilateral R1 response and a late bilateral R2 response. The blink reflex test stimulates the supraorbital nerve branch to evaluate conduction along the trigeminal and facial nerve pathways. Abnormalities in the R1 and R2 responses can localize lesions in different parts of the brainstem or peripheral nerves. The test involves recording electromyography of the orbicularis oculi muscle in response to supraorbital nerve stimulation.
This document discusses ataxia in children. It describes the different types of ataxia including sensory ataxia and cerebellar ataxia. It outlines the characteristic features, locations of lesions, physical exam findings, and hints to differentiate between sensory and cerebellar ataxia. The document also provides guidance on evaluating a child with ataxia including taking a thorough history, performing a full physical and neurological exam, ordering appropriate tests and imaging, and considering possible consultations. Common causes of ataxia in childhood are discussed such as congenital, degenerative/genetic, infectious, metabolic, neoplastic, toxic, traumatic and vascular etiologies.
Guillain Barre Syndrome (GBS) is an acute immune-mediated polyneuropathy where there is demyelination of peripheral nerves. It presents with rapidly progressive symmetric motor weakness, areflexia, and sensory symptoms. Diagnosis is based on clinical features and albuminocytological dissociation seen on lumbar puncture. Treatment involves plasmapheresis, IVIG, or steroids to reduce immune-mediated damage. Physiotherapy management focuses on maintaining respiratory function, range of motion, muscle strength, and functional mobility through various exercises to aid recovery.
Neurosyphilis and its physiotherapy managementMuskan Rastogi
This document discusses neurosyphilis, a sexually transmitted disease caused by Treponema pallidum that affects the nervous system. It describes four clinical types of neurosyphilis: asymptomatic neurosyphilis, meningovascular neurosyphilis, Tabes dorsalis, and general paralysis of insane. For each type, it outlines the characteristic symptoms, areas of the nervous system affected, and typical progression. The document also covers investigations, medical management focusing on penicillin treatment, and principles of physiotherapy management including assessment, goals, and specific plans and exercises.
This document discusses facial paralysis, which can be aesthetically, functionally, and psychologically devastating. It affects the 18 paired and 1 unpaired muscles that animate the face. Symptoms discussed include dry eyes, tearing, eye closure issues, nasal obstruction, oral symptoms like incontinence and speech problems, and psychological and communication difficulties displaying emotions. Examination focuses on areas like the brow, eyes, mouth, and nasolabial fold. Treatment goals are to protect the eye, restore symmetry, and allow facial movements. Surgical management techniques mentioned include brow lifts, gold weight placement, tarsorrhaphy, tendon sling placement, microneurovascular muscle transplantation, and static tendon sling placement. The
This document discusses facial nerve paralysis, including:
- The anatomy of the facial nerve and branches that innervate facial muscles.
- Common causes of facial nerve paralysis like Bell's palsy.
- Evaluating facial nerve paralysis through examining facial muscles, taste sensation, lacrimation, and nerve conduction velocity.
- Treating facial nerve paralysis with physical therapy including heat, electrotherapy, exercises and occasionally splinting.
An incomplete spinal cord injury results in partial damage to the spinal cord, leaving some motor and sensory function remaining below the level of injury. The effects depend on the area of the cord damaged, such as the anterior, central, or posterior regions. Common types of incomplete injury include anterior cord syndrome, central cord syndrome, and Brown-Séquard syndrome. Recovery from incomplete injuries can vary greatly between individuals based on the specific nerves impacted.
Orthopedic Surgeries and Physiotherapy in Cerebral PalsySreeraj S R
This document discusses orthopaedic surgeries and physiotherapy for cerebral palsy, focusing on spine/scoliosis, hips, knees, and lower legs. For scoliosis, conservative treatments include bracing and physical therapy while surgical treatment is posterior spinal fusion. For hips, soft tissue releases and osteotomies are used to treat subluxation/dislocation, while contractures may be treated with botulinum toxin or soft tissue lengthening. Knee flexion contractures are treated first with stretching and bracing but may require hamstring lengthening, capsulotomy, or femoral osteotomy. Post-operative rehabilitation focuses on range of motion, stretching, strengthening, and functional training.
constraint induced movement therapy.pptxibtesaam huma
Constraint induced movement therapy
Dr. Quazi Ibtesaam Huma (MPT)
Dr. Suvarna Ganvir (Phd, Prof & HOD)
Dept. of Neurophysiotherapy
DVVPF’s College of Physiotherapy
Content
Introduction
History of CIMT
Components of CIMT
Population for CIMT
Advantages of CIMT
Recent advances
Introduction
History of CIMT
CIMT is based on research by Edward Taub ,his hypothesize that the non use was a learning mechanism and calls this behavior “Learned non-use”.
It was observed that patients with hemiparesis did not use their affected extremity .
Overcoming learned non use
Mechanisms of CIMT
Population for CIMT
Stroke
Traumatic Brain Injury
Spinal Cord Injury
Multiple Sclerosis
Cerebral Palsy
Brachial Plexus Injury
Advantages of CIMT
Overall greater improvement in function than traditional treatment.
Highly researched and credible treatment approach.
There are brain activity and observed gray matter reorganization in primary motor, cortices and hippocampus.
Increase social participation
Components Of CIMT
Types of CIMT
Restraining Tools for CIMT
Minimal Requirement of hand function for CIMT
Recent Advances
The EXCITE Trial: Retention of Improved Upper Extremity Function Among Stroke Survivors Receiving CI Movement Therapy.(2008)
The Extremity Constraint Induced Movement Therapy Evaluation (EXCITE) demonstrated that CIMT administered 3-9 months post-stroke, resulted in statistically significant and clinically relevant improvement in upper extremity function during the first year compared to those achieved by participants undergoing usual and customary care.
This study was the first randomized clinical trial to examine retention and improvements for the 24 month period following CIMT therapy in a subacute sample.
Study design - single masked cross-over design, with participants undergoing adaptive randomization to balance ,gender, prestroke dominant side, side of stroke, and level of paretic arm function across sites.
CIMT was delivered up to 6 hours per day, 5 days per week for 2 weeks.
Subsequent evaluations were made after the two week period, and at 4, 8, and 12 months.
Because the control group was crossed over to receive CIMT after one year.
Primary outcome measures – Wolf Motor Function Test
Motor Activity Log
Secondary outcome measure - Stroke Impact Scale (SIS)
were assessed at each of these time intervals, was administered only at baseline, 4, 12, 16 and 24 month evaluations.
Result :There was no observed regression from the treatment effects observed at 12 months after treatment during the next 12 months for the primary outcome measures of WMFT and MAL.
In fact, the additional changes were in the direction of increased therapeutic effect. For the strength components of the WMFT the changes were significant (P < .05) Secondary outcome variables, including the SIS, exhibited a similar pattern.
Conclusion: Mild to moderately impaired patients who are 3-9 months post-stroke demonstrate
This document discusses various types of movement disorders including tics, chorea, dystonia, ballismus, myoclonus, tremors and ataxia. It describes the characteristics, causes and treatment of each condition. Movement disorders can have different presentations but often represent an underlying neurological or medical issue. Precise definitions can be difficult, and treatment may involve addressing the root cause in addition to specific therapies for symptom management.
Functional Independence Measure (FIM)
Is an 18-item, 7-level ordinal scale
Is designed to assess areas of dysfunction in activities that commonly occur
The scale has few cognitive, behavioral, and communication-related functional items
Is not specific for spinal cord injuries but is designed to assess neurological, musculoskeletal, and other disorders.
Guillain-Barré syndrome with Physiotherapeautic managementsSAGAR KUMAR GOUDA
GBS, also known as Guillain-Barre syndrome, is an acute immune-mediated polyneuropathy that results in demyelination of peripheral nerves. It typically presents with ascending paralysis, though some patients experience descending paralysis or a Miller-Fisher variant characterized by ophthalmoplegia. Physiotherapy management aims to prevent complications through techniques like chest physiotherapy, range of motion exercises, positioning, and addressing pain and weakness. Treatment includes supportive care, plasmapheresis, IVIG, and focusing on recovery of motor and sensory function.
Occupational therapy management in traumatic brain injuryDineshKandeepan
The document discusses occupational therapy management for patients with traumatic brain injury. It describes common impairments patients may experience such as abnormal reflexes, muscle tone issues, weakness, sensory changes and more. It then outlines the evaluation tools and interventions occupational therapists use at different stages of recovery including positioning, range of motion exercises, splinting, sensory stimulation and family education. The goal is to optimize motor and cognitive functioning and help patients regain independence in daily activities.
Brachial Plexus Injury - An Introduction to the PhysiotherapistsJebarajFletcher
The document provides details about the brachial plexus, which is formed by the ventral rami of spinal nerves C5-T1. It innervates the upper limb and pectoral girdle. The brachial plexus consists of roots, trunks, divisions, cords, and branches. The trunks are the upper, middle, and lower trunks formed from C5/C6, C7, and C8/T1 respectively. The cords are the lateral, medial, and posterior cords. The major nerves include the axillary, radial, musculocutaneous, ulnar, and median nerves. Injuries to different parts of the brachial plexus can result
The document discusses Bell's palsy, which causes sudden weakness or paralysis of the muscles on one side of the face. It is caused by inflammation and swelling of the 7th cranial nerve, which controls facial muscle movement. Symptoms include an inability to smile or close one eye fully. Treatment involves corticosteroids to reduce swelling along with antiviral medications, as herpes simplex virus is a common cause. Most people fully recover facial function within a few months, though symptoms may persist in rare cases.
This document provides an overview of syringomyelia, including its pathogenesis, pathology, classification, clinical features, and natural history. Syringomyelia is a condition characterized by fluid-filled cavities within the spinal cord. It most commonly affects the cervical and thoracic regions. Clinical features include pain and sensory loss. The natural history varies, but symptoms typically progress slowly over years, with some patients experiencing stabilization or spontaneous resolution in rare cases.
This presentation briefs out the approach of dementia assessment in line with consideration of recent advances. Now the pattern of assessment has evolved towards examining each individual domain rather than lobar assessment.
How to Prevent and Treat Shoulder Subluxation After Stroke?Techcare Innovation
Yvonne Khor is a senior physiotherapist and founder of YK Natural Physio & Academy with over 8 years of experience. She provides training on how to prevent and treat shoulder subluxation, a common complication after stroke where the shoulder partially dislocates. The document discusses assessing the grade of subluxation, using positioning, slings, bracing and exercises to strengthen muscles and support the shoulder joint. Prevention techniques like proper positioning and avoiding overstretching can help reduce the risk of subluxation developing after a stroke.
This document outlines the Fugl-Meyer Assessment of motor recovery after stroke (FMA-UE), which evaluates upper extremity impairment and physical performance in several domains. It assesses: I) Reflex activity, II) Volitional movement within synergies, III) Volitional movement mixing synergies, IV) Volitional movement with little synergy, V) Normal reflexes, B) Wrist function, C) Hand function, D) Coordination/speed, and also evaluates H) Sensation, J) Passive joint motion, and J) Joint pain. Scores are provided for each domain to quantify impairment and higher scores indicate better motor recovery and function.
This document provides an overview of Complex Regional Pain Syndrome (CRPS). It defines CRPS as a multi-symptom syndrome affecting one or more extremities that is usually out of proportion to the inciting cause. CRPS involves pain, changes in skin temperature or color, swelling, or restricted joint movement. It discusses the stages of CRPS from initial pain and swelling to potential long-term tissue damage. The document also outlines medical and surgical treatment options.
The document describes the Motor Re-Learning Program (MRP), an approach to improving motor control after stroke. The MRP focuses on relearning daily activities through task-oriented practice and is based on theories of distributed motor control. The summary is:
1. The MRP involves analyzing tasks, practicing missing components, practicing whole tasks, and transferring learning to other contexts.
2. Intervention follows four steps - analyzing the task, practicing missing components, practicing the whole task, and transferring learning.
3. The program evaluates and improves functions like upper limb use, sitting, and walking through identifying normal movement and compensatory strategies.
Bell's palsy is an acute onset of non-suppurative inflammation of the facial nerve above the stylomastoid foramen, causing unilateral facial paralysis. It has an incidence of 23 per 100,000 people and affects men and women equally of all ages. Common causes include HSV type 1 and varicella zoster virus. Symptoms include drooping of the mouth corner, inability to close the eyelid on the affected side, and loss of taste sensation. Most patients recover facial function within 3 months, though 10-15% may have some permanent weakness or contractures. Treatment focuses on eye protection and facial exercises, with corticosteroids sometimes used to reduce inflammation and swelling.
The blink reflex is a disynaptic or multisynaptic reflex that involves the trigeminal and facial nerves. It has two responses - an early ipsilateral R1 response and a late bilateral R2 response. The blink reflex test stimulates the supraorbital nerve branch to evaluate conduction along the trigeminal and facial nerve pathways. Abnormalities in the R1 and R2 responses can localize lesions in different parts of the brainstem or peripheral nerves. The test involves recording electromyography of the orbicularis oculi muscle in response to supraorbital nerve stimulation.
This document discusses ataxia in children. It describes the different types of ataxia including sensory ataxia and cerebellar ataxia. It outlines the characteristic features, locations of lesions, physical exam findings, and hints to differentiate between sensory and cerebellar ataxia. The document also provides guidance on evaluating a child with ataxia including taking a thorough history, performing a full physical and neurological exam, ordering appropriate tests and imaging, and considering possible consultations. Common causes of ataxia in childhood are discussed such as congenital, degenerative/genetic, infectious, metabolic, neoplastic, toxic, traumatic and vascular etiologies.
Guillain Barre Syndrome (GBS) is an acute immune-mediated polyneuropathy where there is demyelination of peripheral nerves. It presents with rapidly progressive symmetric motor weakness, areflexia, and sensory symptoms. Diagnosis is based on clinical features and albuminocytological dissociation seen on lumbar puncture. Treatment involves plasmapheresis, IVIG, or steroids to reduce immune-mediated damage. Physiotherapy management focuses on maintaining respiratory function, range of motion, muscle strength, and functional mobility through various exercises to aid recovery.
Neurosyphilis and its physiotherapy managementMuskan Rastogi
This document discusses neurosyphilis, a sexually transmitted disease caused by Treponema pallidum that affects the nervous system. It describes four clinical types of neurosyphilis: asymptomatic neurosyphilis, meningovascular neurosyphilis, Tabes dorsalis, and general paralysis of insane. For each type, it outlines the characteristic symptoms, areas of the nervous system affected, and typical progression. The document also covers investigations, medical management focusing on penicillin treatment, and principles of physiotherapy management including assessment, goals, and specific plans and exercises.
This document discusses facial paralysis, which can be aesthetically, functionally, and psychologically devastating. It affects the 18 paired and 1 unpaired muscles that animate the face. Symptoms discussed include dry eyes, tearing, eye closure issues, nasal obstruction, oral symptoms like incontinence and speech problems, and psychological and communication difficulties displaying emotions. Examination focuses on areas like the brow, eyes, mouth, and nasolabial fold. Treatment goals are to protect the eye, restore symmetry, and allow facial movements. Surgical management techniques mentioned include brow lifts, gold weight placement, tarsorrhaphy, tendon sling placement, microneurovascular muscle transplantation, and static tendon sling placement. The
This document discusses facial nerve paralysis, including:
- The anatomy of the facial nerve and branches that innervate facial muscles.
- Common causes of facial nerve paralysis like Bell's palsy.
- Evaluating facial nerve paralysis through examining facial muscles, taste sensation, lacrimation, and nerve conduction velocity.
- Treating facial nerve paralysis with physical therapy including heat, electrotherapy, exercises and occasionally splinting.
Bell's palsy is a facial paralysis caused by inflammation of the facial nerve as it passes through the stylomastoid foramen. It affects the muscles of facial expression on one side of the face. Causes include trauma, infection, tumors, and idiopathic. Symptoms include pain behind the ear, inability to close the eye, and drooping of the mouth corner on the affected side. Treatment involves corticosteroids to reduce swelling, vitamin B, physical therapy like massage and electrical stimulation to prevent muscle atrophy, and heat/cold for increased blood flow and muscle contraction.
Bell's Palsy is a sudden paralysis of the facial nerve that causes unilateral facial weakness or paralysis. It is the most common cause of acute facial nerve paralysis. The exact cause is unknown but is believed to sometimes involve reactivation of the herpes simplex virus. Symptoms include facial drooping, weakness of muscles on one side of the face, and impaired taste sensation on the affected side. Most patients recover fully within 3-6 months through treatment with corticosteroids or antiviral drugs. A small percentage of patients may experience long-term sequelae such as incomplete recovery or facial spasms.
This document provides information on facial paralysis (palsy) including its causes, types, treatments, and more. It begins with an introduction to facial function and paralysis. It then covers nerve anatomy and classifications of nerve injuries. Specific topics include facial nerve anatomy, types of facial paralysis (central vs peripheral), common causes like Bell's palsy, and surgical treatment options depending on when paralysis occurred (acute, intermediate, or chronic stages). Evaluation methods and the House-Brackmann grading scale for facial function are also summarized.
The facial nerve is a mixed nerve that carries motor, sensory and parasympathetic fibers. It has several branches that innervate the muscles of facial expression. Facial nerve palsy can result from a variety of causes including Bell's palsy (idiopathic, viral), Ramsay Hunt syndrome (herpes zoster virus), tumors, trauma, infections and other conditions. Clinical testing assesses for signs of facial asymmetry, eye problems and inability to move facial muscles. Treatment depends on the underlying cause but may include eye protection, steroids, antivirals, surgery and other approaches.
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The nursing process document outlines the 5 steps of the nursing process: assessment, diagnosis, planning, implementation, and evaluation. It provides examples of assessing a patient with facial paralysis including being unable to close their eyelid or raise their eyebrow. The diagnosis is disturbed sensory perception and body image. The plan is to provide wet tissues, eye drops, corticosteroids, and rest. Implementation includes monitoring for visual changes, providing private meals, and pain control. Evaluation finds the patient fully recovered or the need to revise the care plan if goals are partially met.
Bell's palsy is a condition that causes temporary weakness or paralysis of the muscles on one side of the face. It is caused by inflammation and damage to the seventh cranial nerve, which controls facial muscle movement. Symptoms include an inability to smile or close one eye. The condition is usually diagnosed based on symptoms and improves within a few weeks for most people, though full recovery can take up to a year. While the exact cause is unknown, it is often linked to viral infections like herpes.
1. Acute flaccid paralysis (AFP) is defined as sudden onset of weakness or paralysis over 15 days in patients under 15 years old. It suggests involvement of the lower motor neuron complex.
2. Common causes of AFP include poliomyelitis, Guillain-Barré syndrome, transverse myelitis, botulism, and non-polio enteroviruses. Clinical features and investigations can help differentiate between these causes.
3. Treatment depends on the underlying etiology but may include supportive care, IV immunoglobulin, plasmapheresis, and corticosteroids. Prognosis ranges from full recovery to residual deficits or death, depending on the cause and extent of
1. Recent advances in grading facial nerve function have led to the development of several new grading systems to improve on existing scales like the House-Brackmann Grade Scale (HBGS).
2. The Movement, Rest, Secondary defects, and Subjective scoring (MoReSS) system aims to improve reproducibility over HBGS by separately assessing dynamic and static components as well as secondary defects.
3. The Facial Nerve Grading System 2.0 (FNGS 2.0) incorporates regional scoring of facial movement to provide additional information while maintaining agreement with the original HBGS. It also addresses ambiguities in use.
4. The Gordon Facial Muscle Weakness Assessment
Acute suppurative otitis media is an inflammation of the middle ear caused by bacterial infection, usually following a viral upper respiratory infection. It involves several stages: tubal occlusion from Eustachian tube swelling, presuppuration with bacterial invasion and symptoms like earache, suppuration with pus formation and high fever, resolution upon rupture of the eardrum and drainage of pus, and potential complications like mastoiditis. Treatment involves antibiotics and analgesics; myringotomy may be needed for persistent fluid or complications. Prevention includes childhood vaccines and reducing risk factors like passive smoking.
This document summarizes a study that evaluated the effectiveness of prednisolone and acyclovir in treating Bell's palsy. The study was a double-blind, randomized controlled trial conducted in Scotland from 2004-2007. Over 500 patients with Bell's palsy were randomly assigned to receive prednisolone, acyclovir, both, or placebo. The primary outcome was complete facial recovery at 3 and 9 months, assessed using a standardized grading scale. Results showed patients receiving prednisolone had significantly higher recovery rates compared to those without prednisolone at both timepoints. There was no significant difference in recovery rates between those receiving acyclovir and those who did not. Secondary outcomes like
The document discusses the embryology, anatomy, components, causes of injury, grading systems, evaluation, and treatment of the facial nerve. It covers the development of the facial nerve from the embryonic stage through maturity and describes the various parts of the nerve and their functions. The document also outlines different classification systems for nerve injuries, approaches for evaluating facial nerve paralysis, and surgical and non-surgical techniques for treating injuries or reanimating paralysis of the facial nerve.
This document discusses the management of Bell's palsy, which is an acute, unilateral paralysis of the facial nerve. It describes the causes, symptoms, diagnosis, and various treatment options for Bell's palsy. For initial treatment, oral steroids and antiviral drugs are often prescribed within 72 hours. Surgical options are also discussed, including nerve grafts and transfers to restore facial function. Prognosis depends on factors like age and severity, with about 71% recovering fully within 6 months. Residual effects may include muscle contractures or synkinesis that can sometimes require additional surgery.
inflammation of the ear, usually distinguished as otitis externa (of the passage of the outer ear), otitis media (of the middle ear), and otitis interna (of the inner ear; labyrinthitis).
The document provides information on facial palsy/paralysis, including its causes, symptoms, diagnosis, and treatment options. It discusses how facial palsy can result from various congenital, traumatic, infectious, neoplastic, and metabolic disorders. Diagnostic tests are described that evaluate different branches of the facial nerve, such as the Schirmer test for the lacrimal branch. Management includes medical approaches like corticosteroids as well as surgical options when needed like nerve decompression or microsurgery. Prognosis depends on factors like results from electrophysiological tests measured within the first weeks.
This document provides information on facial palsy (facial paralysis), including:
1. It discusses the anatomy of the facial nerve and different classifications of nerve injuries.
2. Common causes of facial palsy are also outlined, such as Bell's palsy which is an idiopathic sudden onset paralysis of the facial nerve.
3. Evaluation and assessment of facial nerve function is described, including tests of tear production, taste, saliva flow, and electrical nerve testing to determine the severity and likely prognosis of the palsy.
The document summarizes the anatomy and clinical applications of the facial nerve. It begins with the nuclear origin and functional components of the facial nerve. It then describes the intra cranial and extra cranial course of the nerve, its branches including the greater petrosal, chorda tympani, and terminal branches. Applications including facial nerve palsy, Bell's palsy, and preventing injury during dental procedures are discussed. Clinical testing and special tests of facial nerve function are also outlined.
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.
A 57-year-old female presented with sudden right facial drooping and weakness associated with 3 days of fever. Her symptoms are consistent with Bell's palsy, which is characterized by unilateral facial paralysis of sudden onset. Diagnostic workup aims to rule out other potential causes through blood tests, imaging, and electrodiagnostic testing. Treatment includes corticosteroids, antivirals, eye care, facial exercises and massage therapy. The goal of rehabilitation is to prevent complications and restore facial function.
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Facial nerve palsy BY DR. CHANDRA PRAKASH ARYA (B.Sc. B.D.S.; M.D.S.; P.M.S....DR. C. P. ARYA
This document provides an overview of facial nerve paralysis, including its structure, embryology, functions, signs and symptoms, causes, diagnosis, classification, prognosis, and treatment. The facial nerve is the seventh cranial nerve that controls facial expression muscles and conveys taste sensations. Facial nerve paralysis can result from various causes such as Bell's palsy, stroke, infections, tumors, and injuries. Diagnosis involves medical history, exam, and sometimes imaging or blood tests. Prognosis depends on the extent of nerve damage, with better recovery odds if some function remains. Treatment aims to reduce symptoms and promote nerve healing.
This document provides information on the facial nerve (cranial nerve VII) including its embryology, anatomy, functions, and various disorders. It discusses the facial nerve's motor and sensory roles. Disorders covered include Bell's palsy, Ramsay Hunt syndrome, Moebius syndrome, and Guillain-Barré syndrome. Classification systems for facial nerve paralysis and nerve injuries are also summarized. The document provides detailed information on evaluating facial nerve disorders.
This document provides information on physiotherapy treatment for Bell's palsy. It begins with an overview of Bell's palsy, including its causes, symptoms, and grading scales. It then discusses specific assessments, including cranial nerve and facial muscle testing. Treatment approaches covered include corticosteroids, antiviral medications, eye care, facial exercises, electrical stimulation, massage, and rarely, surgery. Outcome measures used to evaluate recovery are also outlined.
This document provides an overview of Bell's palsy, including causes, risk factors, signs and symptoms, diagnosis, and management. Bell's palsy causes sudden weakness or paralysis of the muscles on one side of the face. It is usually temporary and results from swelling or inflammation of the facial nerve. Common symptoms include facial drooping, inability to smile or close an eye. While the exact cause is unknown, it may be due to a viral infection. Diagnosis is based on symptoms, and treatment focuses on electrical stimulation, massage, eye protection and exercises to aid recovery, which occurs within 6 months for most people.
This document discusses recent advances in the management of Bell's palsy. It begins with the anatomy of the facial nerve and describes its intracrannial and extracranial course. It then discusses Bell's palsy itself, including causes, clinical features, prognosis, and treatment options. The mainstay treatments are corticosteroids, antiviral drugs like acyclovir, and sometimes combined steroid and antiviral therapy. Surgery is generally not indicated unless there is not complete recovery with medical treatment. Overall advances include better understanding of Bell's palsy etiology and more evidence supporting combined steroid and antiviral therapy.
This document provides an overview of the anatomy and embryology of the facial nerve (cranial nerve VII). It discusses the nuclei of origin, functional components, course through the skull and branches/distribution. Key points include that the facial nerve has motor, secretomotor and sensory fibers and exits the skull via the stylomastoid foramen. It describes associated ganglia like the geniculate ganglion and presents variations, disorders like Bell's palsy, and evaluation methods involving tests of motor/sensory function.
This document discusses the anatomy and functional areas of the frontal lobe and their relation to psychiatry. It begins with the anatomical structures of the frontal lobe including the lateral, medial and orbital surfaces. It then covers the primary functional areas - primary motor cortex, premotor cortex, supplementary motor cortex, frontal eye fields, Broca's area, and the prefrontal cortex including dorsolateral, dorsomedial and orbital regions. Neuropsychiatric disorders are discussed like frontal lobe syndrome, traumatic brain injury, frontotemporal dementia, and the relationships between the frontal lobe and conditions like schizophrenia, depression, ADHD, OCD, and alcohol use. Assessment techniques are also covered.
Bell's palsy is a condition that causes temporary weakness or paralysis of the muscles on one side of the face. It is caused by inflammation and swelling of the facial nerve as it passes through the facial canal. The symptoms include an inability to smile or close one eye, weakness of the mouth muscles on the affected side, and a loss of taste on the tongue. Most people recover fully within a few weeks or months, though some may experience long-term issues like facial spasms. Treatment focuses on the use of corticosteroids and antiviral drugs to reduce inflammation and speed recovery.
This document provides an overview of the anatomy and clinical management of Bell's palsy. It describes the course of the facial nerve from its central pathways through the various segments in the skull and temporal bone. Key points include use of steroids and possibly antivirals within 72 hours, eye protection for impaired closure, and selective use of electrodiagnostic testing or decompression surgery for patients with complete paralysis. Management aims to reduce inflammation and promote recovery of facial nerve function.
Bell's palsy is caused by inflammation of the 7th cranial nerve, resulting in facial muscle weakness. Symptoms include facial distortion, tearing, and pain. Treatment includes corticosteroids to reduce inflammation and physical therapy to prevent muscle atrophy.
Parkinson's disease is a progressive neurological disorder caused by dopamine depletion in the brain. Symptoms include tremors, rigidity, slow movement, and impaired gait. Treatment focuses on managing symptoms with levodopa and surgery may be used in severe cases. Nursing care addresses mobility issues, self-care deficits, nutrition management, and constipation related to the disease.
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. Title
Otol Neurotol. 2003 Jul;24(4):67781. Positive effects of mime
MIME
Method
sample
Stability of benefits of mime
therapy in sequelae of facial
nerve paresis during a 1-year
period.
Result/
conclusion
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.
Outcome
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