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Facial Protocol

Facial Protocol

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Published by: mohamedwhatever on Sep 21, 2010
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11/01/2012

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PHYSICAL THERAPY 
 MANAGEMENT FOR 
 
FACIAL NERVE PARALYSIS
 
Prepared by:Committee of Physical Therapy ProtocolsOffice of Physical Therapy AffairsMinistry of Health – Kuwait2007With collaboration of:Physical Therapy DepartmentKuwait University
 
 
ACKNOWLEDGEMENT
Our sincere thanks and gratitude to Ministry of Health for itscontinuous support and encouragement that extended to us.And, I extend my sincere thanks to all committee members of thephysical therapy protocol for their excellent work in preparation of thisscientific material and to the physical therapy department in KuwaitUniversity for their participation in this endeavor.Lastly, I would like to dedicate this protocol to all colleagues with inthe profession, medical team members, and who are interested inphysical therapy profession, wishing that this booklet will be useful andhelpful toward improving physical therapy services in Kuwait.With best wishes….
 Director of physical therapy affairs NABEEL Y. ALHUNAIF, P.T., B.Sc.
Committee of Physical Therapy Protocols
 
Ali Al-Mohanna M.Sc. P.T. (Farwaniya Hospital)
 
Khadijah Al-Ramezi, P.T. (Ibn Sina Hospital)
 
Lobna A. Abdulkareem, P.T. (Al-Adan Hospital)
 
Noura Al-Jwear, P.T. (Farwaniya Hospital)
 
Maali Al-Ajmi, P.T. (Maternity Hospital)
 
Dr. Surreya Mohomed B.Sc.; D.Ed. (Kuwait University)
Note:
This protocol is a guideline only and it may vary frompatient to patient.
 Definition:
It is a neurological condition that results from a lesion of the 7
th
cranialnerve leading to an acute onset of weakness or total paralysis on theipsilateral side of the face.
Causes:
 
1)
 
Bell’s palsy*2)
 
Ramsey-Hunt syndrome**3)
 
Middle ear infection4)
 
Trauma5)
 
Tumors6)
 
Post acoustic neuromas surgery7)
 
During surgery injuries.
*
Although idiopathic facial paralysis ( Bell’s Palsy), is the mostcommon cause of unilateral facial paralysis accounting forproximately 50% of the causes. it’s important for clinicians toconsider all causes to avoid overlooking potentially life-threateningdisease.
1,2,4
** A condition caused by herpes zoster of the geniculate ganglionof the brain or neuritis of the facial nerve and characterized bysevere facial palsy and vesicular eruption in the pharynx, externalear canal, tongue, and occipital area. Deafness, tinnitus, and vertigomay be present.
3
 
 
Time of intervention:
As soon as the patient reaches physiotherapydepartment.
 Physical Therapy Assessment:
-
 
Assessment should be finished within the first 3 sessions.(Appendix A for assessment sheet and guidelines).-
 
Documentation can be done by photo- and/or video recordingsfor static and dynamic movement (eyes closed, blowing,smiling, etc.) can be included.
Goals:
1)
 
To educate / reassure the patient about the condition.2)
 
To relief pain.3)
 
To establish the bases for re-education of muscle and nerveconduction.4)
 
To re-educate sensation if involved (sensory integration: touch,2 point discrimination, temperature)5)
 
To facilitate / improve muscle contraction.6)
 
To facilitate / improve facial symmetry.7)
 
To prevent complications.
 Frequency of treatment:
Frequency of treatment sessions differs according to the severity andprognosis of each patient. However, by using the House classificationsystem for re-evaluating the patient, it’s
suggested to have;
 
Month Session / Week
1
st
3 sessions per week 2
nd
twice per week 3
rd
once a week Patient should then be referred to the physician for further evaluation if no progression is noticed. A period of 14 months is allowed forrecovery.
4
 
Management: 
 Patient Education and Reassurance:
 
4,5,14
 
1)
 
Explain the condition to the patient; its causes, incidence, prognosisand treatment.2)
 
Re-assure the patient, but be realistic (don’t give high expectations).3)
 
Advice the patient to take the prescribed medication from thephysician, and to avoid therapy given by non professionals. Explainto the patient that taking medication and following the physicaltherapy program are enough.4)
 
If eyes are involved, the patient should do the following:a)
 
Use eye drops ( as the physician prescribed)b)
 
Don’t expose yourself to direct sunlight, being too close to TVlight, or strong room lightingc)
 
Wear sun glasses to protect eyesd)
 
Don’t exhaust eyes by reading for long timee)
 
Avoid direct contact with air conditioners5)
 
Explain to the patient how the psychological state can affect thetreatment, so avoid any emotional conflict and seek family or friendsupport to increase self awareness and self esteem.6)
 
Be aware of postural imbalance (especially for Ramsey-Huntsyndrome).7)
 
Follow the given home program.

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