Case 3

Bells palsy
Bell's palsy is a condition in which the muscles on one side of your
face become weak or paralyzed. It affects only one side of the
face at a time, causing it to droop or become stiff on that side. It's
caused by some kind of trauma to the seventh cranial nerve. This
is also called the “facial nerve

SOCIAL AND MEDICAL OUTLINE

A 68 years old female patient came in physical therapy OPD with the complain of ear pain ,
inability to close eye,unilateral weakness of right side of face and facial asymmetry. She is
taking physical therapy services since 2 weeks. She has pain on behind right ear , right side of
face and the intensity of pain is 6/10 according to NPRS scale. She is financially stable .she lives
with her husband .

Scales Scoring:
1) MINI-COG SCALE:

Is used for screening dementia. As our patient scored 4 points which means she is cognitively
stable and negatively screened for dementia.

2) KATZ INDEX of Independence, Activities of Daily Living (ADLs):

Her total score was 6/6 which shows she was independent in every aspect of daily life, and
does not requires assistance from family members.

3) (LAWTON- BRODY) Instrumental Activities of Daily Livings (IADLs):

Her total score was 5/8 which suggests that she would represent 62.5% function (62.5%
independence, 37.5% dependence).

4) (TINETTI) Performance Oriented Mobility Assessment (POMA):

Her balance score was 12/16 .

5) POMA GAIT SECTION:

she scored 12/12 in the gait section,

Total Gait Score = (12+12) = 24, 24/28 which means she was at low risk of falling.

TREATMENT GOALS
SHORT TERM GOALS:

•To reduce pain from 6/10 to 3/10 within 3 weeks.

• To be able to close eye within 3 weeks

• To be able to close mouth within 3 weeks.

LONG TERM GOALS

• To regain facial expressions within 4 weeks.

• To uphold facial symmetry and facial movement within 4 weeks.

• To be able to sleep with 4 weeks

• To be able to drink within 4 weeks.

TREATMENT PLAN:
SESSION 1:

• TENS (burst mode, 150 Hz, 10 mins) to generate muscle contraction.

• Active assisted eye brow raising 10 repetition 3 sets

• Circular stroke on cheek for 3 minutes

• Tissue blowing twice daily

• Balloon Blowing twice daily

• Vowels twice daily

• Blow mouth twice daily

• Pout making twice daily

• Smiling exercise with or without teeth showing 10 repetition 3 sets

HOME EXERCISE PROGRAM:

Tissue blowing twice daily

Vowels twice daily

Blow mouth twice daily

Pout making twice daily

Smiling exercise with or without teeth showing 10 repetition 3 sets

SESSION 1:

• TENS (burst mode, 150 Hz, 10 mins) to generate muscle contraction.

• Active assisted eye brow raising 10 repetition 3 sets

• Circular stroke on cheek for 3 minutes

• Tissue blowing twice daily

• Balloon Blowing twice daily

• Vowels twice daily

• Blow mouth twice daily

• Pout making twice daily

• Smiling exercise with or without teeth showing 10 repetition 3 sets

HOME EXERCISE PROGRAM:

Tissue blowing twice daily

Balloon Blowing twice daily

Vowels twice daily

Blow mouth twice daily

Pout making twice daily

Smiling exercise with or without teeth showing 10 repetition 3 sets