KHUSHBOO WALIA

BPT IV YR
DEMOGRAPHIC DATA
Name –Rahul sachdeva
Age – 26 yrs
Sex – Male
Occupation – student
Handedness – RT
Room no - 144 bed no-2
Address - phagwara
D.O.Ad – 10-11-2010
D.O.As – 12-11-2010
 chief complaints:

Difficulty in speech

Difficulty in holding the food in mouth

Difficulty in closing the right eye

HISTORY
Present med history:
Patient was apparently well before 9th Nov,2010.On 9th
Nov,2010 around 9p.m. in the evening, patient felt
difficulty in speech and suddenly felt difficulty in eating
food while having dinner. On 10th Nov, in the morning
patient felt drooping of right eye and right side corner of
the mouth, So was immediately taken to Doaba hospital
and now is under the medical and physiotherapy
management both.
Past med history :
Positive history of ear infection 4-5 weeks before.
Personal history :
No h/o Smoking & Alcohol

Socio-economic history :
Middle class
 Vitals
 T0 – 98.4o F

 BP – 130/80mmHg

 HR – 74

 RR – 18
OBJECTIVE EXAMINATION
ON OBSERVATION
Built – Mesomorphic

Posture – Half lying

Attitude of face
Drooping of corner of RT eye
Drooping of RT side corner of the mouth.
Drooling of saliva from the RT side of the mouth
Attitude of limb
RT UPPER LIMB RT LOWER LIMB

Shoulder – Add & flexed Hip – ER & Flexed

Elbow Knee – Extended

– Flexed

Forearm – Pronated Ankle – Mild PF

Wrist Toes – PF
– Slight extended

Fingers - Semiflxd
Attitude of lt ul & ll
Shoulder – Add & flexed Hip – ER & Flexed

Elbow – Slightly flexed Knee – Extended

Forearm – Mid prone Ankle – Mild PF

Toes – PF
Wrist – Slight extended

Fingers - Semiflexed
Type of respiration – Abdomino-thoracic

Pattern of respiration -Normal(Eupnoea)

Mode of ventilation – Spontaneous

ON PALPATION
Muscle tone

Soft and flabby tone on right side of the face.

Firm tone on the left side of the face.
 Higher Mental Function

Level of consciousness –GCS

Activity Score
Eye opening 4
Motor response 6
Verbal response 3
Total 13

Communication - dysphasia
Higher cortical function
Cognition-normal
 
Perception-normal
Cranial nerve assessment
FACIAL NERVE-
Motor function (rt side of face)
Wrinkling-difficulty
Raising the eyebrows - difficulty
Show the teeth- difficulty
Whistling- difficulty
Compression of cheeks-difficulty
Closing eyes tightly- difficulty
Sensory function
Taste sensation is absent on anterior 2/3rd of the tongue
TRIGIMINAL NERVE
• Superficial sensations intact on both side of the face.

VESTIBULAR NERVE
Weber’s test
Normal-no sound/sounds in both ears.
Sensations:
Superficial
RT SIDE OF LT SIDE OF
FACE FACE

Pain Normal Normal

Touch Normal Normal

Pressure Normal Normal

SUPERFICIAL AND DEEP SENSATIONS of both rt
and lt upper and lower limb is normal
Motor system
RANGE OF MOTION
Upper limb
Joints Moveme RT- LT
nts ACTIVE
SHOULDER Flex 0-165

Abd 0-170
ELBOW Flx 0-140
FOREARM Pron 0-80

Supin 0-80
lower limb
joints movement Rt-lt
active
hip flexion 0-110
abd 0-40
knee flexion 0-130
ankle plantarflexion 0-50
dorsiflexion 0-15
MUSCLE POWER
MMT OF FACIAL MUSCLES
Muscles Grade(RIGHT)
Frontalis NF(ONLY SLIGHT MOTION
DETECTED)
Orbiculrais oris NF(HAS SOME LIP MOVEMENT BUT
UNABLE TO BRING LIP TOGETHER)
Buccinator NF(MOVEMENT IS DETECTABLE
BUT NOT COMPLETE)
Orbicularis oculi NF(UNABLE TO CLOSE THE EYES)
Corriugator supercili NF(SLIGHT MOTION DETECTED)
MMT of LT side of face is having grade-F ie functional
Differential diagnosis
Facial nerve palsy
Upper part of face is preserved.
• Trigeminal neuralgia
Severe stabbing pain over the face
Superficial sensations of affected side of face is lost
Diagnosis

Etiological diagnosis – infection of the internal

ear( rt)
Anatomical diagnosis – lower fibres of the facial nerve
Pathological diagnosis – inflammation of the facial
nerve
Provisional diagnosis- right side BELL’S PALSY
Management

Goals:
 To facilitate / improve muscle contraction.
 To facilitate / improve facial symmetry.
To facilitate the muscle contraction

• Electrical stimulation of the affected facial muscles

• Biofeedback
To improve the facial symmetry
MANUAL MASSAGE –Massage manipulations on the
face include:
1. Effleurage
2. Finger or thumb kneading
3. Stroking
4. Hacking
5. Tapping
Neuromuscular retraining:
 Neuromuscular retraining is applied using selective motor
training to facilitate symmetrical movement of face.
 EMG feedback and/or specific mirror exercises are given that will
provide a sensory feedback to promote learning.
 Repetitions & frequency of exercises can be modified according
to improvement status.
 The movements should be initiated slowly and gradually to avoid
abnormal movement.
 The patient can apply a manual resistance as isolated facial
movement improved in affected side to be obvious without any
abnormal movement.
PRECAUTIONS
a) Use of eye drops regularly.
b) Exposure to direct sunlight should be avoided.
c) Sun glasses should be wear to protect eyes.
THANX……..