Physical Therapy Management For Facial Nerve Paralysis Dr. Muhammad Mustafa Qamar Assistant Professor, Department of physical Therapy, Sargodha Medical College, UOS
Note: This protocol is a guideline only and it may vary from patient to patient. Facial nerve paralysis: It is a neurological condition that results from a lesion of the 7th cranial nerve leading to an acute onset of weakness or total paralysis on the ipsilateral side of the face. Causes: Bell's palsy1, Ramsey-Hunt syndrome2, Middle ear infection, Trauma, Tumors, Post acoustic neuromas surgery, Iatrogenic. Time of intervention: As soon as the patient reaches PT department. Physical Therapy Assessment: - Assessment should be finished within the first 3 sessions. - Documentation can be done by photo- and/or video recording for static and dynamic movement. Goals: To educate / reassure the patient about the condition. To relief pain. To establish the bases for re-education of muscle/nerve conduction. To re-educate sensation if involved (sensory integration) To facilitate / improve muscle contraction. To facilitate improve facial symmetry. To prevent complication Frequency of treatment: Frequency of treatment sessions differs according to the severity and prognosis of each patient. However, by using the House classification system for re-evaluating the patient, it's suggested to have; Month Session / Week st
1
nd
2
3 sessions/ week twice / week
3rd Once/ week Patient should then be referred to the physician for further evaluation if no progression is noticed. A period of 14 months is allowed for recovery. Management: Patient Education and Reassurance: Explain the condition to the patient; its causes, incidence, prognosis and treatment. Re-assure the patient, but be realistic (don't give high expectations). Advice the patient to take the prescribed medication and physical therapy treatment. If eyes are involved, the patient should do the following: Use eye drops (as the physician prescribed), don't expose yourself to direct sunlight, being too close to TV light, or strong room lighting, wear sun glasses to protect eyes, don't exhaust eyes by 1 2
Idiopathic facial paralysis A condition caused by herpes zoster of the geniculate ganglion of the brain or neuritis of the facial nerve.
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Physical Therapy management for facial nerve paralysis Dr. Muhammad Mustafa Qamar Assistant Professor, Department of physical Therapy, Sargodha Medical College, UOS
reading for long time and avoid direct contact with air conditioners. Patient should avoid any emotional conflict and seek family or friend support. Be aware of postural imbalance (especially for Ramsey-Hunt syndrome). Follow the given home program. Treatment options: movement, because rapid movements can't A) Electrotherapy help the patient in controlling the abnormal Electrotherapy modalities can be used as movement. an adjunct therapy. The electrotherapy The patient can apply a manual resistance modalities included: electrical stimulation as isolated facial movement improved in (ES), electromyography biofeedback affected side to be obvious without (EMG), ultrasound, laser, and short-wave synkinesis. diathermy (SWD). C) Soft tissue techniques: Lesion recovery depends on type of Soft tissue techniques can be performed in lesion, age, nutritional & metabolic conjunction with other treatment options. It status of the patient. can be done to improve perceptual awareness. Neuromuscular retraining: Manual manipulations on the face include: Neuromuscular retraining is applied using Effleurage, Kneading, Wringing, Taping selective motor training to facilitate and stroking symmetrical movement and control undesired D) Kabat Rehabilitation: gross motor activity (synkinesis*). Kabat rehabilitation is type of motor control Patient re-education is the most important rehabilitation technique based on PNF. aspect of the treatment process. EMG During Kabat, therapist facilitate the feedback and/or specific mirror exercises will voluntary contraction of the impaired provide a sensory feedback to promote muscle by applying a global stretching then learning. resistance to the entire muscular section and When each muscle group is being assessed, the motivate action by verbal input and manual patient observes the action of these muscles contact. in the mirror and instructed to perform small When performing Kabat, 3 regional are symmetrical specific movements on the sound side to identify the right response. Each considered: the upper (forehead and eyes), patient presents with different functional intermediate (nose), and lower (mouth). disability, so there are no general list of Prior to Kabat, ice stimulation has to exercises. perform to a specific muscular group, in As patient identifies the specific area of order to increase its contractile power. dysfunction, patient can begin to perform Prognosis: exercise to improve facial movements' About 85% of patients with facial guided by the affected side so isolated nerve paralysis begin to recover muscle response is preserved and within the first 3 weeks after onset. coordination improved. Repetitions & About 15% of patients, recovery frequency of re- exercises can be modified begins after 2 to 3 months from according to improvement status. onset. The movements should be initiated slowly Poor recovery is usually determined and gradually so that the patient can observe after 6 months of onset. the angle, strength, and speed of each 03315426095 | RAI MEDICAL COMPLEX, 148 SATELLITE TOWN SARGODHA
Physical Therapy management for facial nerve paralysis Dr. Muhammad Mustafa Qamar Assistant Professor, Department of physical Therapy, Sargodha Medical College, UOS
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Poor recovery notice for patients with history of diabetes,
Gross
hypertension and obesity.
Grade
Degree
1
Normal
2
Slight
Slight weakness on close inspection, Slight asymmetry
Normal tone & symmetry
3
Moderate
Obvious but not disfiguring facial asymmetry. Synkinesis is noticeable but not severe. may havehemi- facial spasm or contracture
Normal tone & symmetry
4
Moderately severe
Asymmetry is disfiguring &/or obvious facial weakness
Normal tone & symmetry
5
Severe Only slight,
Barely noticeable movement
Asymmetrical facial appearance
6
Total paralysis
No facial function
No facial function
Normal facial function in all nerve branches
At rest Normal facial function in all nerve branches
At motion Normal facial function in all nerve branches Forehead: good to moderate movement Eye: complete closure with minimum effort Mouth: slight asymmetry Forehead: slight to moderate movement Eye: complete closure with effort Mouth: slight weakness with maximum effort Forehead: no movement Eye: incomplete closure Mouth: asymmetrical with maximum effort Forehead: no movement Eye: incomplete closure Mouth: slight movement No facial function
House-Brackmann Classification of Facial Function 03315426095 | RAI MEDICAL COMPLEX, 148 SATELLITE TOWN SARGODHA
References:
Qamar MM, Qamar MF. Strength training restores morphological changes occur during Aging. Medical channel. 2014; 20 (1): 79-82.
Qamar MM. Long-term strength training reverses aging effects in skeletal muscles of healthy elderly men. Diva-academic archive online (D). 2012
Qamar MM, Basharat A, Shah IH, Qamar MF. Osteoarthritis: Exercise and impact of Mechanical loading. Annals of KE. 2013; 19(1): 107-111.
Qamar MM, Basharat A. Gout: Causing factors and counter strategies. Annals of KE. 2013; 19(1): 101106.
Qamar MM. Can aerobic exercise normalize endothelial growth factor (VEGF) in patients of peripheral arterial disease (PAD). Journal of physical therapy and sports medicine.2012; 1(1): 1-10.
Qamar MM, Basharat A. Addition of new myonuclei as a pre-requisite for muscle growth. Journal of public health and biological sciences. 2012; 1 (4): 67-73.
Basharat A, Naeem A, Basharat ZN, Qamar MM. A systematic review on the effectiveness of exercise in sarcopenia. Journal of Public Health and Biological Sciences. 2012; 1(2): 61-67.
Basharat A, Qamar MM, Basharat S, Naeem A, Basharat ZN. Non-pharmacological strategies to fight against sarcopenia. Journal of Public Health and Biological Sciences. 2012; 1(4): 127-133.
Basharat A, Qamar MM, Rasul A. Mulligan (Grade I&II mobilization) is superior way in early rehabilitation of ACL partial injury. International journal of medicine and applied health. 2013; 1 (1): 15.
Basharat S, Qamar MM, Rasul A, Basharat A. Combination therapy of diet and physical therapy is very handy to combat osteoporosis. International journal of medicine and applied health. 2013; 1(2):36-40.
Rasul A, Shoaib M, Qamar MM, Basharat A, Islam A, Tariq M, Munem HA, Rasheed MA . Manual therapy or electrotherapy: comparative study for the treatment of chronic low backache. International journal of medicine and applied health. 2014; 2 (1).
Qamar MM, Basharar A, Rasul A, Basharat S, Ijaz MJ. Perception of physical therapy students and professionals about the importance of professional ethics. International journal of medicine and applied health. 2014; 2 (2): 57-61.
Iqra Yaseen, Mobina Ulfat, Ahmad Sohaib, Shazia Khurshid, Saba Qaiser, Muhammad Fiaz Qamar, Uzma Hanif and Muhammad Mustafa Qamar .effects of different cooking procedures on the nutritional status of ghia kadu (lagenaria siceraria) and tinda (citrullus vulgaris var. Fistulosus) Sci. Int. 2014; 26 (1):
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Muhammad Fiaz Qamar, Rashida Sharif, Muhammad Mustafa Qamar and Ayesha Basharat. Comparative efficacy of sulphadimidine sodium, toltrazuril and amprolium for Coccidiosis in Rabbits Sci.Int. 2013,25(2):295-298.