5 Facial Paralysis

Question 1

What are conditions associated with Facial Paralysis?

Answer 1

• CVA
• Bells
• Tumor associated neuroma
• Herpes simplex type I
• Trauma
• Post surgical complication

Question 2

What are the facial conditions of stroke?

Answer 2

• Can lift eyebrow bc frontalis is bilaterally innervated
• Possible sensory loss to face
• Rapid onset

Question 3

What are the facial conditions of Bells Palsy?

Answer 3

• CANNOT lift eye brow on lesion side .. ipsilteral CN VII innervation
• No sensory loss to face (trigeminal is sensory to face)
• Rapid onset

Question 4

What are facial conditions of a tumor?

Answer 4

• Tumor compresses nerve
• mild heaing loss
• balance impacted
• slow growing, pt compensates well
• facial paralysis can be first sign of tumor

Compresses VII VIII

Question 5

What are signs and symptoms of bells palsy?

Answer 5

• weakness of facial muscles
• inability to lubricate eye
• changes in taste
• biting the inside of mouth (flaccid muscles)
• drooling/keeping food in mouth
• poor food management

Brow on one side

widening of parebral fissure (eye)

Drooping of corner mouth(

Question 6

What are you looking for in the facial examination?

Answer 6

weakness

tightness

synkinesis

Facial expressions

Question 7

What is the prognosis for facial paralysis ?

Answer 7

• 70% will have full recovery
• 18% significant dysfunction
  
  • contracture
  • sunkinesis
  • Weakness
  • Asymmetry

Question 8

What are the outcome measures for Facial paralysis?

Answer 8

• Facial disability index
  
  • 2 subscles: physical function/ social well being
• House-Brackmann
  
  • symmetry in movement ton in 6 categories
• Sunnrybrook facial grading scale
  
  • performance based

FDI/FGS most used in PT

Question 9

What are the 2 pharmalogical interventions used?

Answer 9

• corticosteriod (more success)
• Antiviral

Question 10

what interventions DO NOT WORK for facial paralysis

Answer 10

• General facial expressions
• FES

Question 11

What interventions are used for facial paralysis?

Answer 11

• Quality over quantity movement
• DO NOT tell them to try as hard as they can
• Lip centering “fffff” “cheecks

dose: 5-10 reps of 3-5 exercises 2/day

Change exercise to maintain saliency and interest

EMG > neuroreducation for synkinesis

Question 12

What are interventions for bells sign?

Answer 12

• look down, close eyes, look down with eye
• Obicularis muscles. squint, look down, close eyes, relax squint

EYE CARE for cornea - prevent drying