Pns and Bell’s palsy

Question 1

Disorder of pns

Answer 1

Affecting cell body of alpha motor neuron in SC or BS, axon from peripheral nerve, motor end plate of nerve and muscle fibers that the motor nerve innervates

Question 2

S/s of peripheral nerve (LMN)

Answer 2

Decreased/absent muscle tone
Decreased/absent reflexes 
Ipsi paresis or paralysis
Muscle fibrillations and fasciulations
Neurogenic atrophy

Question 3

UMN signs

Answer 3

Disturbance of selective movement control

• Abnormal mass synergies
• Hyperreflexia
• Spasticity
• Clonus
• Paresis

Question 4

Neurapraxia

Answer 4

Reduction/complete blockage of condition across segment of nerve while axonal continuity is maintained and nerve condition is preserved
Compression

Question 5

Axonotmesis

Answer 5

Interruption of axon w/ preservation of surrounding CT around axon
Stretch injury

Question 6

Neurotmesis

Answer 6

Both nerve and sheath disrupted

Question 7

Neurapraxia repsonse to injury

Answer 7

Rapid demyelination by Schwann cells

Shorter intermodal distance - nerve conduction does not return to normal

Question 8

Axonotmesis or neurotemsis recovery

Answer 8

Wallerian degeneration and anterograde degeneration of axon

-

Question 9

Nerve healing events

Answer 9

1. Sensory nerve body cells in dorsal root canglia produce axoplasm to fill endometrial tubes
2. Size important
3. Smallest C fibers regenerate fastest=pain perception first
4. Proximal section must grow across lesion site before demyelination occurs

Question 10

Average speed of regeneration for nerves

Answer 10

1 mm per day

Or 1 in per month

Question 11

Bell’s palsy

Answer 11

Common condition where facial nerve unilaterally affected

Question 12

Common age for Bell’s palsy

Answer 12

15-45

DM and pregnant have increased incidence

Question 13

prior to onset of Bell’s palsy

Answer 13

Severe pain in mastoid or sensation of fullness may be present

Question 14

Bell’s palsy inflammation creates

Answer 14

Compression of facial nerve in auditory canal resulting in demyelination

Question 15

Bell’s palsy EMG most effective

Answer 15

After 1 weeks

Question 16

LMN vs UMN facial weakness

Answer 16

UMN close eye and wrinkle forehead, no smile

LMN unable to close eye, wrinkle forehead or smile

Question 17

UMN vs LMN forehead

Answer 17

In UMN voluntary control of muscles of forehead spared

Question 18

Left CVA will cause

Answer 18

Right sided lower face weakness

Question 19

Damage to right facial nerve

Answer 19

Bell’s palsy

Right sided upper and lower face weakness

Question 20

Bell’s palsy clinical manifestation

Answer 20

Sensory and autonomic fibers innervates for
Taste
Lacrimation
Salivation

Question 21

I flexion proximal to where fibers of chorda tympani enter facial nerve

Answer 21

Pt will have loss of taste on affected side

Question 22

Bell’s palsy clinical s/s

Answer 22

Unilateral facial paralysis that develops rapidly
Corner of mouth droops
Eyelid does not close
Dry eye, lacking of tearing
Loss of taste on affected side
Reduced/thicker saliva on affected side

Question 23

Corticosteroids and Bell’s palsy

Answer 23

No later than 10 days after onset of symptoms
Administered for 5 days
Antiviral may be helpful as well secondary to herpes

Question 24

100% recovery obtained if tx began

Answer 24

W/in 3 days

Question 25

If tx delayed until day 4

Answer 25

Prognosis dropped to 86%

Question 26

Bell’s palsy -protection of

Answer 26

Cornea critical
Eye patch or classes
Artificial tears

Question 27

For incomplete involvement recovery is usually complete and occurs in

Answer 27

3 weeks

Question 28

For complete involvement recovery is

Answer 28

Longer

75% recover normal motor function

Question 29

Factors associated w/ poorer outcome

Answer 29

Age >60
Systemic disease like DM, HTN
Lesions w/ autonomic involvement

Question 30

Bell’s palsy and PT

Answer 30

Facial neuromuscular re-ed.
Estim can be disruptive to reinnervation
Max effort facial activation exercise can lead to synkinesis or mass action

Question 31

Synkinesis

Answer 31

Abnormal synchronization of multiple facial movements

• thought to occur when facial nerve fibers implant into incorrect muscles as healing occurs
• crocodile tears when facial nerve crosses autonomic branch of superior pterosaurs nerve, when face contracts, tears appear

Question 32

Bell’s palsy PT initiation

Answer 32

Drooped resting posture, minimal movement, marked functional problems
Tx w/ AAROM (position w/ fingers then attempt to hold)
3-4 x /day

Question 33

Bell’s palsy pt facilitation

Answer 33

Minimal droop at rest, mild to mod weakness
AROM and resistive- maintain symmetry avoid synkinesis
High reps 1-2x/day

Question 34

Bell’s palsy pt Movement control

Answer 34

Demonstrating synkinesis and continued mild to moderate facial weakness
Isolated and matched movements
Quality not quantity w/ high frequency

Question 35

Bell’s palsy pt relaxation

Answer 35

Resting facial tension, twitches/spasms
Massage and stretching
Low to mod reps performed as needed

Question 36

Surface EMG biofeedback in Bell’s palsy

Answer 36

Can be used to record and display small changes in muscle activity that cannot be seen in a mirror
Work on abnormal movement patterns or synkinesis