A 64-year-old male presented to the emergency department after waking with acute facial nerve palsy. His main complaints were of right-sided facial drooping, difficulty keeping food or drink in his mouth, pain, and inability to blink or close his right eye. During the intake examination, he could not identify a precipitating event that led to the weakness, citing good health in the 3 months prior to onset. His past medical history was remarkable for hypertension, hypercholesterolemia, and shingles 10 years ago. Neurologic examination revealed slight movement of the muscles of the right side of face with an inability to close the right eye, raise the right eyebrow, sniffle, smile, pucker, or frown. The rest of the neurologic examination was within normal limits including light touch sensation to the right side of the face, intact jaw reflex, and intact ability to see and distinguish smells. The patient was not admitted to the hospital and was discharged with no specific laboratory testing or imaging studies performed. A diagnosis of Bell's palsy was made because of the idiopathic onset of signs and symptoms and the absence of other neurologic deficits. He was prescribed ibuprofen and prednisone to reduce pain and inflammation associated with facial nerve swelling, and was advised to visit his primary care physician (PCP). At the time of his follow-up visit with his PCP 10 days later, the patient reported no improvement in function and a worsening of facial weakness that continued for about 5 days after the initial onset. An electromyography (EMG) test was performed which demonstrated a motor response that was 25% of the amplitude of the left side. The physician decided to refer the patient to physical therapy. The physical therapist is evaluating the patient in an outpatient clinic 2 weeks after onset of the facial palsy. The patient is a retired engineer who is active in his community. He lives in a three-story home with his wife.
Identify possible psychological/psychosocial factors apparent in this case.
What is his rehabilitation prognosis?
Describe a physical therapy plan of care based on each stage of the diagnosis.
What are the most appropriate physical therapy interventions?
What examination signs may be associated with this diagnosis?
- BELL'S PALSY: Temporary facial paralysis (complete loss of movement) or paresis (weakness) resulting from damage or trauma to one (in some occurrences both) of the facial nerves; synonyms include: acute peripheral facial nerve palsy, idiopathic nerve palsy
- BELL'S PHENOMENON: Rolling of the eyeball upward and outward when an attempt is made to close the eye on the affected side of the face
- HYPERACUSIS: Increased sensitivity to sound in certain frequency ranges
- PREDNISONE: Glucocorticoid given to decrease inflammation and suppress the immune system
- SYNKINESIS: Abnormal regeneration of the facial nerve that results in a cross-wiring in the muscle ...