Physiotherapy Management in Bells Palsy Conditions

MODULE 4 PHYSIOTHERAPY MANAGEMENT IN BELLS PALSY CONDITIONS 1.Physiotherapy Problems and Diagnosis • Bells palsy occurs suddenly several hours before weakness in the facial muscles occurs • Usually there is pain in the mastoid area • Mild to severe muscle weakness • Always on one side of the face • The side of the face with weakness appears expressionless • Diagnosis After conducting a physiotherapy assessment, the next step is to determine a physiotherapy diagnosis according to the physiotherapy problem. Physiotherapy diagnosis is an effort to prevent problems based on interpretation results. ➢ Impairments There is weakness on the right side of the facial muscles, a decrease in facial function and the presence of thick feeling on the left side of the face. ➢ Functional Limitations This patient experiences obstacles or disturbances in carrying out daily activities such as: drinking and gargling spills onto the left side of the face, food collects on the left side of the face and must be helped to open the mouth with the hand so that the food is swallowed. ➢ Participation restrictions Patients experience obstacles in interacting and socializing with their surroundings due to lack of self-confidence, such as: social gatherings, reciting the Koran, and exercising with neighbors 2. Physiotherapy Intervention • Infrared • Electrical Stimulation • Massage • Exercise A. Equipment Required 1. Bed Treatment 2. Infrared 3. Electrical Stimulation 4. Mass Oil B. Practical Activities 1. Infrared Infra Red is given with the aim of reducing pain, reducing swelling and increasing blood supply. An increase in temperature will cause vasodilation, which will cause an increase in blood to the local tissue and eliminate the remains of metabolic products which are irradiated using infrared rays which have a heat effect which can facilitate blood circulation so that the tissue's need for O2 is met very well and facilitates the reduction of pain. 2. Electrical stimulation Electrical Stimulation (ES) is a modality that helps produce muscle contractions with stimulation that uses electricity. In this case, the Electrical Stimulation used is a faradic type current. This type of current has a pulse duration of 0.1-1 ms at a frequency of 30 to 100Hz. 3. Massage Massage techniques commonly used in Bell's Palsy cases include: Stroking, effleurage, finger kneading and tappotement. a. Stroking is a light and smooth rubbing manipulation without any pressure, and is usually used to spread the lubricant. b. Effleurage is a rubbing manipulation with light and gentle pressure using the entire surface of the hand, preferably given from the chin up to the temples and from the middle of the forehead down to the ears. c. Finger kneading is a massage done with the fingers by applying pressure and circular movements, given to all the facial muscles affected by the lesion with the movement moving towards the ear. d. Tapotement is a manipulation that is given by rhythmic patting with a certain strength, to the facial area, especially on the side of the lesion. Tapotement is done with the fingertips. Indications for massage are fatigue, sprains, asthma, rheumatism, headaches, lower back pain, insomnia, muscle stiffness, dysmenorrhea, diabetes mellitus, high and low blood pressure. Contraindications for massage are high fever, leprosy, pregnancy, tumors, fractures, dislocations, luxations, fissures, skin inflammation, muscle inflammation, smallpox, cardial asthma. 4. Exercise Mirror exercise is a form of exercise using a mirror which will provide a "biofeedback" effect. When carrying out this mirror exercise, it is best to do it in a quiet and isolated place so that the patient can concentrate more on the facial movement exercises. Giving mirror exercises can increase the strength of facial muscles and the functional ability of facial muscles, this is because the movements can be carried out actively or passively, and the patient will find it easier to control and correct the movements made. So that this voluntary movement can increase muscle strength and functional ability of facial muscles.The various movements are as follows: a. Eyebrow raising movement b. Eye opening and closing movements c. Frowning movement d. Smiling movement of the lips e. Squirting movements on the lips