Case Study: Bell’s Palsy – 71-Year-Old Female

-

 Managed in Clinical Physiotherapy Setting (2010–2012)

This case involved a 71-year-old female who presented with sudden onset facial asymmetry and difficulty in closing her right eye and mouth, which had developed overnight during the winter months. She was brought in by her daughter, concerned about the change in her facial expressions. The patient was hypertensive, but her blood pressure was under control with medication. There was no history of trauma, recent viral infection, or stroke, and the condition was identified as Bell’s palsy, likely triggered or aggravated by cold exposure, which is common during winter.

Presentation and Complaints:

• Inability to close the right eye completely

• Drooping of the right corner of the mouth

• Difficulty with facial expressions (smiling, blowing, frowning)

• Mild drooling while eating

• Slight slurring of speech

• No limb weakness, vision disturbance, or altered consciousness

• Symptoms appeared within 24 hours, and she sought therapy within a few days of onset

Assessment (Based on Clinical Practice 2010–2012):

• Observation: Marked asymmetry on facial movements, particularly during smile and eye closure

• House-Brackmann grading used to assess severity – graded as Grade IV (moderately severe dysfunction)

• Facial muscle testing: Weakness in frontalis, orbicularis oculi, buccinator, and zygomatic muscles on the right side

• Eye closure lag and incomplete blinking on affected side

• Sensation over the face intact; no signs of central lesion

• Mild emotional discomfort due to appearance and frustration with speech

Physiotherapy Management:

The treatment spanned over 12 daily sessions in a clinical setting, with continued home follow-up. Focus was placed on electrical stimulation, facial muscle retraining, and supportive care to help restore movement and symmetry.

1. Electrotherapy – Electrical Nerve Stimulation (ENS):

  • Used low-frequency galvanic current (faradic interrupted pulses)
  • Applied over affected facial muscles using surface electrodes
  • Duration: Short bursts, focused on orbicularis oculi, buccinator, zygomaticus, and frontalis
  • Aim: To maintain muscle tone and stimulate neuromuscular re-education
  • Care was taken to avoid overstimulation, especially in elderly skin

2. Facial Muscle Exercises (Facial Retraining):

  • Started with passive movement – guided facial massage and muscle gliding to reduce stiffness
  • Progressed to active-assisted and active exercises:- Eye closure and blinking repetitions,  smiling, puffing cheeks, raising eyebrows, whistling, and frowning, mirror feedback to help regain coordination and voluntary control
  • Focused on slow, controlled movements to avoid synkinesis (abnormal linked movements)

3. Home Program and Family Involvement:

  • Educated the patient and daughter on safe home facial exercises
  • Taught how to gently massage the affected side, encouraging muscle relaxation
  • Eye care advice: Protective glasses during the day and eye patch at night to prevent dryness and injury

4. Supportive Therapy and Monitoring:

  • Ensured that hypertension remained stable during sessions
  • Encouraged positive reinforcement, as emotional outlook also influences recovery
  • No corticosteroids were part of the therapy since medical management was handled externally

Outcome:

By the end of the 12-day session plan, the patient showed noticeable improvement:

• Eye closure improved significantly, with near-complete blinking

• Smiling and cheek movement became more symmetrical

• Speech clarity improved, and she could eat without drooling

• The patient expressed high satisfaction with her progress and was more confident in social interaction

• Continued with home exercises and follow-up reviews as advised

 This case stands out in my memory not just because of the clinical progress, but also because of the patient’s emotional turnaround. Initially very anxious about her facial appearance, she left the treatment phase with renewed confidence and function, which reinforced the impact that short, structured physiotherapy can have in Bell’s palsy recovery, especially when started early.


Popular posts from this blog

Case Study: Stroke Rehabilitation

-
Multispecialty hospital, outpatient clinic, and freelance settings During my practice, I had the opportunity to work with several stroke patients across varied settings — including a multispecialty hospital and clinical OPD setup as well as a freelance physiotherapist providing home-based care. These experiences allowed me to develop a comprehensive and adaptable approach to post-stroke rehabilitation, tailored to each individual’s condition and environment. Presentation and Common Complaints: Most patients I managed during this period had suffered an ischemic or hemorrhagic cerebrovascular event affecting either the dominant or non-dominant hemisphere. They commonly presented with: • Hemiparesis or hemiplegia • Spasticity, especially in the upper limb flexors and lower limb extensors • Poor balance and postural control • Gait disturbances or inability to ambulate • Shoulder subluxation or pain on the hemiplegic side • Difficulty with activities of daily living (ADLs) • C...
Read more

Introduction to Women's Health Physiotherapy

-
Introduction Women’s Health Physiotherapy focuses on the prevention, assessment, and treatment of conditions that specifically affect women. These conditions can span the entire female lifespan, from adolescence to post-menopause. It covers a wide range of issues related to musculoskeletal, pelvic health, reproductive health, post-pregnancy care, and more. Women's health physiotherapists play an important role in improving the quality of life for women by addressing these physical, emotional, and psychological aspects.   1. Overview of Women's Health Physiotherapy What is Women’s Health Physiotherapy? • It is a specialized area of physiotherapy that focuses on treating physical and musculoskeletal issues, particularly those that are specific to women. • It also involves education and prevention techniques to address issues that women face due to physiological changes (such as pregnancy, menstruation, or menopause). Core Areas of Focus in Women's Health Physiotherapy: • ...
Read more

Physiotherapy Management of Low Back Pain

-
  Lower Back Pain and Pelvic Health: Understanding, Healing, and Empowering Women Lower back pain—something so many women experience but often feel like they have to “just live with.” Whether it’s a dull ache that won’t go away, sharp, stabbing sensations that come and go, or a tight, nagging discomfort that makes everyday tasks feel impossible, lower back pain is something you don’t have to accept as a part of life. It’s common, but it’s also something you can address and improve with the right tools and support. What’s even more important? Lower back pain and pelvic health are often deeply connected, and understanding this connection can unlock the path to relief. In this article, we’ll dive into what lower back pain is, how to identify it, why it’s often tied to pelvic health, and how you can start healing from home. We’ll also talk about when to reach out for professional help and how you can support other women in spreading awareness about the importance of pelvic and spinal...
Read more