PNS Injury

Peripheral Nerve Injury (PNI)

Bell's Palsy

Description/Overview

Bell's palsy (BP) is facial muscle weakness or paralysis resulting from injury to one of the two facial nerves (LMN type). BP affects only one side of the face with the frontalis muscle of the same side being affected, though in UMN types of facial palsy, the frontalis muscle on both sides of the face remains intact.

Precautions

• Eye & cornea drying due to inability to close eye

• Balance, gait, & driving may be impaired especially if the patient with BP wears an eye patch

Physical Therapy Examination

History (Refer to Tab 2)

• Was onset of symptoms sudden?

• Does patient have any recent flu-like symptoms?

• Has patient had any recent dental treatment?

Vital Signs

• Assess BP, HR, RR, & body temperature

Tests and Measures

Arousal, Attention, and Cognition

Assessment (Refer to Tab 2)

Potential findings

• Patients with BP may demonstrate dysarthria (slurred speech) due to poor lip closure

Cranial and Peripheral Nerve Integrity

Assessment - Assess

• Cranial nerves (focusing on VII) & peripheral nerves

• Corneal reflexes (cranial nerves V & VII)

• Taste (anterior 2/3 of tongue)

• Auditory acuity

• The following facial expressive muscles (Tab 2):

  • Frontalis (raise eyebrow)

  • Orbicularis oculi (close eyes tightly)

  • Corrugator supercilii (frown)

  • Nasalis & procerus (wrinkle nose)

  • Zygomaticus major (smile, show top teeth)

  • Orbicularis oris (lip closing)

  • Platysma (show bottom teeth)

  • Buccinators (suck in cheeks)

Potential findings

• Unilateral facial muscle weakness or paralysis (ipsilateral frontalis affected)

• An inability to fully close eye on affected side

• Drooling

• Impaired taste (anterior 2/3 of tongue on the affected side)

• Dry eye or excessive tearing on affected side

• Dry mouth

• Hyperacusis (hypersensitivity to sound)

Gait, Locomotion, and Balance

Assessment (Refer to Tab 2)

Potential findings

• Balance and gait may be affected especially if patients with BP wear an eye patch

Orthotic, Protective, and Supportive Devices

Assessment (Refer to Tab 2)

Potential findings

• Patients with BP may need to wear an eye patch on the involved side to protect affected eye

Pain

Assessment (Refer to Tab 2)

Potential findings

• Patients with BP may experience posterior auricular pain