Bell’s Palsy

[Farisshd]

For this posting, I chose to discuss a recent patient interaction that we rarely get in our primarily orthopedic clinic. I noticed on my schedule that I had a Bell’s Palsy evaluation coming up in a few days. I was immediately a bit nervous given that I rarely work with a neuro population in my full time outpatient position, but confident that I could offer a competent, skilled evaluation drawing on my acute care skill-set and with some preliminary research and review. I reviewed my cranial nerve screening, neuro evaluation, and reviewed research regarding PT intervention for Bell’s Palsy and some common exercises and protocols for PT.
The patient arrived and fit the bill very well. He had been cleared by the hospital following an extensive stroke work-up, and following the subjective history and evaluation continued to not show further signs of CVA. The case was slightly complicated by a recent episode of neck pain that had since resolved, and the fact that he had experienced an episode of Bell’s Palsy on the other side of his face 9 years ago with no medical intervention. He had not regained full function of the right side of his face, but displayed minimal deficits on that side.

While I felt i was able to offer a solid evaluation and initial HEP, I was a bit biased by my preliminary research. I went straight into the subjective with the Bell’s palsy in mind and was not as open ended in my questioning as I could have been initially, which led to an awkward flow when I circled back to address the neck pain. I had fully prepared myself for the evaluation and intervention of the condition, but was not expecting the cervical pain accompanying the complaint. I was able to evaluate both, and plan to continue addressing the upper cervical complaint in future sessions.
Given that the patient had experienced Bell’s Palsy before and had near full natural recovery, he was aware that the natural progression would occur, but he needed guidance to know how common recovery was, what could be done to reduce risk of incomplete or minimal recovery, and the timeline he could expect for return of function of his muscles of facial expression, including ability to close his left eye and mouth. He benefitted from further guidance on eye protection, exercises, and education on recognizing signs and symptoms of stroke and the importance of timely intervention. He expressed relief following the encounter and stated that he felt prepared moving forward.

In the future, while preliminary research into the diagnosis given is still warranted, I will set that aside at my initial encounter and approach the subjective history taking with an unbiased, and open ended approach to be sure I do not miss any secondary complaints or potentially meaningful symptoms that I may not have expected.

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