Subjective Information

 Name : Mdm.N
 Age : 52 years old
 Sex : Female
 Race : Malay
 Occupation : teacher
 MRN : 424424
 D.O.A : 10.4.14
 D.O.AX : 12.4.14 @ 10am
 DR. Diagnosis : Rt. Facial palsy
 DR. MX : Refer to physiotherapy
1.Chief complaint
• Pt c/o numbness and discomfort at Rt. Side of face and tongue
• Pt c/o difficulty to close her Rt. Eyes and mouth since 2/7 ago

2.Current Hx :
• pt. woke up at 5am in the morning to prepare for her work when she
realize he Rt. Side of face dropped and uneven
• She then went to PSH with her husband on 10.4.14 @ 7.00am for further
medical attention
3.Past Hx :
• Pt. suffers massive headache on and off since 10 years ago
• The pain became regular lately since 3/7ago
• She went to local clinic at larkin for medical attention but no
improvement in her headache
 Medical hx
◦ Migrain since 10years ago
◦ °DM, °HPT, °Asthma

Family hx
-NIL
5.Social Hx :
 Nature of work : prolong walking, standing and sitting
 Marital status : Married and has 3 children
 Smoking/alcohol : NIL
 Type of house : single storey terrace houce
 Transportation : car (auto)
 Hobby/sport : pt is not active in sport

6.Medication Hx :
 Pain killer

7.Investigation
CT scan done on 10.4.14 @10.00am
-conclusion : no significant abnormality
Patient Name - Arshdeep Singh, 27/ Male

Pain Scale

On rest
 Rt Lt Lt Lt

Muscle weakness
6.Type of Pain :
 Numbness of Rt. Side of face

7.Aggravating Factor :
 Lying on Rt.side

8.Ease factor :
 Lying on Lt.side

9.Irritability
high
Objective Information
1.General Observation
 A mesomorph size Malay woman come to physiotherapy department
independently
 No gait abnormality
 Depressed facial expression
 Pt is cooperative

2.Local Observation
 Asymmetrical face on Rt.side
 °Redness, °scar, °swelling

3.On Palpation
 Warmness noted at Rt. Side of face
Muscle Action Remarks (Rt.) Remarks(Lt.)
Frontalis Raise eyebrow 2/5 5/5
Obicularis oculi Close eye 2/5 5/5
Proceus Frawn 3/5 5/5
Zygomatic Smile 3/5 5/5
minor
Zygomatic Smile(with seen 3/5 5/5
major teeth)
Buccinator Blowing 2/5 5/5
Obicularis oris Close mouth 2/5 5/5
Mentalis Wrinkle chin 1/5 5/5

Reduced muscle power on Rt. Side of facial d/t muscle weakness

Test Rt Lt
Hot and cold Intact Intact
Light touch Intact Intact
Sharp and blunt Intact Intact

No sensory deficit
7.Problem Listing
 Asymmetrical face (dropped on Rt. Side) d/t muscle weakness
 Reduced muscle strength d/t underlying condition

8. Short term goal

To improve facial muscle power within 1 months
To reeducate and gain functional movement of facial muscle within 6
months

9. Long term goal

To maximize ADL function
To improve confidence level
To prevent secondary complication eg. Eyes and mouth infection
Plan of Treatment
 Faradic current
◦ To reeducate muscle movement
 Kabat rehab technique (pnf)
◦ to approach functional muscle movement
 Cryotherapy
◦ To reduce swelling and reduce pain
Intervention
• cryotherapy
• Pt in Lt. side lying, cryocuff on Rt.facial area, 20minutes
• Faradic stimulation
• Pt in Lt.side lying, faradic stimulation at pt.’s Rt. Muscle group, 20minutes
 Evaluation
◦ Pt claimed better after treatment
◦ Pt was able to perform all activities that had given

Review
◦ Kiv facial mmt for next ass.
◦ Kiv ADL assessment for next ass.
 Home advices
◦ Do not lie on affected side
◦ Massage facial upwards when washing face
◦ Blow strwas or balloons
◦ Use eye patch or wet cotton on affected eyes
during sleep