Miss N Opperman has been treated for her left Bels Paralysis, by myself, since date 26/02/2010. She has a history of recurrent episodes of Bells-paralysis. The first episode occurred at 14 years of age. The second and third incident was in 2004 and 2008 respectively. The first incident affected the left side of her face and the last two times it occurred on the right side of her face. This time the facial nerve paralysis was on the left side. The last two times took approximately 6 weeks to recover.
When I saw the patient for her first consultation on the 26th of February 2010 the paralysis was about 2 days old and quite severe. On an Oxford muscle grading scale the muscles innervated by the facial nerve scored mostly zero (0/5) and only the orbicularis oris muscle did present with a flicker / muscle twitch (Oxford grade 1/5).
From as the first consultation up to date 25/03/2010 she was seen for a total of 9 treatments. During these sessions she was treated with ultrasound, laser, facial exercises and other electro-modalities to stimulate the facial muscles and nerve fibres.
On The 25th of March 2010, a neurologist, Dr PH Kritzinger, saw her. He did an EMG study. His findings reported that there was no conduction present in the left facial nerve and also found that there was active axondegeneration present in the facial muscles. He classified this as a demyelinating neuropathy.
In regards with further physiotherapy treatment, in May 2010 we introduced Xavant’s nerve stimulator (NMS neuromodulation device) to her treatment and since the 13th of May all other modalities were stopped and the patient’s treatment consisted only out of nerve stimulation by means of this stimulator. She was given the device to stimulate the left facial nerve by herself once a day. The reason for her only doing a session once a day, was purely because the patient preferred it this way due to her busy schedule. Her sessions lasted between 5 and 10 minutes.
Since the 13th of May the patient’s progress has been measured purely subjectively. I contacted her telephonically every 3 weeks and since the above mentioned date she has also come to see me 3 times to show me her progress. She reported that her left side of her face felt much better every time after she used the device and there was visible improvement in the facial muscles function. If I could refer back to the Oxford muscle grading scale, the last time I saw her, which was end of June, most of the facial muscles scored a definite 3/5 and some muscles even a 3+/5 and 4-/5. The only muscle that scored a 2/5 was the orbicularus oculi muscle as the left eye could not actively close completely.
The patient took photos to measure the progress. Photos were taken on the following dates: 1 May, 28 May, 5 June, 23 June, 12 July and 18 July. See Attachment B.for an image as taken on the 1st of May and the latest photo dated 18 July 2010.
The ideal would be to measure the function of the facial nerve by means of a second EMG. The patient’s medical aid does unfortunately not cover this. We have requested funds for this from her medical scheme and are awaiting a response.
Regards
Deidre Muller (Physiotherapist)
Courtesy Xavant Technology (Supplier of the NMS 460 neuromodulation device)
