CRANIAL NERVE,ITS

FUNCTIONS & DISORDERS

Dr. Sania Saeed PT
DPT 8th Semester
Roll# 17
NEUROPHYSICAL THERAPY
CRANIAL NERVES:
 12 pairs of cranial nerves. • These are called as cranial nerve because they originated directly from
the brain; inside the cranium, named according to their descending order of origin.
CRANIAL NERVE FUNCTION
TYPES OF CRANIAL NERVES:
12. HYPOGLOSSAL:(tongue control+strap muscles of neck)
Ask patient to STICK out the tongue
Push tongue left and right
 CRANIAL NERVE
DISORDERS
Cranial nerve disorders are often classified as peripheral neuropathies. The disorders
usually involve the motor and/or sensory branches of a single nerve
(mononeuropathies). Causes of cranial nerve problems include tumors, trauma,
infection, inflammatory processes, and idiopathic (unknown) causes
1. Minor disorders
2. Major disorders
MINORS DISORDERS:
 Olfactory Nerve:
partial of total loss of smell(ANOSMIA)
 Optic nerve:
1. Colour-blindness
2. Visual Aquity defects:
o nearsightedness
o farsightedness
 Occulomotor nerve:
1. Ptosis
2. Squinting of eyes
3. Pupil dilation
 Troclear nerve: (uncommon)
1. Diplopia
 Trigeminal nerve:
1. Trigeminal neuralgia (M.common)
2. loss of mastication and sensation in teeth, gums, face and sinuses
 Abducens nerve:
Gaze palsy
 Facial nerve: “facial nerve palsy”
1. Bells palsy
2. Inability to taste(Ant 2/3) and closing eyes
 Vestibulo(equilibrium)_cochlear(hearing) nerve:
Vertigo ,ataxia, nystagmus, tinnititus, deafness,
 Glossophyrangeal nerve:
1. loss of taste and tongue sensation (post 1/3)
2. Dysphagia
3. Redcuced salivation
Microvascular cranial nerve palsy. This health problem affects
one or more nerves, typically those that go to the eye. It is most
common in people who have diabetes and high blood pressure.
Third nerve palsy. This condition affects the third cranial nerve.
This nerve helps manage muscles that control eye movement as
well as the size of the pupil.
Fourth nerve palsy. This is also called superior oblique palsy. It
affects the superior oblique muscle, which helps you converge
your eyes (to look at the tip of your nose).
Sixth nerve palsy. This is also called cranial nerve VI or
abducens palsy. It affects the sixth cranial nerve, which also helps
control eye movement.
Some of the symptoms of different types of cranial neuropathies
include:

Bell palsy can cause drooping of part of the face. It usually affects
only one side of the face.
Microvascular cranial nerve palsy can cause double vision,
droopy eyelid, and other problems with eyesight.
Third nerve palsy can cause an eyelid to sag and droop, double
vision, trouble moving the eye, and a pupil that is bigger than
normal.
Fourth nerve palsy causes the eye or eyes to turn abnormally. It
sometimes makes you see double. It may force you to tilt your
head when looking.
Sixth nerve palsy can cause abnormal movement of the eye and
double vision
 Vagus nerve:
vocal cord paralysis ,Dysphagia ,Loss of gag reflex , abnormalities of esophageal motility, gastric
acid secretion, gallbladder emptying, and heart rate; and other autonomic dysfunction.
 Accessory nerve:
1. Palatal paralysis
2. weaknesses or paralysis of trapezius and SCM
 Hypoglossal nerve:
1. Dysphagia
2. Dysarthria
3. Difficulty masticating
TRIGEMINAL NEURALGIA
 Also known as Tic doulourex

*Prosopalgia *Fothergill's Disease *Suicide Disease

 Irritation of 5th cranial nerve(mixed nerve)

TRIGEMINAL NERVE:
 It has mainly 3 major sensory branches, but contains one motor branches which supplies muscle
of mastication, mylohyoid and tensor tympani muscles.
 Responsible for chewing, saliva & tear production, facial sensation to brain

SENSORY FUNCTION:
1. V1:Opthalamic branch supplies sensations to skin of upper nose, eyelid, forehead, scalp, cornea
and conjunctiva.
2. V2:Maxillary branch supplies sensations to lower eyelid, upper cheeks, nose . Upper lip, mucous
membranes of face, sinuses, gums teeth and upper jaw.
3. V3:Mandibular branch supplies sensations to teeth, gums of lower jaw, mucosa of ant.2/3 of
tongue, TMJ and ear
 TRIGEMINAL NEURALGIA
 Trigeminal neuralgia (TN) (tic douloureux) is characterized by sudden, usually
unilateral, severe, brief, stabbing, recurrent episodes of pain in the distribution
of the trigeminal nerve.
 Incidence: Most common in middle aged and elderly people.
ETIOLOGY:
• Unknown causes, but degenerative or viral origin is suspected

• Tumors
• Trauma
• Infection and inflammatory processes
• Multiple sclerosis
• Shingles, or masses in the cerebellum or brainstem
CLINICAL MANIFESTATION
 Severe episodes of knife-like or electric shock-
like pain lasting 30 or 60s affect unilaterally-
Precipitating stimuli include chewing,
brushing the teeth, feeling a hot or cold blast of
air on the face, washing the face, yawning, or
even talking.
 Lightning-like shock in the lips, upper or lower
gums, cheek, forehead, or side of the nose.
 Facial twitching, grimacing, and frequent
blinking and tearing of the eye
 Facial sensory loss
DIAGNOSTIC EVALUATION:
 History
 Physical and neurological examination

a) Sensory:
Corneal and conjunctival reflexes by touching with cotton wisp
b) Motor:
 Messeter> clenching the teeth
 Pterygoid> ask the patient to open the jaw and move laterally against resistence.
 JAW Jerk: increased in UMN palsy of trigeminal nerve.

 MRI may be used to assess for sinusitis, cancer, multiple sclerosis, or masses in the
cerebello-pontine angle.
 3D reconstruction and angiography MRI are helpful with seeing the specific brain
anatomy, nerve roots, and vasculature involved
MEDICAL MANAGEMENTS
 Drug therapy – Anticonvulsants (e.g., carbamazepine, oxcarbazepine ,
gabapentin) – Tricyclic antidepressants (e.g., amitriptyline)
 Local nerve block
 Percutaneous methods
– Balloon surgery – Thermal lesioning
 Surgical therapy:
Micro vascular decompression with or without neurectomy –
Steriostatic radiosurgeory – Glycerol rhizotomy
 TRIGEMINAL NEURALGIA PT & REHABILITATION:
PATIENT EDUCATION:
 Avoid triggering factors
 eating softer foods,
 Try drinking warm or cold drinks through a straw on unaffected side

 Wear a protective eye shield and avoid rubbing eyes

ELECTROTHERAPY:
 Electrical Stimulation (TENS) as the most effective and most often used technique
 Interferential therapy(IFT)
 Ultrasound

Physiotherapy Management :
Aims at reducing pain and improve the ability to carry on with the activities of daily living (ADLs) by
using:
 Acupuncture to relieve facial pain and pressure
 Massage using deep pressure
 Isometric neck exercises
 Relaxation techniques such as deep breathing exercises
 Distraction techniques
 Cardiovascular exercises to improve health and fitness levels
 Functional Activities for problems associated with ADLs
 Patient's education on diet, management of sleep, and rest
 Low impact yoga
 Advice on how to avoid using cold water for drinking and washing their face but
also chewing with the non affected side
 Physiotherapy can alternatively play different roles in the management of TN in
educating, advising, and motivating patients. [28] Although physiotherapy
treatment is effective in the Management of TN, there is a need for awareness of
its role among the general public
 BELL’S PALSY:
DEFNITION:
Bell's Palsy is the paralysis or severe weakness of the nerve that controls the facial muscles on the
.side of the face - the facial nerve 7th cranial nerve
 Lower motor neuron type weakness
 Caused by herpes simplex I virus infection that results in swelling if the nerve within facial canal
in the petrous temporal bone characterized by
 Loss of taste sensation
 Lower eyelid droops
 Tears drip continuously and eye cannot be completely closed (dry eye may occur)
 INCIDENCE:
 More common in pregnant women and in diabetics.
 Affects people over 15 and under 60 years of age. • Affects men and women equally.
 Condition my disappear spontaneously in 3-5 weeks without treatment .
 CAUSES OF BELLS PALSY:
Diabetes
➔ High blood pressure
➔ Injury,Toxins
➔ Toxins
➔ Guillain-Barré syndrome
➔ Multiple sclerosis
➔ Infection, especially
following a viral infection with
Herpes simplex virus
SYMPTOMS OF BELL’S PALSY:
 Rapid onset of mild weakness to total paralysis on
one side of your face
 Facial droop and difficulty making facial
expressions, such as closing your eye or smiling
 Drooling
 Pain around the jaw or in or behind your ear on the
affected side
 Headache
 A decrease in your ability to taste
 Dribbling of tears and saliva from affected side
Tearing
 Inability to close the eyes on the affected side of face
 photophobia
 SIGNS OF BELL’S PALSY:
 Loss of wrinkling and closing on affected side
 Flattening of nasolibial fold

 BELL’S PHENOMENON:
On closing the eye ,the eyeball moves upwards and inwards. This is on the affected side due to
ineffective closure of the eyelids.

EXAMINATION TEST:
1. Wrinkling of the forehead: upper and lower MNL*
2. Closing the eyes: not close forcibly, bell’s phenomenon
3. Inflation tests: ask pt. to inflate mouth and blow out his cheeks . Tap with finger on cheeks of either side,
paralyzed side will blow out more easier .
4. To whistle, to smile, to show teeth: loss of retraction of angle of mouth
Dx:
 EMG(nerve damage)
 CT-Scan, MRI
 HOUSE-BRACKMANN GRADING
SYSTEM
 Grade I - Normal
 Grade II - Mild dysfunction, slight weakness on close inspection, normal
symmetry at rest
 Grade III - Moderate dysfunction, obvious but not disfiguring difference between
sides, eye can be completely closed with effort
 Grade IV - Moderately severe, normal tone at rest, obvious weakness or
asymmetry with movement, incomplete closure of eye
 Grade V - Severe dysfunction, only barely perceptible motion, asymmetry at rest
 Grade VI - No movement
TREATMENT:
 Most people with Bell's palsy recover fully with or without treatment.
 There's no one-size-fits-all treatment for Bell's palsy
 Medical (Corticosteroids, Antiviral drugs)
 Surgical (Decompression surgery )
 Physiotherapy
 Allied therapy Eye care is essential to maintain lubrication if unable to close the eye. May
be need to be patched during sleeping
ELECTROTHERAPY:
Electrotherapy is commonly used ,its main purpose is
to reestablish facial control and movement in Bell’s palsy and
1. when denervation occurs, to delay muscular atrophy;
2. it is also useful to diminish pain, muscle weakness
3. to facilitate facial movement.
 ELECTROTHERAPY
 Galvanic (continuous) / Faradic (pulsating) of 0.2-100 Hz commonly used frequencies •
Duration- 10-30 min, depending of the lesion type,with pad or pen electrode
 OTHER THERAPY INCLUDES
 1. Ultrasound
 2. Laser
 3. Pulsed electro magnetic waves
 4. Infra red rays All these therapy in combination with stimulator and exercises.
CONVENTIONAL EXERCISES •
1. Exercises include elevating eyebrows after brushing forehead.
2. Elevating corner of lips like saying “E” cheek after brushing of affected side of
face.
3. Closing slowly eyes, closing only one of eyes alternately.
4. Wrinkling and opening wings of noise.
5. Opening mouth and saying “a”, “o”, saying alternately “e”, “a”, “o”, •
6. Smiling with and without showing teeth. •
7. Wind-upping cheeks with closed lips. •
8. Reading and speaking aloud
9. Massage therapy ib aid for lymphatic circulation and to reduction
edema
10. Tapping ,protective eye goggles for preventing entry of dust particle.
 PNF EXERCISES:
 Techniques of PNF is applied to facial motions include :
Pressure, 2. Stretch,
3. Resistance, 4. Reinforcement,
5. Repeated contractions 6. Reversal of antagonistic.
7. Relaxation techniques may be used as indicated.

EXERCISES FOR CLOSING EYES

Look down
➔Gently place back of index finger on eyelid, to keep the eye closed
With opposite hand gently stretch eyebrow up…working along the brow line. This will help relax the
eyelid and stop it from becoming stiff.
Close your eyes as much as u can.
➔Gently press the eyelids together with your fingers
Acupuncture. Placing thin needles into a specific point in your skin helps stimulate
nerves and muscles, which may offer some relief. •

Biofeedback training. By teaching you to use your thoughts to control your body, you
may help gain better control over your facial muscles.

HOME REGIME:
Exercise regularly.
Blow balloons , use straw to drink.
Goggle the mouth with water, chew gums.
Use splints to correct deviation of mouth.