can anyone please explain the role of physiotherapy in the treatment of occulomotor nerve palsy
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can anyone please explain the role of physiotherapy in the treatment of occulomotor nerve palsy
Firstly some information on the occulomotor nerve:
The occulomotor nerve is responsible for motor enervation of upper eyelid muscle, extraocular muscle and pupillary muscle.
Lesions of the oculomotor nerve results in ptosis (dropping eyelid), deviation of the eyeball outward, double vision and a dilated pupil.
Synonym: cranial nerve III
Here is one study describing an over view of the facilitation techniques used for treating ophthalmoplegia. Although the techniques used in that study are mainly for ophthalmoplegia due to a brain stem lesion, yey they can also be utilized for treating other causes of oculomotor nerve lesions.
1: Clin Rehabil. 2005 Sep;19(6):627-34. Related Articles, Links
New facilitation exercise using the vestibulo-ocular reflex for ophthalmoplegia: preliminary report.
Kawahira K, Shimodozono M, Etoh S, Tanaka N.
Department of Rehabilitation and Physical Medicine, Faculty of Medicine, Kagoshima University, Kagoshima, Japan. [email protected]
OBJECTIVE: To study the effect of facilitation exercises using the vestibulo-ocular reflex on ophthalmoplegia due to brainstem injury. DESIGN: A single-baseline design (A-B: A without specific therapy, B with specific therapy) across individual subjects. SETTING: Inpatient rehabilitation facility. SUBJECTS: Eight patients with ophthalmoplegia (total of 15 affected muscles) due to brainstem injury. INTERVENTIONS: Basic rehabilitative treatment that included physical therapy, occupational therapy and/or speech therapy for impairments such as hemiplegia, ataxia or dysarthria was administered for two weeks (control treatment). Then, two facilitation exercise sessions (100 times/day, five days/week for two weeks) were administered in addition to the basic rehabilitative treatment for four weeks to the eight patients with ophthalmoplegia. Ophthalmoplegia was evaluated at study entry and at the end of each two-week session. The goal of the facilitation exercises is to facilitate voluntary eye movement using conjugated eye movements in the direction opposite to passive movements of the head. MAIN MEASURES: To assess ophthalmoplegia we measured the distance between the internal/external corneal margin and the canthus of the affected eye on images recorded on a video tape recorder. RESULTS: After the initial two-week basic rehabilitative treatment, the distance between the corneal margin and canthus decreased slightly. Subsequently, after each of the two facilitation exercise sessions, there were significant reductions in the distance between the corneal margin and canthus compared with that at the beginning of the respective facilitation exercise session. CONCLUSION: Facilitation exercises significantly improved the horizontal movement of eyes with ophthalmoplegia due to brainstem injury.
Some more reports of studies on the management of oculomotor nerve lesion are described below.
Acquired oculomotor paralysis: a new therapeutic approach. Apropos of 10 cases]
El Mansouri Y, Bentahar H, Laouissi N, Zaghloul K, Amraoui A.
Service d'Ophtalmologie, Hopital 20 Aout 1953, CHU Ibn Rochd, Casablanca, Maroc.
PURPOSE: The aim of this work is to report our rehabilitation scheme and outcome in patients with acquired oculomotor palsy. PATIENTS AND METHODS: We cared for 10 patients with oculomotor palsy between January 1996 and March 1998 at the Casablanca University Hospital. Our orthoptic rehabilitation scheme was based on reinforcing the patient's sensorial potential using a prism dioper and motor capacities by soliciting vergency and version movements. RESULTS: The 10 patients (7 males, 3 females, mean age 39.5 years) had unilateral IV palsy (n =3), bilateral IV palsy (n= 1), unilateral VI palsy (n= 2), bilateral VI palsy (n= 1), partial unilateral III palsy (n= 1) and dissociated bilateral III palsy (n= 2). Mean delay to initiation of rehabilitation was 49 days and mean duration for treatment was 3 months. We achieved total recovery in 50% of the cases and partial recovery in 40%. Intermittent diplopia persisted in 10 per thousand of the cases. These results differ slightly from those in the literature where total regression is reported in about 50% of the patients after therapeutic abstention. CONCLUSION: This small series is insufficient to validate our method. The results obtained do however show that rehabilitation is safe and should be applied more widely in patients with oculomotor palsy.
J Neurol Neurosurg Psychiatry. 2002 Apr;72(4):517-22. Related Articles, Links
Concurrent excitatory and inhibitory effects of high frequency stimulation: an oculomotor study.
Bejjani BP, Arnulf I, Houeto JL, Milea D, Demeret S, Pidoux B, Damier P, Cornu P, Dormont D, Agid Y.
Centre d'Investigation Clinique, Federation de Neurologie, and INSERM U289, France.
OBJECTIVE: To describe a reversible neurological condition resembling a crossed midbrain syndrome resulting from high frequency stimulation (HFS) in the midbrain. METHODS: Postoperative evaluation of quadripolar electrodes implanted in the area of the subthalamic nucleus of 25 patients withParkinson's disease (PD) successfully treated by HFS. RESULTS: Four of the 25 patients experienced reversible acute diplopia, with dystonic posture and tremor in the contralateral upper limb when the white matter between the red nucleus and the substantia nigra was stimulated. The motor signs resembled those caused by lesions of the red nucleus. The ipsilateral resting eye position was "in and down" (three patients) or "in" (one patient). Enophthalmos was seen. Abduction was impaired and vertical eye movements were limited, but adduction was spared. The movements of the controlateral eye were normal. The ocular signs could be best explained by sustained hyperactivity of the extrinsic oculomotor nerve. Simultaneous tonic contraction of the superior rectus, the inferior rectus, and inferior oblique may cause the enophthalmos and partial limitation of upward and downward eye movements. Antagonist tonic contraction of the ipsilateral medial rectus severely impairs abduction. CONCLUSION: This crossed midbrain syndrome, possibly resulting from simultaneous activation of oculomotor nerve and lesion-like inhibition of the red nucleus suggests that high frequency stimulation has opposite effects on grey and white matter.