Articles

Physiotherapy Management of Vocal Cord Paralysis in a Nigerian Hospital: A Case Report

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Background: Vocal cord paralysis is disabling and can lead to morbidities such as dysphagia, dysphonia and aspiration. It can also lead to loss of quality of lives and productivity in sufferers. An appropriate understanding of etiologies, signs and symptoms, diagnosis and management are essential in offering patients appropriate treatments. This article discussed a case report of the physiotherapy assessment and management of a patient with vocal cord paralysis.

Case Presentation and Treatment Outcome: A case report of the assessment and management of a 38-year old male patient with vocal cord paralysis. Patient was referred from Ear, Nose and Throat (ENT) department to the physiotherapy department after an emergency tracheostomy done 2 months prior to referral. He was given appropriate physiotherapy intervention after a thorough assessment. Voice Handicap Index Score (VHIS) was used to assess voice projection of the patient. The Numerical Pain Rating Scale (NPRS) was used to assess the level of pain while tape measure was used to measure chest excursion. The CARE: CAse REport guideline for case reports was followed. All ethical procedures were followed as well. Treatment outcome revealed full AROM of the neck, increased chest excursion (from 2cm to 3.5cm),  no hoarseness, no choking during deglutition and a Voice Handicap Index score of 25 after 10 treatment sessions. Pain level on Numerical Pain Rating Scale (NPRS) was reduced from 8/10 to 2/10.

Conclusion: Physiotherapy is effective in the management of vocal cord paralysis. Early referral to Physiotherapy is advised for good prognosis. Adequate teamwork and proper communication pathways should be encouraged in hospitals for good treatment outcome.

A Case Report of Limb Dystonia Management in a Nigerian Hospital: Physiotherapy Perspective

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Background: Dystonia is a common movement disorder characterized by abnormal postures of the affected body part. The disabilities associated with dystonia are socially disabling and disfiguring, ranging from pain, loss of muscle strength and activities of daily living, poor quality of sleep and even depression. This article presents a case report of physiotherapy approach in the management of a patient with limb dystonia with major focus on pain management, balance control and functional independence.

Case Presentation and Treatment Outcome: A case report of the management of a 48-year old female patient with limb dystonia. Patient was referred from the neurology unit, department of Internal Medicine, University of Port Harcourt Teaching Hospital (UPTH) to the neurology unit of the physiotherapy department, UPTH as a case of lower limb dystonia with an unknown cause. Appropriate physiotherapy intervention was given for a period of 12 weeks after a thorough assessment of the patient. The Numerical Pain Rating Scale (NPRS) was used to assess the level of pain in the affect limbs. The Berge Balance Scale (BBS) was used to assess the patient’s balance while Barthel Index (BI) was used to assess the functional independence of the patient. The case report was presented in line with CAse REport (CARE) guideline for case reports. All ethical procedures were followed. Treatment Outcome revealed that the score on Berg Balance Scale increased from 25 to 45 while that of Barthel Index scale increased from 13 to 18 after 12 weeks of intervention. Pain level on Range of Motion (ROM) based on the Numerical Pain Rating Scale (NPRS) reduced from 4/10 to 0/10 on the upper limb and from 9/10 to 1/10 on the lower limbs.

Conclusion: Physiotherapy is effective in the management limb dystonia. Early referral to Physiotherapy is key to pain management, balance control and overall functional independence of the patients.